Category: Therapy

How to Know If You’re Making Progress in Psychotherapy

There’s a moment many people experience in therapy, but rarely talk about out loud.

You sit in your car after a session, staring at the steering wheel, and think:
“Is this actually working?”

Not “Do I like my therapist?”
Not “Did today feel emotional?”
But something deeper:
Am I really making progress in psychotherapy,or just showing up every week and talking?

This question sits at the heart of therapy effectiveness and psychotherapy outcomes, and it’s far more common than most people realize, especially among clients in fast-paced, high-pressure environments like California and across the U.S.

As a psychotherapy practice committed to evidence-based care at Heal-Thrive, we see this question not as doubt—but as a sign of engagement. Wanting to understand your progress means you care about change. And that’s where real therapy begins.

Here’s the truth (and I want to be very clear about this):
Progress in psychotherapy is rarely obvious, linear, or dramatic.

In fact, research consistently shows that meaningful change often appears in subtle emotional changes, small behavioral shifts, and improvements in the therapeutic alliance, long before clients feel “better” in a traditional sense (Lambert, 2013; Lueger, 1998).

This article will help you learn how to evaluate your therapy progress using:

• Research-backed indicators of psychotherapy outcomes
• Tools like routine outcome monitoring and patient feedback therapy
• Real, anonymized client examples
• Clear signs of emotional and behavioral change
• And honest red flags when therapy may not be working

Whether you’re new to therapy, months in, or wondering if it’s time to adjust your approach, this guide is designed to give you clarity, without oversimplifying the process.

What Does “Progress” Really Mean in Psychotherapy?

One of the biggest reasons people doubt therapy effectiveness is surprisingly simple:

They were never taught what progress in psychotherapy actually looks like.

Many clients enter therapy expecting:

• Constant relief
• Clear solutions every session
• Feeling calmer, happier, or more confident right away

But psychotherapy outcomes, according to decades of research—don’t work that way.

Definition of Therapy Progress In a research context

On a professional level, progress in psychotherapy can be defined as a positive change manifested through measurable and quantifiable improvements in three realms:

1. Emotional changes in therapy
2. Behavioral changes during and outside sessions
3. Strengthening of the therapeutic alliance

Michael J. Lambert, one of the most influential researchers in psychotherapy outcomes, emphasizes that improvement often begins internally before it becomes visible externally (Lambert, 2013).

In other words:
You may be changing long before you feel “better.”

Progress Is a Process, Not an Event

Here’s something clients are rarely told (and honestly, they should be):

Progress is not a breakthrough moment.
It’s a pattern.

It looks like:

• Pausing before acting
• Labeling emotions rather than suppressing them_
• Noticing thoughts you used to believe automatically
• sensing a lack of comfort and persevering despite it

This is perfectly illustrated in Timothy Carey’s “Method of Levels” when he says that the most efficacious form of therapy involves the removal of obstacles to the naturally occurring process of change rather than the imposition of a solution (Carey, 2006).

So if therapy feels slower, messier, or more reflective than you expected… that doesn’t mean it’s failing.

Often, it means it’s doing exactly what it’s supposed to do.

Signs You’re Making Progress in Psychotherapy

One of the most reliable ways to evaluate psychotherapy outcomes is to stop asking,
“Do I feel good?”
and start asking,
“What is actually changing?”

Research in patient feedback therapy and routine outcome monitoring (ROM) shows that progress appears first in patterns, not in mood spikes (Lueger, 1998; Lambert, 2013).

Below are evidence-based signs ,emotional and behavioral, that therapy is working, even when it doesn’t feel that way yet.

1. Emotional Changes in Therapy (Often Subtle at First)

Many clients expect emotional progress to mean less pain.
In reality, emotional progress often means more clarity.

Common emotional indicators include:

• You can name your feelings more accurately
• Emotions feel intense, but less overwhelming
• You notice emotions sooner instead of being blindsided
• You tolerate discomfort without immediately escaping it

I remember a client (details changed) who said, “I don’t feel happier, but I feel more honest.”
That was a turning point.

According to Weiss (1993), emotional awareness is a prerequisite for lasting therapeutic change, not a byproduct of it.

Key Insight: Feeling more emotions does not mean therapy is failing.
It often means defenses are loosening.

2. Behavioral Changes Therapy: Small Shifts, Big Meaning

Behavioral change in therapy rarely looks dramatic.

Instead, it shows up as:

• Pausing before reacting
• Setting boundaries imperfectly, but setting them
• Saying “no” without a full explanation
• Returning to routines faster after setbacks

These micro-changes matter.

A relevant example of the applicability of Lambert’s outcome research is the finding that small changes in behaviour are better predictions of improved outcomes than feelings of relief (Lambert, 2013

3. Patterns That You Previously Didn’t Even Pick Up

One of the indicators of the efficacy of therapy is the recognition of patterns.

