In many cases, it's difficult for clients to know whether they're making progress because therapists do not necessarily state the goals and desired outcomes of therapy sessions. Clients may need to rely on their own global impressions. When clients are treated by cognitive behavior therapy (CBT) clinicians, though, they know how well therapy is working, because CBT therapists monitor progress each week by:
- evaluating clients' symptoms
- measuring the occurrence of specific target behaviors
- assessing progress toward specific goals
In fact, research shows that when both therapists and clients receive feedback on progress, clients tend to have better outcomes (Lambert, et al., 2002).
For example, CBT clinicians ask clients to fill out symptom checklists before each session, such as those for depression and anxiety. If applicable, clients may track and report the occurrence of panic attacks, angry outbursts, or incidents of self-harm behavior. They may also track the frequency and amount of alcohol, drugs, nicotine, or food they ingested in the previous week -- or the number of minutes they engaged in compulsive rituals. The type of monitoring and assessment varies from client to client, based on the goals they've decided they want to work toward. CBT therapists discuss these assessments with clients. When clients do not make expected progress, they conceptualize the difficulty and modify treatment accordingly.
How long can it take before clients' symptoms decrease? Sometimes clients notice improvements almost immediately, especially when they have three kinds of experiences:
- They realize that the treatment plan their therapist describes makes sense to them. They understand how it is that they'll overcome their difficulties. And they have confidence that their particular therapist will be competent and helpful.
- They change their unhelpful thinking in session and feel better.
- They enact an "action plan," at home and notice an improvement in their mood. The action plan, collaboratively designed with their therapist, usually includes (1) reading "therapy notes" of the most important things they learned in session and (2) engaging in specific activities that are linked to the accomplishment of their goals. For example, a depressed client might make plans with friends; an anxious client might expose himself to a feared situation to find out to what degree a negative outcome occurs.
These three kinds of experience increase hope and clients are able not only to arrest their downward negative spiral but also to reverse direction. They then find themselves on an upward positive spiral.
So how can clients tell if therapy is working? They can ask themselves:
- How is my mood throughout the week (not just at the end of sessions)? Is it at least gradually improving (albeit with ups and downs)?
- Are my specific symptoms or problematic behaviors improving?
- Am I solving problems and working toward my goals?
If the answers are yes, then therapy is working.
Lambert, M., Whipple, J., Vermeersch, D., Smart, D., Hawkins, E., Nielsen, S., & Goates, M. (n.d.). Enhancing psychotherapy outcomes via providing feedback on client progress: A replication. Clinical Psychology & Psychotherapy Clin. Psychol. Psychother., 91-103.