Part of what makes success in therapy so difficult to measure—or even explain—is that success means different things to different providers, in different kinds of therapy, and for different conditions or purposes.

While this is a generalized list, it can be a good place to start. 

Signs Therapy is Working/Effective/Helpful 

• You gain insight: you learn why you do what you do 

• You avoid less things you used to avoid because of fear 

• You decrease/stop self sabotaging behaviors 

• You learn to love yourself unconditionally 

• You create a life worth living 

• You feel more hopeful 

• You learn skills/tools to manage overwhelming situations and life stressors (negative thoughts, rumination, guilt, anxiety, fear, emotional pain) 

• You can cope/manage stressors relying less on unhelpful survival strategies (substances, distraction, overworking, avoidance, etc.) and more helpful strategies (asking for help, communicating needs, self soothing, taking care of yourself, feeling emotions, etc.)

• You feel more balanced 

• Your mood has improved

• Your behaviors have changed

• You have more flexible ways of thinking/thoughts

• You feel more confident and competent to handle things on your own 

• You try things outside of therapy and are more able to experiment and take risks

• You are more curious, open, and flexible 

• You practice more compassion 

• You trust your therapist 

• You trust yourself more

• You feel you can be honest with your therapist 

• You feel more empowered 

• You feel more motivated 

• You can identify your values and what’s most important to you

• You feel like your therapist is competent enough to help you with your issues 

• You have a good working relationship with your therapist (personality, common goals, expectations) 

• You feel supported, heard, and validated by your therapist 

• There’s a balance between validation and challenge 

• There’s a balance between gaining insight and learning/building skills

• Conflict, disagreements, and tensions are talked about openly and honestly 

• You feel more satisfied in life (work, relationships, with yourself)

• You have healthier relationships with yourself and others

The Therapist…

• Is licensed in appropriate local and state guidelines 

• Uses evidence based techniques backed by research 

• Is an effective communicator 

• Collaborates with you rather than using their power to tell you what to do/how to be 

• Creates an unique treatment plan for you and your issues 

• Checks in from time to time about how treatment is going (goals being met, taking a break, progress, etc.) 

• Gives you options during treatment (different therapeutic approaches, right to file a complaint, right to end treatment at any time, etc.) 

• Explains the therapeutic process, risks, benefits, answers your questions, does not guarantee success/promises results (you receive, review, and sign a packet of paperwork including informed consent or review it verbally with them) 

• Continually attends lifelong consultation, workshops, trainings, conferences to expand their skills and knowledge 

• Provides you a good faith estimate if you don’t use insurance to avoid surprise bills

• Tells you therapy has a beginning, middle, and end. That therapy will end one day.

• And more

Signs Therapy Isn’t Working/Isn’t Effective/ Isn’t Helpful 

• You feel judged consistently

• You feel invalidated consistently

• You feel uneasy consistently

• You received unsolicited advice telling you what to do

• You have opinions and judgements imposed on you regarding religion, spirituality, and or other beliefs 

• Your personalities clash and are not a good fit (e.g. you want a direct therapist and they are more passive/says very little or they are too direct/pushy and you want someone more laid back/relaxed)  

• You feel pressured to say the right thing and to please them 

• Insensitivity to your beliefs, identities, background, culture, experiences

• Your experiences are assumed rather than asked about/questioned/practicing curiosity/inquiry

• When conflict and tensions occur, they are not brought up directly and talked about 

• Breaking confidentiality without good reason (e.g. suicidality, safety, elder abuse, child abuse, consultation)

• You feel pushed/rushed to talk about things/topics you don’t want to/are not ready to talk about

• You feel like treatment is going nowhere/very little (not seeing and experiencing changes after several months or getting worse)

The Therapist…

• Avoids admitting mistakes when they occur 

• Seems bored and/or uninterested during session 

• Checks their phone during session regularly

• Gives you unsolicited advice

• Tells you about other clients and reveals personal, identifying information

• Talks about themselves constantly or too much (excessive self disclosure) 

• Is defensive when you give them feedback or criticism 

• Doesn’t listen and respond to your concerns or feedback

• Tries to be your friend 

• Doesn’t give you the time allotted to you (e.g. 45-minutes, 50-minutes, 60-minutes)

• Goes over allotted time regularly in excess of 5-10 minutes (not a 1 or 2 time occurrence, but consistently)

