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In therapy? Here's how to assess effectiveness

So, you've been in therapy for several months and aren't sure if you're improving. You seem to feel better, getting things off your mind each week, but how do you know if you're actually gaining from seeing your therapist? There's a difference between feeling better and getting better. The former usually brings immediate relief. The latter results in lasting life change that will lead to healthy behaviors and new ways of coping with stress and problems. This comes only when you acquire tools and skills you can apply beyond the immediate crisis or concern that brought you to the therapist in the first place.

by Jonathan Alpert in LA Times 26 Mar 2007

article continues: In psychotherapy, regardless of the school of thought, a collaborative effort should exist in which the client and therapist both work hard to achieve the desired outcome.

One of the first things that you should do is make a list of realistic goals and what you're hoping to gain from therapy. Share it with your therapist so that a specific treatment plan can be established. Reviewing the goals every few sessions will give you and the therapist an opportunity to monitor progress.

Ideally, as insight, support, and direction are provided, you should move closer to reaching the goals with each session.

Homework should be given, ... if social anxiety is the problem, then homework may be practicing relaxation techniques and an exercise in which the patient approaches others casually, asking for the time or directions ...

As treatment continues, information learned in sessions will be more accessible when a patient is away from therapy, and come more naturally. The patient will develop a set of skills that can be applied with confidence to situations that once proved to be problematic ...

Be a good consumer of this personalized service and assess your progress ...

What are some signs that you should shop for a new therapist? Beyond a lack of progress toward your goals, there are some other things you should chec k...

Don't just accept the therapist's methods. In fact, the talk therapy model where patient talks and therapist listens, offering an occasional, "I see" or "tell me how that makes you feel," isn't necessarily the gold standard or helpful.

Rather than being a passive participant, take an active role and question the course of treatment and outcome. After all, with a physical disorder, if the doctor prescribed medication or physical therapy and you saw no improvement, you'd probably speak up.

If, say, after a month of treatment for anxiety you still worry excessively, feel restless or edgy and have difficulty concentrating, then bring it to the therapist's attention. Share how you feel and don't assume it's known. A disorder such as anxiety is treatable and results are measurable. Frequency, duration and intensity of symptoms can be monitored — and there should be noticeable, if not marked, improvements after several weeks as you learn new skills and develop insight.

If you try therapy and don't feel comfortable, chances are it's just not a good fit — and not necessarily a reflection on you...

Although it may be a sensitive matter, word of mouth is probably the best way to find a good therapist. If someone you know has gained from seeing one, then he or she will probably be proud to share those improvements with you and tell you about the person who helped.

Full article »


In On the Mind, Jonathan Alpert, a psychotherapist in New York, answers questions about healthy mental living. Send questions and comments to