You have been going every week for four months. Some sessions you come out lighter, others you come out worse than you went in, and there is a question you never quite put into words: whether this is achieving anything, or whether you have simply got used to going on Tuesdays.

It is a reasonable doubt and a rarely voiced one, partly because raising it feels disrespectful towards the person treating you. It is not. Knowing whether therapy is working is part of the treatment, and there are fairly concrete ways of checking that do not depend on how you feel walking out of the room.

Why it is so hard to tell

Three reasons, and all three work against intuition.

Improvement is not linear. You do not advance a little each week. You advance in jumps, with long plateaus and occasional setbacks that frighten more than they should. Judging the whole process by the last session is like judging a winter by the one Tuesday it was sunny.

Sometimes things get worse before they get better. In treatments working with exposure or with difficult memories, the first weeks can be more uncomfortable than the starting point. That does not mean it is going badly; often it means the opposite. What should exist is an explanation beforehand of why it happens and how long it is expected to last.

Memory erases the starting point. This is the treacherous one. When something improves gradually, the new state becomes the reference and the precise recollection of how you were in March disappears. Plenty of people conclude nothing has changed when, if they looked at their own data from four months ago, they would see otherwise.

The signs that it is going well

The US National Institute of Mental Health sums up the goals of psychotherapy in three: relief from symptoms, maintaining or improving daily functioning, and improving quality of life. That is where to look. And first, what is not a sign: feeling good on the way out. There are hard sessions that shift the most, and pleasant conversations that change nothing. The criterion is outside the room.

What changes outside the consulting room

This is the main indicator. You have started seeing people again, you sleep half an hour longer, you made the call you had been avoiding for months, you argue with your partner without it turning into three days of silence. Small, concrete changes, not revelations.

How you react, not what you feel

In many cases the symptoms keep appearing for a while, but the reaction changes: the anxiety arrives and no longer takes the whole afternoon, the thought turns up and does not drag two hours behind it. That is often the first real change, and it goes unnoticed because it does not match the idea of "being cured".

The conversation changes subject

At the start you talk about symptoms. Later you talk about decisions, relationships, what you want to do about something. When the original reason for coming stops filling the whole session, something has moved.

How to measure it instead of guessing

Here is the practical part, and the one almost nobody applies.

Systematic progress monitoring — a short questionnaire at intervals, compared over time — is standard practice in public psychotherapy services in several countries, and the research on it is fairly consistent: when the clinician has data on how things are going, cases that are deteriorating get spotted and corrected sooner. It is not bureaucracy: it is what prevents four months on autopilot.

You can do it yourself. At the start, and then every six or eight weeks, answer the same questionnaire and note the score with the date. The Anxiety Test if what brought you was worry and arousal, the Depression Test if it was mood, the Stress Test if it was a specific overload. They are in the psychological tests catalogue, free, anonymous and calculated on your own device.

Two warnings. First: answer at an ordinary point in the day, not right after an intense session or a bad night, because the score comes out distorted. Second: do not read it as a pass or a fail. What informs you is the trend between measurements, not the isolated number. Our guide on the Mental health test: what it measures, which ones exist and how to read your result covers how to interpret them without overreaching.

And there is an even simpler record that works well: write down on your phone three concrete things that are hard for you today. Read them again in two months. It is the cheapest antidote to the memory that erases your starting point.

Woman writing in a notebook by the window, tracking her progress in therapy

What timescales are reasonable

It depends on the problem and the approach, but there are orders of magnitude.

The first signs usually appear between the fourth and sixth session, and not as symptoms disappearing: you notice it sooner in how you react to them. A cognitive behavioural treatment for anxiety or depression usually runs between twelve and twenty sessions; we go into it in Cognitive behavioural therapy: what it is, how it works and what it treats. Complex trauma work runs longer, because it includes a preliminary stabilisation phase.

What should exist from the start, whatever the approach, is a plan with concrete goals and some way of knowing whether they are being met. If after eight or ten sessions absolutely nothing has changed — not outside, not in your reactions, not in the scores — there is no need to wait longer before raising it.

Signs that something is off

Two types are worth separating, because they are not the same.

Lack of direction

There are no agreed goals, every session starts from scratch, nobody revisits what was said the week before, and asking how long this might take always gets a vague answer. It is not bad faith: it is a lack of structure, and it can be corrected by asking for it.

Lack of fit

You feel judged, you cannot say certain things, you sense they do not understand you or that the approach does not suit you. Fit matters as much as technique: the quality of the bond between client and professional is one of the factors that best predicts the outcome of a treatment, above the particular school being followed.

Signs that are not negotiable

There are no nuances here. A professional who talks about their own problems and takes up the session, who pressures you into buying more services, who breaks confidentiality, who makes dismissive comments about your life, who proposes any kind of relationship outside the therapeutic frame, or who promises guaranteed cures. In those cases it is not a matter of talking it through: you change. And where appropriate you report it to the relevant professional body: in Spain, the General Council of Psychology brings together the official colleges, which hold the register of practitioners and handle ethics complaints.

What to do if you think it is not working

First, and it is hard: say it in the session. "I have had the feeling for a while that we are not getting anywhere" is a perfectly legitimate sentence, and a good professional receives it as useful information rather than an attack.

There is a technical reason for doing so. The literature on the therapeutic alliance describes so-called ruptures — moments of disconnection or disagreement between client and therapist — as frequent and, when repaired by talking them through, associated with better outcomes. Put another way: raising the doubt does not damage the process; quite often it unblocks it.

If talking about it changes nothing, there are three options:

  • Revise the goals. Sometimes what is failing is not the approach but the focus: the work is on something that is no longer what weighs most.
  • Change approach. A different one may suit the problem or you better: the UK's National Health Service funds nine different modalities on its own. The full map is in Types of psychological therapy: what they are and how to choose.
  • Change professional. It is not a failure or a betrayal, it is a normal clinical decision.

How to change therapist without losing your progress

If you decide to change, three things make the handover much easier.

Do not just disappear. A final closing session, however brief, serves to order what has been worked on and stops the ending becoming one more unfinished matter.

Ask for a summary. You are entitled to a report of what was covered and how you progressed. With that, the next professional does not start from zero and you are spared repeating the whole history.

Check credentials before starting again. A clinical psychologist with health accreditation and a registration number verifiable with their regional college. If you are looking online, the checks to make beforehand are in our guide Online psychologist: how to choose well and what to expect from video-call therapy; and if you are weighing up starting over, When to see a psychologist: signs, common doubts and what happens in the first session covers what happens at a first appointment.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: