Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
A frequent question I get from readers is how long does therapy last and how do I know if my therapist is helping me? These are good questions because it is all to common that patients can stay in therapy too long and they have little idea how to answer the second question, is my therapist helping me?
Cognitive Behavior Therapy (CBT) usually starts out with therapist and patient setting goals so that progress can be measured. However, in other types of psychotherapy that is not so easy. For example, in psychoanalysis, psychodynamic therapy, supportive therapy and others the entire issue of goals is fuzzy because the therapy is less focused on specific behavioral goals and more on feeling better and having more insight into one’s behavior. In a general sense, feeling and functioning better are the measures used to determine progress.
Nevertheless, in all types of psychotherapy, there are clear signs that things are improving if the therapy is working. Examples of making progress in therapy is that, 1. There is a feeling that one’s life is more manageable and that it feels like one is more in control of life, 2. There is a clear feeling of increased self confidence and that one is moving forward in life, 3. Not only does the patient see behavioral changes but so do friends and relatives and, finally, 4. There is a much better understanding of one’s self and ones behaviors. In addition to these signs it is worth asking one’s self, “Am I getting my money’s worth from the sessions? Of course, these are very subjective questions to ask or to rely on. Still, it’s important to think this way as a guide to answer the question, “Should I continue with this therapist or not?”
In addition to these watching for these signs of progress, there are certain questions that each patient should think about in relation to the mental health practitioner they are seeing. For example, 1. Does my therapist listen to me and to the concerns I bring up in therapy? 2. Does my therapist talk more about himself than about me? It’s amazing how often I hear the complaint from readers that their therapist spends vast parts of the session talking about his life. 3. There seems to be no structure or focus to the sessions. Sessions meander from one topic to another and have little to do with why one came to therapy. Of course, this can be a defense used by a patient but it’s still the role of the therapist to refocus the patient.
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When asked, I always advise patients to talk to their therapist and raise these concerns if they are troubling. Some people have difficulty with this advice because they either fear they will hurt the feelings of the therapist or they fear the therapist will get angry and scold them. In answer to these concerns I always point out that a good therapist is able to be accepting and even open to the anger and, or, complaints of the patient. In addition, it’s always a good idea for the therapist to ask how the patient how they feel things are going. If it’s not possible to discuss these and other things with the therapist then it’s time to move on and find someone else. After all, the patient does not pay the fee to get nowhere in their treatment nor to protect the feelings of the therapist for fear that talking openly will hurt his feelings.
Allan N. Schwartz, PhD
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