How to Know if Therapy Is Working

It should feel different from venting to a friend. Here’s how to assess whether you’re getting something out of your sessions.

Illustration: Virginia Gabrielli

FFor over a year, Lia, a Bay Area human resources specialist, felt exhausted and unhappy all the time. “I blamed it on a toxic job,” she says. “Finally, my then-partner pointed out that the issue may be something deeper.” Lia realized she was likely depressed and decided it was time to look for some professional help.

It didn’t work.

At least, not at first.

“I first went for the therapist that had a practice close to my apartment and offered evening appointments,” she says. “It took a few months to admit to myself that I always left his office feeling worse than when I went in. I stopped scheduling sessions there and did more research.”

She found a new therapist and made rapid progress, identifying and addressing the sources of her depression and anxieties. For Lia, it’s abundantly obvious that therapy is working. But it’s not always so clear-cut.

Health care needs can vary wildly from person to person, but there are some aspects of therapy that are pretty universal. If you’re not sure whether therapy is working for you, these benchmarks should help you take stock and decide whether to keep it up or make a change.

Your therapist makes you slightly uncomfortable

“Research for the last almost 100 years strongly suggests that it’s not the type of therapy you do so much as the working alliance between you and the therapist that accounts for how successful therapy is,” says Michael Karson, a professor of clinical and forensic psychology at the University of Denver.

A therapist’s role is to push you just enough into the realm of discomfort to reveal the root cause of your issues, he says. “Some therapists don’t do that. They try to make you feel comfortable, so now you just go to therapy because you like your therapist. That’s probably useful in some way, but no more so than talking to another friend or your bartender or your cab driver.”

If you want your therapy to be effective, Karson says, “Don’t look for comfort. Look for change.”

That’s not to say the relationship between you and your therapist should be cold or clinical—that almost definitely won’t help either. The best client-therapist relationships are close enough to encourage the former to share their secrets without worrying the latter will pass judgment.

“You should definitely feel bonds with your therapist,” says Karson. “But I think it’s important to distinguish that it’s not friendship. If you feel like they’re friends with you, it becomes like other friendships. The bond you want is as if you and a stranger are helping to push someone’s car out of the snow. You’re in sync and should feel like, ‘Hey, we’re really doing something together.’”

The best client-therapist relationships are close enough to encourage the former to share their secrets without worrying the latter will pass judgment.

You have a plan and goals

In movies and television, therapists are often one-note characters, listening to the protagonist’s monologue and maybe tossing in a, “and how do you feel about that?” It’s a totally inaccurate representation of effective therapy, says Debra Kissen, co-chair of the professional education committee for the Anxiety and Depression Association of America.

“In the movies, it seems like therapy is just talking and the point of it is to talk,” Kissen says. “But it’s actually about moving in a direction. Think of it as going on a road trip: You should decide where you’re going versus just getting in the car. One should start off by figuring out what goals they want to accomplish. If you don’t get specific, it’s easy to get caught just talking.”

For Lia, therapy became effective once she and her new therapist set a game plan that included specific activities: “Making sure I was meditating or exercising every day, creating a schedule when I was unemployed to keep myself busy,” she says. “When some of the sources of my depression became clear, we set the goals of identifying them all and removing them from my life — quitting a job, ending a relationship, etc.”

You start to feel better

Once Lia and her therapist devised a plan and stuck to it, she says the breakthroughs came one right after another, and she began making connections between anxieties and their causes.

“I was able to take those connections and dig down between sessions to bring logic back to the forefront of my brain, which seemed to scare off some of the anxieties,” she says. “For me, that was the clearest realization that therapy worked.”

One of the most obvious signs that therapy is working is really simple: You start to feel better. If you’re working on panic attacks or anxiety attacks, you should have fewer of them. They may not vanish overnight, and it’s normal to have setbacks, but there should be noticeable reductions in the issues you’re trying to solve through therapy. “Even if you’re still having some panic attacks, you should be able to say, ‘Okay, this makes sense, the therapy maybe hasn’t worked yet, but I’m confident we’re on the right road,’” Karson says.

And while setting benchmarks is good, it’s okay if you stray a little from the timeline. “If you don’t need to change your personality, the whole thing could take weeks. If it’s something fundamental, it can take years and years and years,” says Karson. Either way, he continues, “if there are not noticeable changes, you need to look at the game plan. If it doesn’t start paying off, you have to say, ‘Okay, we need a new one.’”

In fact, if you feel like your progress has plateaued, one of the best things you can do is bring that up with your therapist. It’s okay to disagree with them, take the reins a bit, and advocate for yourself.

“Check in and be like, ‘Can you remind me why I’m even doing this?’ Ask to review the treatment plan and see if it’s still in line with where you are,” Kissen, CEO of LightOn Anxiety Treatment Center in Chicago, says. “A good therapist is not going to be offended by you saying, ‘Can we just regroup here?’”

Once you feel like you’ve achieved your objectives, it’s okay to stop going to therapy. It’s also okay to stick with it or establish a whole new set of goals; you’re the only one who can really determine your mental health needs.

“For the most part, I’m in maintenance mode,” says Lia, who still goes to therapy. “[I’m] just keeping up the habit and making sure I’m keeping my more illogical anxieties in check. Maintenance is still progress to me. I don’t see myself ever being ‘finished’ with therapy, and I’m a strong believer that everyone can gain something from it.”

Kate is a freelance journalist who’s been published by Popular Science, The New York Times, USA Today, and many more. Read more at bykatemorgan.com.

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