How To Know If Therapy Is Working

In many cases, it’s difficult for clients to know whether they’re making progress, however when clients are treated by Cognitive Behavioural Therapy (CBT) they know how well therapy is working, because their progress is monitored each week by:

1. Evaluating their symptoms
2. Measuring their occurrence of specific target behaviours
3. Assessing their progress toward specific therapy goals

In fact, it has been shown that when both therapist and client receive feedback on progress, clients tend to have better outcomes.

For example, as a CBT therapist I ask my clients to discuss or fill out a symptoms checklist before each session, such as those for depression and anxiety. If applicable, clients may also track and report the occurrence of panic attacks, angry outbursts, or incidents of self-harm behaviour.

They may also track the frequency and amount of alcohol, drugs, nicotine, or food they ingested in the previous week or the number of minutes they engaged in compulsive rituals.

The type of monitoring and assessment varies from client to client, based on the goals they’ve decided they want to work toward. When clients do not make expected progress, I conceptualise the difficulty and modify their treatment accordingly.

How long can it take before clients’ symptoms decrease?

Sometimes clients notice improvements almost immediately, especially when they have three kinds of experiences:

• They realise that the treatment plan I have described for them makes sense.
• They understand how it is that they’ll overcome their difficulties. And they have confidence in my competence.
• Their unhelpful thinking changes during and after each session allowing them to feel better.
• They enact an “action plan,” at home and notice an improvement in their mood. The action plan, collaboratively designed, usually includes (1) reading “therapy notes” of the most important things they learned in session and (2) engaging in specific activities that are linked to the accomplishment of their goals. For example, a depressed client might make plans with friends; an anxious client might expose himself to a feared situation to find out to what degree a negative outcome occurs.

These three kinds of experience increase hope, clients are able not only to stop their downward negative spiral but also to reverse direction. They then find themselves on an upward positive spiral.

So how can clients tell if therapy is working?

They can ask themselves:

• How is my mood throughout the week (not just at the end of each session)? Is it at least gradually improving (albeit with ups and downs)?
• Are my specific symptoms or problematic behaviours improving?
• Am I solving problems and working toward my goals?

If the answers are yes, then therapy is working.