How to Tell If You’re Making Progress in Therapy

Reaching out for help to manage a mental health condition ー whether it’s an anxiety disorder or a mood disorder ー is a sign of strength. Therapy is often included in many different treatment plans. There are many types of therapy ー including cognitive behavioral therapy (CBT), biofeedback, art therapy, play therapy, couple’s therapy, family therapy ーand they all function a little bit differently. 

Regardless of what type of therapy you receive, therapy is an integral part of mental health care. 

According to the American Psychiatry Association, therapy “helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps [people] deal with issues related to their mental health conditions which in turn affect the rest of their lives.”

Therapy is very individualized, and because of its individualized nature, no two people experience therapy quite the same way. Building self-esteem, for example, can look different from person to person.

In fact, a common statement we hear is “I don’t feel like I’m getting any better.” 

That’s just the topic we explore in this blog. Below, Dr. Dan Guy shares the top signs that help you determine if you’re making progress in therapy.

Therapy Isn’t All or Nothing

Although we’d like therapy to “work” instantly, that’s not the way therapy works. Some people might even say, “I’m not 100% better after one session, so it must not work.”

This is an example of all-or-nothing thinking. 

All-or-Nothing Thinking is a Cognitive Distortion, and unfortunately, it’s derailed many people. All-or-nothing thinking means exactly what it says: everything is either a total success or a complete failure.  

Example #1 of All-or-Nothing thinking: 

“If I am not completely free of whatever ails me, then I (or that doctor or that therapist or that counselor has) have failed.  So, I may as well just quit taking this medicine, or stop going to therapy, and definitely stop the hard work of changing my lifestyle. There’s no need to keep exercising, going to bed earlier, eating better, practicing relaxation.  If I’m going to keep having depressive episodes, manic episodes, panic attacks, mood swings; why should I make the effort to make these changes that make me uncomfortable.”

Example #2 of All-or-Nothing thinking: 

“I’m still feeling anxious about going into the office, so therapy must not be working. I might as well stop going.”

Example #3 of All-or-Nothing thinking: 

“I just had my third panic attack month. This medication isn’t working nor is therapy. I thought I’d be free of panic attacks by now.”

All-or-Nothing Thinking happens when you view something (in this case, therapy) as either a success or a failure. The problem with this is that therapy (and the management of mental health disorders) isn’t just black and white. Progress can be measured in increments, not just “success” or “failure.”

Why Therapy Isn’t All-or-Nothing

In the moment (the moment where you think that therapy isn’t working and isn’t worth it), the emotional brain (much of which is in the limbic system of the brain) says, “It’s not worth it.”  

However, if you can just tap the brakes, take a breath, pause….the intellectual brain can kick in and point out some things that you may not be thinking of at that moment.

The intellectual brain ーmuch of it in the prefrontal cortex that is responsible for cognitive function ー helps you look at your PROGRESS from a couple of different angles (perspectives, etc.).

Focusing on the Progress You Make in Therapy: Duration, Frequency, and Intensity

Therapy helps you make progress, and as therapists, we know that the key to overcoming your obstacles is to focus on progress, not perfection. You can look at progress in terms of duration and frequency.

“Progress is not achieved by luck or accident, but by working on yourself daily.”

– Epictetus, Ancient Greek Stoic philosopher

Frequency

While the emotional brain says that therapy isn’t worth it if you’re 100% free of your struggles, the intellectual brain says, “How often were you having depressive episodes before you started treatment?”  Maybe it was once a week, or maybe it was once a month. Identifying your starting point allows you to assess any progress.

If you slow down and consider the questions from your intellectual brain, you may notice that you haven’t had a depressive episode for 3 months.  We are talking about FREQUENCY.  

If you are having fewer episodes because of longer periods of time between episodes, you are PROGRESSing. 

The chart depicted above, published in this study, shows the correlation between the number of weeks in therapy and the decrease in the frequency of panic attacks.

Duration

Next, your intellectual brain can say, “How long did this depressive ー or panic, mood swing, manic ー episode last.  You might notice that each episode used to last for days, weeks, months.  If you look at this last episode, maybe it only lasted for a few hours to a day or two.  This is DURATION.  If the duration of the episode has decreased, once again, this is PROGRESS.  

In the chart above, you can see that the duration of depressive episodes is greatly impacted by the type of care received: no care, primary care, mental health care services.

Intensity

Finally, your intellectual brain says, “How bad did your episodes used to be?”  If you rated your episodes before treatment, you might have rated it as an 8 out of 10 (SUD: Subjective Understanding of Distress), and this most recent episode was a 6.  While it may seem small, it is still PROGRESS. 

In the graph above, you can see how therapy (in the case of this study, exposure therapy) helped reduce the intensity of anxiety symptoms. That’s progress, indeed!

Change Is Hard … So Is Therapy

Remember, change is hard; therefore, therapy, at least GOOD Therapy is hard.  Progress can be slow; not like the weight loss commercials that claim you can lose 87 pounds in 5 weeks ー with a small print that says, “results may vary.”   

Often people in therapy are looking for an excuse to quit the hard work.  Then, they can look at their family and friends, and say, “Hey, I tried, but it didn’t work.  I gave it a shot.  Don’t blame me. Blame them.”  (By the way, blaming is another very common Cognitive Distortion that allows a person to stay stuck.)

The Three Keys of Progress: Frequency, Duration, and Intensity

The next time you want to give up, step back, and look at whether you have made progress in any of the areas of FREQUENCY, DURATION, OR INTENSITY.  Even if you have made progress in one area, it is still progress.  Give yourself some credit for your hard work, and don’t give up because you are too impatient.  Your family, your friends, your life is worth the hard work.

Getting Started with Therapy

NextStep2MentalHealth provides adult, adolescent, and pediatric mental health care, and our multidisciplinary team is dedicated to helping our patients with their mental health needs. Call us for an appointment or simply use our online scheduling tool.

About Dr. Dan Guy

Dr. Guy specializes in the treatment of depression, anxiety, mood swings, relational problems, issues pertaining to self-doubt and self-value, and ADHD. He is skilled in the use of cognitive behavioral therapy (CBT), solution focused therapy, and reality therapy. He also provides psychotherapy for individuals with bipolar disorder and some addictive behaviors. Dr. Guy has helped hundreds of individuals, couples, and families establish loving relationships, healthy communication, and effectively address mental health issues. As a trusted professional, Dr. Guy will walk beside you as you face challenges in your life and will guide you toward healing and fulfillment.

You can now book an appointment with Dr. Guy here or give us a call at our Louisville, Kentucky mental health clinic at 502-339-2442.