• Touches you without your consent and/or inappropriately 

• Flirts with you

• Compliments you in a sexual or romantic way

• Has sex with you (therapy never includes sex) 

• Pursues a dual relationship with you (hires you to do something, wants to be your friend, dates you, gets you to run errands for them, does personal favors for you) 

• Ends therapy to pursue a business, personal, and/or sexual relationship with you

• Lacks adequate training in your issue, especially if it’s a niche/specialty area (e.g. OCD, ADHD, bipolar, psychosis, PTSD, eating disorders, personality disorders, substance use) and doesn’t let you know and/or refer out to someone who can help you

• Doesn’t use evidence based therapy treatments

• Is consistently unreliable (cancels sessions often repeatedly, often more than 5-10 minutes repeatedly, does not show up to session without notifying you)

• Constantly forgets basic details about your life

• Promises results and/or makes guarantees (there are no guarantee in therapy)

• And more

Therapy Is A Personal Experience

• What works for one person may not work as effectively for another person. One person’s preferences will be in opposition to another person’s preferences.

• Therapy is a highly personal experience. Not all therapists will be a good fit for your needs, concerns, and goals.

Tips

• Meet with a few therapists for an initial 10-15 minute consultation to “shop around” and see who you seem to like/vibe with the most. However, some therapists may not offer a consultation. If they don’t, review their website to get a feel for their practice, personality, and approach.

• If you are unsure after one session, either consider a different therapist or set up a follow-up session to clarify your concerns. Do not feel pressured to stay with one therapist.

• Even if a therapist has specialized training and extensive experience in what you are seeking, you may not be a good fit due to factors such as personality differences, communication styles, cultural differences, etc.

• There are so many types of therapy and therapists out there. As a consumer of therapy, you can do your due diligence and educate yourself on what your rights are and what to expect (see below for more information).

• Look out for red flags in therapists. This can include: sexual advances, trying to be your friend, being repeatedly late, making sessions all about them and not you, and so forth.

• If you find a therapist you find a good fit, try to stick with therapy at least for 3-6 months. It takes time for thoughts, feelings, and experiences to metabolize and make more sense. These are deeply entrenched patterns you are living with and attempting to alter and change. Practice patience.

• Take a break as needed and communicate this need with your therapist. Healing is non linear.

• Be as honest as possible with your therapist with what is working, what is not working, and whatever else you might not want to bring up. Feedback is helpful and a good therapist will value this feedback (even if it is not positive).

• Try out different types of therapists based on context (e.g. time and place in your life). You might need a different type of therapist during school. Another type of therapist as you are looking for a job. Another type of therapist as you are in a long term relationship. And a different type of therapist when a sudden shift or adjustment occurs in life.

• There are no guarantees counseling will solve all problems, or how quickly changes will occur. There are no miracle cures, but it improves the odds, particularly if you start early.

What Makes Therapy Effective?

• Research shows using outcome measurement tools and asking for feedback throughout psychotherapy results in therapeutic effectiveness including more treatment gains and fewer client dropouts (Lambert, Whipple & Kleinstäuber, 2018).

• Research shows the relationship between client and therapist accounts for client improvement (or lack of improvement) as much as, and probably more than, the particular treatment method/approach (Norcross and Lambert, 2018).

  • Moreover, the therapeutic alliance (a warm, supportive relationship) is also important. The therapeutic relationship is defined as: 1) Agreement on what the problem is, 2) What will be worked on in therapy, and 3) How this will be achieved (approach).

• Research shows that clients and factors outside of the therapy account for about 40% of change (Assay & Lambert, 1999). This includes 1) The client’s level of motivation, 2) Perceptions of the therapy, 3) Commitment to the therapy framework, and 4) Integration of concepts into everyday life (Bohart & Wade, 2013).

  • Other factors include: 1) The therapeutic relationship, 2) Therapeutic alliance, 3) Therapy approach, 4) The therapist’s qualities, and 5) Client’s hope for change.
    

References

1) Lambert MJ, Whipple JL, Kleinstäuber M. Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy (Chic). 2018 Dec;55(4):520-537.
2) Asay, T.P., & Lambert, M.J. (1999). The empirical case for the common factors in therapy: Quantitative findings.
3) Bohart. A. C., & Wade, A. G. (2013). The Client in Psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 219-257). Hoboken, New Jersey: John Wiley & Sons, Inc.
4) Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III.Psychotherapy, 55(4), 303–315.
5) Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectical therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). Basic Books.