by Karen Cassiday
therapist and therapy

Many people wonder if their therapy is really helping them overcome their problem. Why? They often have therapists who tell them that they are doing well, but their therapist does not make clear to them what they mean by making progress. Does it mean facing your emotions, being able to talk about difficult things, or does it mean that you feel better and function better? Many people also like their therapist’s kindness and empathy, but feel guilty about questioning the outcome because their therapist is so nice even though they are not getting better. Unless you clarify with your therapist what a good outcome is at the start of therapy by mentioning your goals and agree what recovery looks like, then you may be likely to go to therapy for years without any noticeable improvement in your daily life. So, here are some hot tips for questions to ask to determine is your therapist is really helpful.

  1. How will you help me get better?
  2. Why are you using the methods or modalities that you use to help me get better?
  3. Is there any research that shows that the way that you will work with me is likely to help my problem(s)?
  4. How long will it take for me to expect noticeable improvement?
  5. What will I have to do to get noticeable improvement?
  6. What will you do if I plateau and do not see changes in my every day life?
  7. What do the steps to recovery look like?
  8. When do you refer patients for evaluation for medication? Other therapies?
  9. What do you think make it difficult for patient like me to recover?
  10. How will you measure my progress?
  11. Will you help me practice doing real life skills that are necessary for recovery, or will you just tell me what to do, or talk about what I should do?
  12. What will you do if I have difficulty doing your recommended home practice?
  13. Do you assign home practice?

Some things that suggest that your therapist may be less than helpful are the following:

  1. You complain about not being able to make any significant progress and your therapist tells you that you have to process the problem emotionally before you can expect any changes
  2. Your therapist talks a lot and does not have you talking and doing new things that help you make progress
  3. You like your therapist and think that they are really nice, but you never really get down to working on the actual behaviors that make your life difficult
  4. Your therapist tells you that your brain scans or blood values have improved but you do not feel or function any better
  5. Your therapist tells you that you are expecting too much and that your condition is chronic, or that nothing more can be done to help you
  6. Your therapist tells you that if you could get to the problem underneath your issues, then you would be able to recover
  7. You therapist tells you that you are in denial about the true issues underlying your problem and that you need to do more therapy in order to get better
  8. You have not experienced any noticeable progress after two month of treatment-most treatments that are effective should show some progress within several weeks to several months
  9. You disagree with your therapist’s ideas about the problem and their explanations do not make sense to you.

About the Author

Karen_Cassiday350_2.jpgKaren Cassiday, PhD, is ADAA's past board president. Dr. Cassiday’s areas of interest are anxiety disorders in children and teens, social anxiety disorder, treatment-refractory OCD, and working with children and teens who suffer from both developmental concerns and anxiety disorders. Her research has focused on information processing in posttraumatic stress disorder and cognitive-behavioral treatment of anxiety disorders in children, teens, and adults.

Your therapist prescribes or only prescribes medication with little to no discussion about your illness, associated problems, and/or doesn't ask if you would like therapy or offer it as a treatment.

While I agree on the surface they sound like valid comments, I think the problem is how its framed, "you have to process..." & "if you could get to..." Where the onus of responsibility is on the patient to clear the haze themselves they would find improvement, when I believe a good therapist wouldn't lead with that and possibly make them guilty and/or not take responsibility for their lack of impact/problem solving.