Jeff Guenther, MS, LPC on Sep 30, 2018
Part 1: How to find a therapist
Part 2: What to ask in the consult
Part 3: What to expect in the first few sessions
Part 4: How can you tell if therapy is working
Part 5: How to end therapy
We’ll define what “working” means in just a bit. What you need to know first is that it may take awhile for therapy to start having it’s intended effect. Hopefully you’ll start seeing some traction after just a few sessions. But that’s often not the case. I like to look back at a client’s progress after the 3 month, 6 month and one year marks. When you’re active in therapy for that long, you can look back on your time and really start to see some of the changes that have occurred. Sometimes you’ll get “aha moments” and experience revelations in session. But what’s more common is that you’ll experience a slow, subtle, steady change over the course of therapy.
But what does it mean that therapy is “working?” There are all different types of therapists that could give different answers about how therapy is supposed to work. So keep in mind that I am just one therapist giving my opinion on how a client can tell if therapy is working for them.
Like I said in part 3, I’ll just be focusing on individual therapy for this series. But if you’re going to therapy for something else (like marriage or family therapy), I urge you to keep reading because many of the things I mention in this article will still apply.
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A client may experience one or all of the following outcomes of therapy. They may even experience an outcome that I haven’t listed here.
I think most people going into therapy are looking for relief from their presenting issue or problem. If the issue is straightforward, such as a fear of spiders or feelings of sadness, then symptom relief is likely something you can track pretty easily. At the start of therapy, most therapists will take note of how intense and obtrusive your symptoms are and they’ll probably keep a sharp eye on it moving forward. It wouldn’t be out of the ordinary for a therapist to help you rank how painful your symptoms are on a scale of 1 to 10 and then revisit that scale periodically.
Something to note is that relief from your presenting symptoms may be up and down for a bit as you start therapy. You may feel a real sense of relief and optimism after you finally talk to someone for the first time. But then the hard work of figuring out ways to cope with the symptom or treat the symptoms might be a battle for a little while. You should eventually start feeling better at a steady pace as you get further away from the first session. And of course, as the cliche goes, it might get worse before it gets better. So keep that in mind. Also, going to therapy doesn’t mean that the symptom goes away for ever.
If you enter therapy in order to treat your regularly occurring panic attacks a therapist might take a couple different approaches. They’ll probably want to get to the root of the panic. For example, they’ll want to know why exactly are you experiencing the panic, how you developed the panic and what triggers it. And just as important, they’ll want to equip you with tools and techniques to handle the panic attacks when they arise. Getting the panic to never come back is preferable, but is not always realistic. So the next best thing is to create a tool belt of your favorite coping skills that you can metaphorically carry with you just in case panic starts to bubble up and attempts to hijack your brain. Personally, I like to make sure that my clients have at least 5 different coping mechanisms that they can count on in any situation. Everything from breathing techniques to self talk to distraction methods is on the table. There are dozens and dozens of ways to cope with intense emotions. Your therapist wants to help you find the ones that work for you consistently.
Once a client has a strong grasp on coping skills, it often creates a feeling of confidence and strength. If feelings of panic start to rise, they won’t get to extreme levels because the confidence the client feels in handling it provides relief.
You might have been compelled to start therapy because of a traumatic or big emotional event. Whether it’s losing a loved one, getting fired from a job, a bad break-up, an assault, or facing persecution for who you are, you could be emotionally activated and completely overwhelmed when you start therapy. While many things will be talked about and explored in session, one outcome that will hopefully be achieved is a sense of peace. A sense of peace with the world and a sense of peace with yourself. While becoming totally enlightened and at peace with everything forever isn’t a realistic goal, it wouldn’t be surprising if you felt more peace more often in your life as a result of therapy.
Sometimes a feeling of peace can be achieved when an unwanted thing, circumstance or person is more accepted. If that thing or person is accepted in your life and you let go of negative emotions around it, you’ll often feel more peace. Peace can also come from a place of forgiveness. A more general sense of peace can make a person more resilient and is a topic that is often explored in counseling.
One of Freud’s favorite outcomes of therapy was making the unconscious conscious. The unconscious mind houses all of our memories and past experiences. Our conscious mind doesn’t have everyday access to all of that information. It’s just too much to keep track of. But much of our behavior, thoughts, feelings and ideas have been created and influenced by our unconscious mind. So if you were to explore and get access to the unconscious stuff that makes you who you are, then you’d be able to make more deliberate decisions about who you want to be or how you want to experience the world. A therapist can help you get in touch with these unconscious influences. You two could work together to bring unseen influences to the surface so that you can be more intentional about who you want to be and what motivations you want to use in order to behave or think differently.
