After a few weeks or months of therapy, it is natural to wonder whether it is doing anything. With anxiety and depression the question can be especially hard to answer, because both color how you see your own progress. Anxiety may tell you nothing has changed; depression may tell you nothing will. It helps to have a few concrete things to look for.
Three questions to ask yourself
The American Psychological Association (APA) suggests that as therapy goes on, you ask yourself whether the psychologist seems to understand you, whether the treatment plan makes sense, and whether you feel you are making progress. Those three questions cover most of what matters:
- Understanding: Do you feel heard? Does the therapist remember what matters to you and reflect it back accurately?
- A plan that makes sense: Could you explain to a friend what you are working on and why?
- Movement: Compared with when you started, is anything different, even slightly?
Early signs
The APA describes a sense of relief and a sense of hope as good early signs. Many people feel some relief simply from saying things out loud for the first time or from finally taking action. Other early signs can include:
- Looking forward to sessions, or at least not dreading them
- Understanding your anxiety or low mood a little better, including what sets it off
- Noticing patterns between sessions that you only saw in hindsight before
- Feeling a bit less alone with the problem
Later signs in daily life
Over time, the change that matters most is the one outside the room. NIMH describes the goals of psychotherapy as relief from symptoms, maintaining or improving daily functioning, and better quality of life. In practice that might look like:
- Falling asleep sooner, or waking without immediate dread
- Doing something you had been avoiding: a phone call, a drive, a doctor's visit, a social plan
- Catching a worry spiral or a wave of self-criticism earlier and recovering faster
- More energy for work, people or interests that had faded
- Arguments at home that end sooner or do not escalate the same way
- Other people noticing a difference, which the APA mentions as one sign you may be nearing your goals
Change is often uneven. A good month can be followed by a hard week. What you are looking for is the overall direction over several weeks, not every session. It can help to compare with a specific moment, such as how you felt the week you first called, rather than with how you hoped to feel by now. Low mood and worry can make small gains easy to forget, so writing them down as they happen gives you a fairer picture.
When feeling worse is part of it
Therapy can stir things up. The APA notes that as therapy progresses you may feel more angry, sad or confused than at the beginning, and that this does not mean it is not working. It can be a sign you are facing difficult truths or doing the hard work of change. Talking about a painful history, or noticing a pattern you would rather not see, can leave you raw for a day or two.
The difference is direction and safety. Feeling stirred up after a hard session is common. Feeling steadily worse for weeks, losing the ability to function, or having thoughts of suicide is different, and needs attention right away: tell your therapist, and if you are in danger, call or text 988 or call 911.
Signs it may not be working
- After a reasonable stretch, nothing in your daily life has shifted
- Sessions feel like the same conversation each week, with no new understanding
- You do not know what you are working on or why
- You often leave feeling dismissed, judged or misunderstood
- You find yourself holding back important things because you do not trust how they will be received
How long is reasonable? The APA notes that some people begin to feel better in about six to 12 sessions, while others with more complex concerns take longer. How Long Does Therapy for Anxiety or Depression Take? explains the factors.
How to bring it up
NIMH's advice is direct: if you have been in therapy for what feels like a reasonable amount of time and are not getting better, talk to your therapist. The APA adds that if a session did not go well, you can say so and give the psychologist a chance to adjust. You might say:
- "I'd like to step back and look at how this is going. I'm not sure I'm seeing change yet."
- "Can we revisit what we're working toward? I've lost track of the goal."
- "Last session didn't land for me, and I wanted to tell you why."
- "Would it help to add something, like a medication evaluation or more structure?"
A good therapist welcomes this conversation. It often leads to a clearer focus, a change in pace or approach, or a referral. If you are considering medication, that is a question for your physician, psychiatrist or psychiatric nurse practitioner; talk with your prescriber before changing anything you already take. If the conversation does not help, When and How to Switch Therapists covers next steps.
Reviewing progress with Dr. Lehmann
Dr. Lehmann works with adults in individual therapy for anxiety, depression and related concerns, combining insight-oriented work with practical feedback. You can talk about pace and progress with her at any point. More about her approach to low mood is on the depression therapy page.