Depression, anxiety, job stress, grief, substance abuse — there’s often a clear reason why you decided to start therapy. But when will it start working? For some people, it only takes one session to see results. They walk away in a better mood with a clear action plan for the future.
Carl,* a 24-year-old web developer, said that everything changed when his therapist shed new light on an old problem. “I was always nervous about speaking in meetings but something clicked when I realized that I could control my negative thoughts. In my first session, I gained so much insight into how my brain works.”
If your experience of therapy hasn’t been that straightforward, don’t worry, you’re in good company. Studies have found that 50% of people need five to ten sessions before experiencing benefits. By the twenty-sixth session, 75% had seen improvements. Virtually all the research shows that there isn’t a clear path from beginning to end. Each person has their own journey with therapy and, while it is shown to be effective, it simply takes as long as it takes.
There are, however, a few things that help your chances of a successful outcome, including:
- Forming a strong bond with your therapist
- Setting clear goals together
- Committing to the process
These factors are all proven to contribute to a more effective therapy experience. They’re also indicators for how your therapy is going. If you’re several sessions deep and can’t confidently say that you have all three, it’s time to switch things up. Your therapist might not be right for you, you might need more clarity about the treatment plan, or you need to admit that you’re self-sabotaging.
Therapy will work, but it’s not magic. Thankfully, we know that, based on scientific research these factors contribute to helping guide us towards positive therapy experiences, and hopefully shorten the amount of time it takes to feel better.
1. Finding the Right Therapist
From cognitive-behavioral to psychodynamic, there are several schools of thought when it comes to therapy. It can be confusing to understand the difference, let alone decide which approach works for you. The good news is that studies say it doesn’t really matter. Psychologists refer to this finding as the “Dodo Bird Verdict,” after the Dodo Bird in Alice in Wonderland who declared everyone a winner. When researchers asked the question, “What makes therapy successful?” the answer wasn’t necessarily a particular school or type of therapy, it was the therapist.
“You really need to feel comfortable with your therapist,” said Mel, a 36-year-old writer and designer. “I’ve been going to therapy since I was ten years old and finally found a counsellor that I trust. I believe that he genuinely cares about me and wouldn’t steer me wrong.”
Unfortunately there’s no mathematical formula that will find you the perfect therapist (although Talkspace’s matching algorithms and consultation therapists are getting close!). There’s no evidence that a certain age, level of experience, quality of professional degree, or even personality trait makes one therapist better than another. This is because, as they say, different strokes for different folks. What works for one person may not work for another.
“Trust your gut — you’ll know when you’ve found the right therapist,” said Mel.
In therapy, we often share things that we’ve rarely, if ever, said aloud to another person. You need to feel safe with your therapist, secure in the fact that you’re free from judgement and shame. It can be hard to pin down what makes one therapy-client relationship work and another fail. It’s more of a vibe thing and if you don’t click, that’s okay. Therapy is a process of going deeper and deeper, having your core beliefs about the world challenged, and confronting parts of yourself that emerge reluctantly. You should feel like someone is on your team, rooting for you every step of the way.
However, that doesn’t mean you should jump ship at the first sign of conflict or discomfort. The emotional bond between clients and therapists is built together through honest communication. That can be easier said than done.
Some of us can get into “people-pleasing mode” where we say what we think the therapist wants to hear, even if it’s not true. This often takes the form of “false feedback.” Remember that you’re paying for this time and you won’t offend your therapist by saying how you feel.
Interestingly, therapists have been shown to poorly predict how their clients are doing. They rely on your honest feedback to gauge your progress. If it’s been several sessions and you’re not feeling any better, tell your therapist. You’ll know you’re working with the right person when your therapist appreciates your transparency and asks you to tell them more.
2. Knowing Your Goals for Therapy
Your first therapy session can be overwhelming. All the thoughts and feelings that you’ve been bottling up are released. “Before therapy, I was in my head a lot,” said Jay, a 28-year-old teacher. “They would just sit there, unresolved, until enough time passed and they were swept under the rug. But then they would come back and be worse than before. The first time I said those thoughts to a therapist, it was a relief.”
