How Do I Know Whether Therapy Is Helping?

Bandai Choi
Clinical Psychologist | Board-approved supervisor
Breathe-n-Smile Psychology, Essendon North, Footscray and telehealth across Australia

Understanding more without knowing what has changed

Imagine feeling heard in sessions while still avoiding an important call or struggling with the same routine. You wonder whether the direction needs reviewing.

Someone else may have similar symptom scores but notice emotions earlier or make a clearer request to a partner. These changes may matter to the agreed goal.

Ask what you wanted to change, what has shifted, what remains difficult and whether a new barrier has appeared. The answers support a decision about care, rather than grade either person.

Return to the goals you agreed on

If the starting goal was only “feel better,” it becomes difficult to assess after several sessions. Bring it closer to daily life: attend one class each week, leave fewer shops because of panic, discuss one boundary with family, or maintain basic self-care during a period of low mood.

APA guidance recommends monitoring psychological symptoms, interpersonal and social functioning, social support and the quality of the therapeutic relationship.^[1] These areas do not need to improve together. Some work first increases awareness before behaviour changes. A pressing practical problem may require a quicker response.

Goals can also change. New information, a life event or further diagnostic assessment may make the original direction less useful. Updating the goal is not automatically a failure, but the reason and new way of reviewing it should be clear.

One session’s feeling is only part of the picture

An appointment may bring relief or tiredness after painful discussion. Mention either, while also reviewing the pattern over time, daily changes and any worsening or risk.

Some people recall the worst days more readily than small improvements; others tell the therapist that things are “fine” because they do not want to disappoint them. Brief notes about a recent example, repeated at agreed review points, can help make both changes and ongoing difficulties easier to discuss.

At an agreed review point, ask whether the main difficulty, functioning, use of skills and focus of sessions have changed. The review should fit your situation rather than follow a universal timetable.

Measures, examples and feedback offer different information

Repeated symptom or functioning measures can inform shared decisions, as described in APA guidance.^[2] A score still needs context. Sleep may improve while new work stress increases.

Add an example: “I remain anxious, but attended an appointment I usually cancel.” Discuss worsening scores or functioning alongside new stress, health, medication, risk and treatment fit.

Culture, language and circumstances also affect interpretation. Ask what the measure captures and what it misses. Our psychologist or psychiatrist guide explains roles when further assessment or shared care is relevant.

How can I say that I am unsure therapy is helping?

Try: “Could we use part of today to review progress? What were our goals, what changes do you see, and what has not shifted?” Describe which parts of sessions help, which confuse you, and whether you feel able to disagree with the therapist.

APA guidance recommends real-time feedback about treatment response and the therapeutic relationship. Lack of progress, deterioration, reduced support or an alliance rupture should be discussed openly and collaboratively. Options may include changing the approach, further assessment, consultation or referral.^[1]

This conversation does not need to wait for the final session. The therapist may explain the current phase, refocus the work, change the pace or acknowledge that the method is not a good fit. The reasoning should be understandable, with room for your preferences and questions.

Bring a short progress check

Write what you wanted to change, changes noticed, remaining difficulties and questions about the method or relationship. A few lines are enough.

Specific guidelines may recommend regular measures: NICE’s social anxiety guideline includes sessional measures and joint review.^[3] Other concerns use different indicators.

Include changes outside therapy, without using them to dismiss every deterioration. Mention if fear of disappointing the therapist stops honest feedback. Agree on the next review point and an observable goal, with room to change the plan. Our starting therapy guide explains collaborative goals and arrangements.