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Demystifying the Process of Therapy

With the global pandemic, the associated economic downturn, and the civil unrest sweeping the globe, it’s no wonder that depression and anxiety are on the rise. To meet the growing need, more therapists have made their services accessible via telehealth, video conferencing, or web-based apps. Many people who are seeking therapy for the first time […]

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With the global pandemic, the associated economic downturn, and the civil unrest sweeping the globe, it’s no wonder that depression and anxiety are on the rise. To meet the growing need, more therapists have made their services accessible via telehealth, video conferencing, or web-based apps. Many people who are seeking therapy for the first time may wonder what to expect and how to know if therapy is working. Could this be you?

The following key questions can help you determine whether therapy is working for you.

Did your therapist help you identify your aspirations and values?

In many cases, it’s difficult for clients to know whether or not they’re making progress. But it’s quite clear to clients whose therapists practice Cognitive Behavior Therapy (CBT). In this form of treatment, which has been shown in over 2,000 research studies to be effective, CBT therapists initially help clients identify their aspirations (what they really want for their lives, how they want to be) and their values (what’s most important to them in life). They also help clients set specific goals they want to achieve as a result of treatment.

Does your therapist work with you to measure progress?

CBT therapists and clients measure progress at the beginning of each session (J. Beck, 2020). Therapists review with clients the symptom checklists they have filled out just before their appointment. In addition, they ask clients to report on their general mood and functioning from the past week and to rate on a 0-10 or a 0-100 scale their sense of well-being. If clients have been working on a specific goal, for example, to decrease angry outbursts, use of substances, or obsessive rituals, clinicians check on the occurrence of these behaviors. So, from the onset of the session, both clients and therapists have a good idea of whether the client has made progress.

Research shows that when both therapists and clients receive feedback on progress, clients tend to have better outcomes (Lambert, et al., 2002). When therapists assess progress at each session and collaboratively discuss with clients how to improve treatment if progress is not being made, clients tend to feel better faster and are less likely to drop out of treatment (Janse, et al., 2020). In fact, measuring progress has been part and parcel of CBT since its inception. The seminal treatment manual, Cognitive Therapy of Depression (A. Beck et al, 1979), directed therapists to monitor progress every week.

Has your mood improved by following your treatment plan?

Clients also want to know how long it will take to see progress. Some clients notice small improvements in their mood and functioning almost immediately, especially if they experience a sense of hope that therapy will help. CBT therapists inspire hope by their kind, compassionate manner and by relating their treatment plan, describing to clients what they intend to do to help them feel better. They ask for feedback, to make sure the treatment plan makes sense and is a good fit for the client, or whether they need to adapt it to better suit the client.

Do you collaborate on an Action Plan?

Clients also recognize they are making progress when they change their distorted or unhelpful thinking in session and between sessions—and feel better. At each session, therapists and clients collaboratively set an “Action Plan,” which consists of the steps clients want to take in the coming week in the service of their aspirations and goals. Action Plans also include therapy notes, important ideas clients learned in session and want to remember, including effective responses to thoughts that could get in the way of their taking the steps they’ve planned. Action plans many also include implementing solutions to problems or issues and practicing skills clients learned in session. When clients have difficulty completing their Action Plans, or encounter any other difficulty in treatment, therapists conceptualize the obstacle and help clients overcome it.

Does your therapist regularly ask for feedback?

Eliciting feedback toward the end of each session is also crucial to determining whether therapy is working. CBT therapists routinely ask clients what they thought about the session, whether there was anything the client thought the therapist didn’t understand or got wrong, and whether there is anything the client would like to do differently in the next session.

The techniques described above are unique to good CBT. But you may find that another psychotherapeutic modality works best for you. If this is the case, you can determine whether therapy is working by asking yourself whether your mood has been improving, at least gradually; whether your symptoms and functioning have improved; and whether you are making progress toward solving problems and reaching your goals. Positive responses to these questions indicate that therapy is working.

References:

Beck, A. T. (1979). Cognitive therapy of depression. Guilford Press.

Beck, J. S. (2020). Cognitive Behavior Therapy, Third Edition: Basics and Beyond. Guilford Press.

Lambert, M., Whipple, J., Vermeersch, D., Smart, D., Hawkins, E., Nielsen, S., & Goates, M. (2002). Enhancing psychotherapy outcomes via providing feedback on client progress: A replication. Clinical Psychology & Psychotherapy, 9(2), 91-103.

Janse, P. D., de Jong, K., Veerkamp, C., van Dijk, M. K., Hutschemaekers, G. J. M., & Verbraak, M. J. P. (2020). The Effect of Feedback-Informed Cognitive Behavioral Therapy on Treatment

Outcome: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 88(9), 818-828

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