It’s not uncommon for the first few sessions to be heavy on venting, flurries of information, and tears. You’ve been holding so much inside and it needs to get out. Eventually, however, you need to make sense of these thoughts and feelings.
Working collaboratively with your therapist, your problems should be organized into goals with clear outcomes. This will help both of you measure progress and structure future sessions. Although it’s tempting to unload with whatever happened right before your session, you don’t want to waste time by wandering from topic to topic. You want to make the most of your session or texts and stick to the goals you’ve both agreed on.
All of this might sound too rigid for therapy, but research shows that goals are connected to positive outcomes. It will stop you from feeling like therapy is pointless or that you’re paying to talk to a friend. Plus, by focusing on specific goals, you’ll feel like a million bucks when it’s clear that you’ve achieved them. It will also motivate you to take on another goal, maybe something that’s more complicated. This is because specific, actionable goals help to break larger issues down into bite-sized pieces. Instead of “I’m not going to feel depressed,” you start with, “I’m going to manage negative self thoughts,” and then move deeper from there.
“My therapist helped me understand that the negative thoughts were irrational. I knew therapy was working because if I started to spiral, I would remember stuff we talked about in therapy. It was the first step towards combating depression and anxiety,” said Jay.
Some therapists might use more formal assessments for goals, like surveys or forms. This is especially common with cognitive-behavioral therapy (CBT). A simple CBT technique you can use is a mood diary where you rank how you’re doing from a 1-5. By tracking your emotional state throughout the week, you can get a more holistic view of your progress. To make this even easier, download an app like Daylio or iMoodJournal and set an alarm reminder.
3. Committing to the Process
Even though therapy will make your life better, it’s no walk in the park. Change is difficult and sometimes parts of ourselves resist the process. “It was so much easier being depressed,” a little voice might say. “Can’t I just crawl back into bed and stop trying so hard?”
This reaction to therapy is normal. There will be moments when you want to cancel your appointment and never go back. For people with addiction or self-harm issues, this can result in a more serious relapse. Don’t worry, you haven’t disappointed anyone. Your therapist understands that change comes in waves, loops, cycles and squiggles. The key is sticking with it — your breakthrough will come, sometimes when you least expect it.
After you’ve found the right therapist and set goals, you owe it to yourself to see things through. When you feel like giving up, that could be an opportunity for change and you may be right on the precipice. Why are you avoiding therapy? What’s behind that reaction? Are you getting close to something that’s really important? Instead of bailing on the process, bring up these feelings in therapy and you might be surprised where they lead.
It’s also possible that you’re just not ready for therapy at this moment. Claire, a 40-year-old stay-at-home mom said that she had many failed attempts at therapy before she could commit to a weekly appointment. “I knew there was a problem, but I wasn’t ready to deal with it. Looking back, I was sabotaging myself. I could always come up with an excuse for why I couldn’t go to therapy.” And if weekly appointments, scheduling, and commuting to a therapist’s office conflict with your lifestyle, online therapy may be a viable and convenient alternative.
There are four stages of change that a person goes through: precontemplation, contemplation, preparation, and action. In the first stage, we’re not even aware that there’s a problem. Then, we experience conflicting thoughts and feelings as we start to contemplate the idea that things aren’t working as well as we thought. As we prepare to make a bigger change, we take little steps like ordering self-help books or asking friends for their opinion. The final stage is action. We’re mentally ready to put our plans into motion. People who start therapy in the action stage tend to be the most successful and those who are still contemplating have the highest drop-out rate.
“Eventually, I couldn’t ignore my anxiety and I couldn’t fix it on my own,” said Claire. “It was so obviously time to see a therapist. I was at the end of my rope. Now you couldn’t stop me from going. For me, it’s like going to the gym. Sure, sometimes it’s hard work, but it’s an important part of my self-care routine. I’m proud of being a success story.”
*Names changed to protect privacy