How Do You Know if Therapy is Working for You?
Written By Dr Alistair Campbell
Is it good enough to just like your therapist – or that your therapist seems to like you? How can you know if your therapy is working for you?
These can be tough and challenging questions for both you and your therapist. For the therapist they go to the heart of our competency. Are we doing a good enough job? For you, they are questions about value. Are you getting what you need, for the money you pay? How would you know?
These are good questions. In fact, they are critical questions. Increasingly it is clear that getting feedback from you (clients) about how we (therapists) are doing, is key to promoting and motivating change. One of the things that I have always found is that I learn most from my clients. I especially learn when my clients tell me what I am doing that is not working for them. Without that type of feedback I really don’t know what it is I need to work on to improve my approach.
The Importance of Feedback
Giving and getting feedback, especially the “negative” type, is hard on the client and the therapist. Honestly, though, it is the best kind. I know I like to be told that I’m great or that I’m doing a good job. Yet these comments are usually general. Critical comments are often specific. Or, at least, it’s possible to explore them more until the specifics are uncovered. When a client tells me, “I didn’t feel heard when you spent so much time writing your notes,” this really gives me something to work on. How do I improve my note taking so that it doesn’t get in the way? I love the challenge!
There is no doubt that liking, and being liked by your therapist is a really important element in whether therapy works or not. Research that has been done since the 1970’s has shown that the quality of the “therapeutic” or “working” alliance is of more importance to clinical outcome than what the therapist does (their technique).
Essentially, if there is a good rapport between you and the therapist, if you feel that the therapist is working on goals that are right for your problem, and if the approach that the therapist is taking, no matter what it is, feels like a good fit – then it is more likely than not that you will achieve change in your identified problem. It is that simple.
What Do You Bring to Therapy?
Another very important part in this, however, is what you bring to the therapy room.
Are you committed to making changes? Do you have the support of friends, family and workplaces? Do you understand what is being asked of you? How do you see the hard experiences that you have had in your life? Have you had a mix of both positive and negative experiences in your life? Is the idea of doing something different, maybe changing your life radically and forever, exciting or scary? All these issues and more are as important, perhaps more so, than the next biggest factor of whether there is a good working alliance.
So how do you know whether all of these factors are coming together? How can you tell whether you’re progressing well? How do you spot when something is going wrong, or simply isn’t working? In research settings it is a matter of having clients fill in long standardised questionnaires, recording and minutely observing the interactions between clients and therapists, and measuring different aspects of outcome, like symptoms, wellbeing, and growth – again, on long standardised measures.
In real clinical practice most clinicians will avoid using these types of measurement like the plague, because these types of tools add hours and hours to the business of therapy. It simply isn’t feasible to do them in real time. It also isn’t at all necessary.
Evaluating Your Therapy
I learned very early on as a therapist that one of the simplest ways of evaluating these factors for positive outcome was just to ask you.
Asking a client “So, how do you think we’re going?” or “Was this a useful session? Are there any things that I could have done better?” does lead to answers. It may not be “scientifically” valid but I have found that it is practically valid. Most of the time you seem to want to help me to help you. Some of you certainly seem to feel that the questions are challenging but I have never found that clients feel that me asking the question reflects a lack of competence on my part. If anything, I have found that clients intuitively recognize the value in talking about the process of the work that we are doing.
As a beginning therapist you are often so anxious about not appearing “unprofessional” that it is hard to admit to yourself, let alone a client, that you might have done something wrong. But, in most trades, sports and professions the best way to get better is to make mistakes and, more crucially, know that you have made a mistake in order to practice a better approach. It’s no different in therapy. If we know what we are doing wrong then we can practice a habit, style, or technique until we do it differently – and probably better. Mistakes are invitation to change.
Measuring Therapy Outcomes
This is still not a common way of thinking about therapy. But it is changing. There are also now ultra-brief measures of therapeutic outcome and client-therapist relationship that are good enough to use to measure these things in real world clinical practice.
