Achieving Your Goals In Therapy
Working with a psychotherapist requires a significant investment of time, energy and money. Knowing that your efforts in counseling are leading to success is important. But sometimes it is difficult to judge whether progress is being made. This is particularly true if you have no previous experience with psychotherapy.
Sometimes those who have never worked with a counselor harbor mistaken beliefs regarding how progress takes place. For example, although they may feel better after each visit for having ‘gotten things off their chest’, anxiety or depression returns as strong as ever the next day. Or they may gain new insights into the problems that initially led them to seek counseling but find this does nothing to improve their mood or alter the destructive relationships that weigh them down.
Patients with these experiences may believe that therapy is not working, and then prematurely end their efforts. Others may think that this is the normal course of counseling and if they simply persist in seeing their therapist great changes will eventually take root.
Neither of these reactions is helpful because both are based on the patient having only a vague notion of what progress should look like when working toward their specific goals.
Progress In Therapy: Goals and Strategies
To accurately judge whether progress is being made in therapy requires two things. One is that you are clear about the goals you are working on in therapy. Put another way, how will life be different if therapy is successful?
If you enter therapy with the goal of becoming more assertive, progress looks very different than if your goal was to develop better control over your angry outbursts. Obvious? Sure, but sometimes overlooked. Especially when someone enters therapy with vague goals, or multiple goals (which is common).
Secondly, you need to understand how therapy will work to help you reach various goals. For example, counseling might be aimed at learning new skills in order to better cope with stress and thereby reduce anxiety. In this case, progress will be measured by the variety and effectiveness of the skills you are learning.
On the other hand, a different set of criteria for progress would be needed if the focus was on developing greater insight into how your words and behavior alienate others, which in turn leads you to feel isolated and depressed. In this instance, you would want to see that new insights were accumulating, and these insights were helping you understand what changes you needed to make regarding your behavior (or perhaps who you needed to part company within your life).
The bottom line? How you judge whether progress is being made will differ depending upon which of these two therapeutic strategies is being employed to reach your goals.
Two Problems
Let’s briefly look at what we’ve established so far.
ONE: It’s important for patients to know how to judge whether progress is being made in their psychotherapy
TWO: How you measure progress will depend upon the goals of therapy and the strategy used to reach those goals (e.g., a focus on skill building versus insight).
Simple, yes? But there are a couple of problems that make all of this somewhat difficult. Let’s briefly look at each.
Problem 1
The first concern is that you can be making progress advancing a certain strategy but find that it doesn’t lead to progress in advancing your specific goals.
For example, imagine someone entering therapy with the goal of alleviating their depression, and the therapist decides upon a strategy that emphasizes teaching a core set of skills to elevate that person’s mood. These could include skills aimed at increasing gratitude, greater socialization, regular exercise, etc.
All of these have rich empirical support for reducing depression, and even so the patient could practice each skill daily, but still be depressed.
If that patient stops to ask, “Is therapy working?” the answer would be yes if the only thing looked at was having developed a new set of skills that are helpful to most people struggling with depression. But the answer is no with regard to the more important question which is whether his/her depression is less severe.
On the other hand, what looks like no progress might simply be that there is a longer lag time than normal between the time these skills were learned and the time they had a noticeable impact on mood. Not every patient responds to therapy at the same pace.
Consequently, ending therapy at this point might result in robbing the patient of a success that is just around the corner.
The solution (as is often the case) is to talk with your therapist about the problem. You might say “I have practiced learning the skills you taught me, and I put them into practice regularly over the past couple of months. But they don’t seem to be working because I’m still feeling the same as I was when we started.”
Problem 2
The second problem, even more common, is that people seldom enter therapy with a single issue to solve.
Anxiety is a good example. Let’s imagine that someone enters therapy because he is tired of how worry and fear restrict their life and create stress. The therapist does a thorough assessment and concludes that this patient’s coping skills are underdeveloped. Terrific. The solution is to teach the patient effective coping skills.
But… the assessment also finds that this patient learned from an early age to assume the worst about anyone and any situation. In fact, within the patient’s chaotic, dysfunctional childhood home it was only by constantly assuming the worst that he was able to stay safe. (Assuming the worst kept him constantly ready to respond to whatever threats arose).
That’s a new wrinkle. A tendency to assume that things will not work out, and that people will let you down, may help a child survive the hardships of being raised by dysfunctional parents, but when this same perspective is used as a lens to view life as an adult, it leads to constant worry, stress and social isolation.
This patient definitely needs better coping skills. That is 100% true. But there also needs to be a focus on attenuating his tendency to assume the worst.
If this patient asks, “Is therapy progressing?” the answer will involve judgments about the following: are proper coping skills being learned; are these skills being applied effectively; are new insights being developed that help the patient become more aware of his role in creating anxiety; and are his anxiety levels dropping?
That’s four different markers of progress in therapy, all of which are likely to advance at different rates.
This situation is typical. The majority of people who enter psychotherapy benefit most by learning new skills and developing greater insight which in turn leads to practical changes in how they choose to live.
The Solution For understanding If Progress Is Being Made
We’ve seen that answering the question of whether therapy is working is sometimes a difficult task. The best way to make it less difficult to answer is to talk with your therapist. Be direct. Raise your questions and concerns. Most therapists will be grateful for your candor. Their response should be one that shows curiosity as to why you are concerned, followed by an earnest effort to untangle each of those aspects of change looked at above.
By the end of the conversation you should have a clear idea as to what progress has been made, what needs to take place going forward to achieve more progress, and an invitation to periodically revisit the subject so as to keep up the momentum.
On the other hand, if your therapist is defensive, or simply says “Why do you ask?” and fails to really engage you, then it’s time to consider finding someone new with whom to work. The time, energy and money you’ve invested in therapy needs to be respected, and this occurs when your question is met with a straightforward response.
It’s fine if your therapist wants to discuss the frustration you feel, talk about your ideas as to what may be blocking progress, or asks why the question comes up at this particular point—all valid concerns to explore.
But before leaving the office, you should also get some clear answers from the therapist as to his, or her, view of your progress and what alternatives exist to address your concerns. If that’s not what you get, then it’s likely you simply are not working with a therapist who is able to help you make the changes you desire.
In that case, the solution is to “saddle up” and look for another therapist who is a better fit.