Even if you don’t specifically go to a mindfulness-based therapist, you’ll probably naturally start becoming more mindful and aware of how you feel and think. It’s just inevitable that improved awareness will develop as you start regularly talking about your internal experience. As you get to know your therapist and see what questions they ask and how they analyze you, you’ll start doing that on your own when you’re outside of their office.
Your improved awareness of how you feel and think will help you become more deliberate in what you want to think and feel. You’ll feel a better sense of balance and more grounded. You might not feel as reactive or quick to jump to conclusions. All of these things can be super handy as you grow and develop. Practicing the skill of observing and witnessing your feelings instead of automatically being overtaken by them can create a lot of liberation and freedom.
As we get older, we often feel defensive and protective as we experience life. It’s common to want to protect yourself if you’ve gotten hurt, been taken advantage of or simply don’t feel safe. At times, those defenses can build and build to the point where you don’t trust some people anymore. That can really get in the way when you’re developing new relationships. Especially new romantic relationships. A therapist can help figure out where those defenses have come from and which ones, if any, you want to hold on to. Or maybe which ones you want to make adjustments to, possibly replacing them with more healthy alternatives. Making an intentional choice about how you want to protect and defend yourself can be really important. It’s often important to be less defensive and closed off in order to more fully experience what life has to offer.
The most common issue to seek therapy for is relationship issues. I know this because I run TherapyDen’s therapist directory and I get to see what issues are being selected by clients looking for a therapist. With relationships being a major focus in therapy, it’s no wonder relationships tend to improve while talking to a therapist. Relationships improving can happen for a host of reasons. Therapy may be making you a better communicator. Or it could be working on figuring out how you want to act in a relationship. Counseling often focuses on the client’s intimacy issues so that they can be closer with people they care about. How a client has been loved and how they want to love others is a popular topic in therapy. Getting insight into all of these things will undoubtedly have an effect on important relationships in your life.
Something to note is that through counseling a client may figure out that they want to end unhealthy relationships in their lives. Ending these toxic relationships could be a sign that therapy is working.
It’s hard to explain, but sometimes you know therapy is having a positive effect on you because you start to feel more like yourself again. You may have gone, or are currently going, through a tough time in your life. If that is the case, you may have become a bit withdrawn or avoidant. You may have regressed into some old behavior in order to cope with the stress. It’s understandable to behave, feel and think differently after going through a trauma or a big adjustment in life. If that’s the case, then talking to a therapist can be a very healing experience. You’ll know that healing is taking place when you feel like you’re acting like your old self again. You’ll feel a sense of freedom and liberation from patterns that have kept you from fully engaging with life.
You may also have the experience of feeling like a totally new person. You could go through an important transformation that allows you to feel and think things that you’ve never before been able to. Therapy could help you move on to the next developmental stage of your life with the proper care and treatment.
Sometimes you know therapy is working simply because you’ve developed a close and trusting relationship with your therapist. Having a strong relationship with a therapist is usually the key to any successful counseling experience. If you regularly look forward to seeing your therapist and talking about your week, then there is probably something good going on. If your therapist is someone you feel comfortable saying absolutely anything to and you know that you won’t be judged or criticized, then you are experiencing an important healing relationship. If you can develop a trusting and healing relationship with a therapist, that usually means you can do the same thing with someone outside of the therapy office. Which will set you up to create healthy and honest relationships in life.
I made sure not to say that you’d know therapy is working if you feel happier. While happiness is sometimes a wonderful side effect of therapy, it’s not always the goal. Therapy is meant to provide insight and analyzation. A therapist will care about you and show you compassion when you need it. A therapist will help you dig into your past, think about your future and help you be at peace in the moment. Therapy is great for feeling relief from symptoms and liberation from old defense mechanisms. Therapy will challenge you to be more honest in relationships and live as a more authentic human being. It will provide you with the support that you may have missed out on as a child. All of these wonderful things can take hard work in therapy. Counseling will challenge you to be honest with yourself and practice discipline when it comes to making big changes. It’s a therapists job to challenge you and encourage you to grow. Not to make you happy. As a therapist, I truly want all my clients to be happy. I’m happier when I see smiles on their faces. But I would rather ask you hard questions instead of tossing you happiness soft balls. You’re paying me to compassionately push you to grow and be honest with yourself. Not to make sure you walk out of every session smiling. I wouldn’t be a good therapist if that was my priority.
Next week we’ll talk about how to end therapy. It’s important to end counseling the right way, so be sure not to miss it!