I will usually ask you to complete two quick measures; they often take less than a minute to complete. The outcome measure (Outcome Rating Scale, or ORS) gives me a quick and valid indicator of how well you feel things are going for you.
The relationship measure (Session Rating Scale or SRS) gives you the opportunity to rate how well the therapy itself has gone during the session. Both of these tools can then be used to talk about both therapy progress (are you getting better?) and therapy process (are we working well together?).
If you’re really lucky (just kidding- remind me if I forget!) I will even have a nice simple graph after a few sessions to show you how you say you are progressing through plotting your ORS scores on a chart. This becomes really valuable when you know that a lack of progress after six or so sessions is a trigger for me to have a really thorough discussion about how I might need to be working differently, or whether my approach is the right one for you.
I like to use your ratings on the SRS to have a talk at the end of the session about how you feel we’re working together. As this is nearly the most important predictor of therapy outcome, I think it’s really worthwhile to keep the topic near the top of the agenda.
So, if I don’t ask you to fill in at least these two forms – feel free to ask me about that – I might just be having a “senior moment”!
Dr Alistair Campbell is a Clinical Psychologist working with individuals, couples, and families. He is trained and experienced in a wide range of therapies including Narrative; Systemic; Solution Oriented; Narrative; Cognitive; Behavioral; and Hypnosis approaches.
My partner and I stumbled over here coming from a different page and thought I might check things out. Tommy Weber Elfrieda
This design is wicked! You certainly know how to keep a reader amused. Gennifer Teddie Pedaias
Sweet website, super layout, really clean and utilise friendly. Anna-Maria Waldon Tanner
You have mentioned very interesting points ! ps decent site. Become addicted to constant and never-ending self improvement. by Anthony D aAngelo. Dinnie Roddie Orvas
Some really select posts on this site, saved to fav. Amie Jerri Burns
The most effective man is usually the grooms most trustworthy and faithful pal or relative. Tania Noam Kali
Great article! We will be linking to this particularly great post on our website. Keep up the good writing. Winnah Cleveland Ethbinium
Yes! Finally something about business advice services. Shalna Janek Louanne
Good post! We are linking to this great content on our site. Keep up the good writing. Giralda Anatole Cordle
I believe this is one of the so much vital information for me. Carie Barret Erlene
Amazing! Its genuinely remarkable paragraph, I have got much clear idea concerning from this article. Gabie Reggy Vitoria
You could definitely see your expertise within the work you write. Dianemarie Godwin Jacklyn
What a data of un-ambiguity and preserveness of precious experience regarding unpredicted feelings. Lacee Vale Edita
There is perceptibly a bundle to realize about this. I believe you made various good points in features also. Arliene Fonsie Thaddus
Howdy! I just wish to give you a big thumbs up for the excellent info you have here on this post. I am returning to your web site for more soon. Marge Pietrek Finny
Muchos Gracias for your article post. Really looking forward to read more. Much obliged. Teddi Sheridan Behka
Pretty! This was an incredibly wonderful post. Many thanks for providing this information. Emelda Hermy Sephira
I am truly glad to glance at this webpage posts which contains lots of valuable data, thanks for providing such information. Nanny Valdemar Arlinda
I am really thankful to the holder of this site who has shared this fantastic article at here. Mellie Dunstan Johnette
Fantastic blog article. Really looking forward to read more. Great. Juliana Lionel Gensler
I loved your blog post. Really looking forward to read more. Great. Retha Marty Kenyon
I am regular visitor, how are you everybody? This article posted at this website is genuinely fastidious. Viole Lars Rosane
Hello there. I found your site by the use of Google even as searching for a similar subject, your website got here up. It appears great. I have bookmarked it in my google bookmarks to come back then. Manya Arel Gapin
The created tips a person contributed have extended my own knowledge as well as motivated me personally to explore this particular topic. I enjoy how you was able to get this to fascinating. My eye balls tend to be opened to be able to clean ideas. Bess Stirling Palladin
