How Do I Know If Therapy Is Working?
This crucial question deserves a thoughtful answer. After 15+ years as a Seattle therapist, I've learned that therapeutic progress rarely follows a straight line, and recognizing improvement requires looking at multiple dimensions of your life. Let me help you understand what progress looks like, when to expect it, and how to evaluate whether your therapy is truly helping.
Understanding Therapeutic Progress
Progress Isn't Always Linear
Healing typically follows a pattern more like:
Two steps forward, one step back
Periods of rapid change and plateaus
Feeling worse before feeling better
Circular spirals upward
Unexpected breakthroughs and setbacks
This non-linear nature can make progress hard to recognize in the moment.
Different Types of Progress
Symptom Reduction The most obvious but not only measure:
Less frequent panic attacks
Improved sleep
Reduced depression
Decreased anxiety
Better appetite
Internal Changes Often precede external changes:
Increased self-awareness
Different thought patterns
Emotional regulation improving
Body awareness growing
Insight developing
Behavioral Shifts
Making different choices
Setting boundaries
Trying new things
Breaking old patterns
Taking healthy risks
Relational Improvements
Communicating better
Less reactive in relationships
Choosing healthier partners
Deeper connections
Increased intimacy
Early Signs of Progress (First 1-3 Months)
Immediate Indicators
Relief from Talking
Feeling heard and understood
Weight lifted from sharing
Hope returning
Less alone with struggles
Validation experienced
Increased Awareness
Noticing patterns more
Catching yourself mid-reaction
Recognizing triggers
Understanding connections
Seeing choices
Small Behavioral Changes
Using one new coping skill
Slightly better sleep
One difficult conversation
Trying something different
Saying "no" once
Therapeutic Relationship Forming
Feeling safer in sessions
Looking forward to appointments
Trusting therapist more
Being more honest
Taking more risks
These early signs suggest therapy is beginning to work.
Middle Phase Progress (3-9 Months)
Deeper Changes
Cognitive Shifts
Challenging old beliefs
Seeing situations differently
Less black-and-white thinking
Increased flexibility
New perspectives emerging
Emotional Regulation
Feelings less overwhelming
Faster recovery from triggers
Wider window of tolerance
Less emotional numbing
More emotional vocabulary
Behavioral Consistency
New habits sticking
Old patterns disrupted
Better decisions regularly
Self-care improving
Boundaries maintaining
Integration Happening
Insights becoming action
Past connecting to present
Understanding deepening
Changes feeling natural
Identity shifting
Later Stage Progress (9+ Months)
Fundamental Changes
Core Belief Shifts
Self-worth improving
World feeling safer
Others more trustworthy
Future more hopeful
Past integrated
Relationship Transformation
Attracting healthier people
Less tolerance for dysfunction
Intimacy capacity increased
Communication transformed
Conflict resolution improved
Life Changes
Career improvements
Living situation better
Health habits sustained
Creativity flowing
Purpose clarifying
Subtle Signs You Might Miss
Internal Shifts
Negative self-talk quieter
Body feeling safer
Dreams changing
Intuition stronger
Self-compassion growing
Micro-Changes
Pausing before reacting
Breathing deeper
Tension releasing
Smile coming easier
Energy returning
Perspective Shifts
Past feeling more distant
Triggers less activating
Problems feeling manageable
Options visible
Hope authentic
How I Track Progress
Regular Check-Ins
Every few sessions, we discuss:
What's different lately?
Progress toward goals
Setbacks or challenges
Emerging patterns
Next focus areas
Multiple Measures
I track:
Symptom changes
Functional improvements
Relationship quality
Your subjective experience
Observable shifts
Collaborative Assessment
Your input valued most
Objective and subjective data
Celebrating small wins
Honest about plateaus
Adjusting as needed
When Progress Stalls
Normal Plateaus
Expected during:
Integration periods
Resistance points
Life stressors
Deeper work approaching
Defense reorganization
These aren't failures—they're part of the process.
Concerning Stagnation
Worth addressing if:
No change in 3-4 months
Symptoms worsening
Hopelessness increasing
Sessions feel pointless
Dread attending
What We Do
When progress stalls:
Honest conversation
Approach evaluation
Possible pivots
Consultation consideration
Referral if needed
Realistic Timeline Expectations
General Guidelines
Acute Issues: 3-6 months
Panic attacks
Mild depression
Specific phobias
Adjustment disorders
Recent trauma
Moderate Complexity: 6-18 months
Chronic depression
Generalized anxiety
Relationship patterns
Grief processing
Identity work
Complex Issues: 1-3+ years
Personality disorders
Complex trauma
Severe dissociation
Attachment wounds
Developmental trauma
Individual Variation
Your timeline depends on:
Issue severity
Support system
Previous therapy
Life stability
Commitment level
What Slows Progress
Life Factors
Ongoing trauma
Major stressors
Health issues
Substance use
Relationship chaos
Therapy Factors
Poor fit
Wrong approach
Insufficient frequency
Avoided topics
Surface work only
Internal Factors
Severe defenses
Unconscious resistance
Secondary gains
Fear of change
Loyalty binds
Maximizing Progress
In Session
Be radically honest
Take emotional risks
Stay present
Ask questions
Give feedback
Between Sessions
Practice new skills
Complete homework
Self-reflection
Apply insights
Notice patterns
Overall
Maintain consistency
Trust the process
Celebrate small wins
Be patient
Stay committed
When to Be Concerned
Red Flags
Feeling worse long-term
Therapist seems stuck
Harmful dynamics
Lost hope completely
Action Steps
If concerned:
Discuss with therapist
Request different approach
Consider consultation
Explore referrals
Trust your instincts
Progress Unique to My Approach
Integration Focus
With my diverse training:
Multiple levels tracked
Body-mind progress
Somatic improvements
Cognitive shifts
Spiritual growth
Trauma-Informed Markers
Nervous system regulation
Trigger reduction
Body safety
Attachment healing
Identity coherence
Collaborative Measurement
Regular progress reviews
Your goals centered
Flexible markers
Honest assessment
Shared decision-making
The Ultimate Progress Marker
Beyond symptom lists, true progress means:
Feeling more like yourself
Living more fully
Choosing from wisdom not fear
Relationships enriching
Life expanding
These deeper changes matter most.
Trust Your Experience
You are the expert on your life. If you:
Feel different inside
Notice life improving
Have more hope
See new possibilities
Know something's shifting
Trust that therapy is working, even if progress feels slow.
Evaluating Our Work Together
In our therapy:
We'll regularly assess progress
Celebrate victories together
Address concerns honestly
Adjust approaches as needed
Honor your journey's pace
Your healing matters, and tracking progress helps ensure you get the support you deserve.