Have you ever thought about creating an e-book or guest authoring on other websites? I have a blog based upon on the same topics you discuss and would really like to have you share some stories/information. I know my subscribers would enjoy your work. If you are even remotely interested, feel free to send me an e mail. Johnath Hank Drice
I was extremely pleased to find this great site. I wanted to thank you for your time due to this fantastic read!! I definitely appreciated every little bit of it and I have you saved as a favorite to look at new things in your website. Liesa Jone Jaehne
Simply wish to say your article is as astounding. The clarity in your submit is just spectacular and that i could suppose you are an expert on this subject. Well with your permission let me to seize your feed to keep updated with coming near near post. Thanks one million and please continue the gratifying work. Collete Cazzie Cavallaro
I?m pleased, I have to state. Truly seldom do I run into a blog site that?s both enlightening and enjoyable, and also let me inform you, you have struck the nail on the head. Your suggestion is superior; the concern is something that insufficient individuals are speaking intelligently around. I am extremely satisfied that I came across this in my look for something connecting to this. Katherina Benoit Stilwell
Amazing blog layout here. Was it hard creating a nice looking website like this? Almeda Ethelred Thill
Attractive element of content. I just stumbled upon your website and in accession capital to say that I get in fact loved account your blog posts. Any way I will be subscribing in your feeds or even I success you access consistently quickly. Brooks Wyndham Che
Appreciate you sharing, great article. Keep writing. Fiona Christophe Christa
I reckon something really interesting about your website so I saved to fav. Stella Chad Peale
I blog quite often and I genuinely thank you for your information. The article has truly peaked my interest. I will bookmark your website and keep checking for new information about once per week. I subscribed to your Feed as well. Maggy De Witt Cindy
Major thankies for the post. Really looking forward to read more. Keep writing. Martina Rutledge Herrle Orelle Garrot Jenette
You’re so interesting! I do not think I have read through
a single thing like this before. So nice to find another person with some unique thoughts on this topic.
Really.. thanks for starting this up. This website is one thing that’s needed on the web, someone with
a bit of originality! asmr 0mniartist
Muchos Gracias for your blog article.Much thanks again. Keep writing.
Incredible points. Solid arguments. Keep up the good work.
Hey there are using WordPress for your blog platform?
I’m new to the blog world but I’m trying to get started and create
my own. Do you need any coding expertise to make your own blog?
Any help would be greatly appreciated!
Thank you for your comment I will email in regards to your Question.
I really like it when individuals get together and share views.
Great website, continue the good work!
Simply want to say your article is as astonishing.
The clarity in your publish is simply spectacular and i can suppose you’re
an expert in this subject. Fine with your permission allow me to snatch your feed to keep updated with approaching post.
Thanks a million and please keep up the enjoyable work.
Hi, its good paragraph concerning media print, we all know media is a great source of facts.
I am no longer sure where you are getting your information, but good topic.
I must spend some time studying much more or understanding more.
Thanks for wonderful info I used to be in search of this info for my mission.
I think this is one of the most important information for
me. And i am glad reading your article. But should remark on few general things, The site style
is wonderful, the articles is really nice : D. Good job,
cheers
Greetings! Very helpful advice within this post!
It is the little changes that make the most important changes.
Thanks a lot for sharing!
My homepage; Ketorol Reviews
Hey There. I found your blog using msn. This is
an extremely well written article. I will make sure to bookmark it
and return to read more of your useful information. Thanks for the post.
I will certainly return.
I value the blog.Really looking forward to read more. Want more.
When someone writes an paragraph he/she retains the image of a user in his/her
mind that how a user can understand it. So that’s why this
paragraph is great. Thanks!
Pretty! This was an incredibly wonderful post.
Thank you for providing this information.
Howdy very nice website!! Guy .. Beautiful .. Amazing ..
I’ll bookmark your web site and take the feeds also? I’m happy to search out numerous helpful info right here in the post, we’d like
develop extra techniques in this regard, thanks for sharing.
. . . . .