You might notice that:

• Repeating relationship dynamics
• Family emotional stimuli

Applications of the Model

• Internal dialogue to

This awareness can be a source of frustration.

Actually, no, scratch that, it typically feels frustrating.

But insight without awareness is impossible, and awareness precedes choice.

Carey’s Method of Levels emphasizes that simply noticing internal conflicts can initiate change without force or advice (Carey, 2006).

4. The Therapeutic Bond Experiences a Feeling of Safety and Authenticity

The therapeutic alliance, the relationship with the therapist, has been identified as among the very best predictors of a positive treatment outcome.

Signs it’s strengthening:

• Feeling understood even when you feel challenged
• You can disagree or express discomfort
• You trust the process, not just the person
• Sessions seem collaborative rather than directive

Moreover, it was found in various studies that the therapeutic alliance was responsible for more outcomes of psychotherapy than the technique itself (Lambert, 2013).

5. Progress Happens Outside of the Therapy Room

One of the common pitfalls that clients fall into is assessing the value of therapy strictly on the experience of the session.

“Real progress tends to occur between sessions:”

• You respond differently to stress
• Relationships feel less reactive
• You recover faster from emotional dips
• You apply insights without trying to

This is why routine outcome monitoring tools are so valuable, they capture change over time, not just session impressions.

Common Challenges When Evaluating Therapy Progress

If you’ve ever searched something like:
“Why is therapy making me feel worse?”
you are not alone.

In fact, many of the most meaningful psychotherapy outcomes emerge during periods of doubt, discomfort, or emotional turbulence.

Let’s address the most common, and misunderstood, challenges people face when trying to assess therapy effectiveness.

1. Progress Is Non-Linear (And That’s Normal)

One of the biggest misconceptions about psychotherapy is that improvement should follow a steady upward line.

It doesn’t.

Progress often looks like:

• Improvement → plateau
• Insight → emotional dip
• Growth → temporary regression

This fluctuation is not failure.
It’s a feature of deep psychological change.

Lambert’s outcome research shows that short-term setbacks are common even in successful therapy cases (Lambert, 2013).

Important: A temporary stall does not mean therapy has stopped working.

2. Temporary Worsening of Symptoms (“Healing Crisis”)

Many clients experience increased anxiety, sadness, irritability, or exhaustion, especially when therapy reaches deeper material.

This is sometimes called a healing crisis or emotional flare-up.

Here’s what’s happening:

• Avoided emotions are being processed
• Old coping strategies are no longer working
• Awareness increases faster than skills

Weiss (1993) explains that symptom intensification often occurs when unconscious conflicts are brought into awareness.

So feeling worse does not automatically mean therapy is harmful.
Context matters.

3. The Changes Are Subtle and Very Likely to Be Missed

Not all progress is dramatic. Progress doesn’t have

Sometimes progress may look like this:

• A slightly calmer conversation
• One fewer argument
• A pause in the place of an automatic reaction

These subtle changes in one’s emotional and behavioral expressions are fundamental but are easily neglected when one looks for major developments.

This is why routine outcome monitoring tools are critical. They track gradual change objectively over time.

4. Therapists Can Overestimate Progress

That is a rather uncomfortable truth, but it is a fact that is borne out by research.

Research has found that professionals tend to be overly optimistic with regard to client progress and may overlook signs of stalemate or deterioration (Lueger, 1998).

Hence, patient feedback therapy is required.

When clients provide feedback on a regular basis, the outcome will improve, and the therapy process will become more responsive.

5. Absence of a Common Method of Monitoring Progress

In many therapy rooms, talk and intuition are mainly used.

Although this approach is very useful, it might not be able to identify Validated tools include:

• Outcome Questionnaire-45 (OQ-45)
• Feedback-Informed Treatment (FIT) protocols

help both therapist and client see what’s actually changing, and what’s not.

Heal-Thrive integrates evidence-based monitoring to avoid “flying blind” in therapy.

6. Unrealistic Expectations and Common Myths

Now, let’s debunk a couple of misconceptions:

–   Therapy should always feel good.

–  The progress has to be fast

–  Speaking alone results in change

Reality:

– Therapy feels uncomfortable

– Change requires time

–  Insight to Action

Such knowledge will save clients from unnecessary disappointment.

7. Lack of Therapeutic Alliance Delays Progress

Unless trust, empathy, and possibly a basic set of common goals are found, therapy will not work

Warning Signs include:

• Feeling judged or misunderstood
• Reluctance to talk about issues because
• Avoiding or d

“The therapeutic alliance is not optional, it is a foundation.”

8. When Therapy Might Truly Not Be Working

Balance matters. Sometimes therapy genuinely needs adjustment.

Red flags include:

• No noticeable change after several months
• Continuous worsening without relief
• Repeating patterns without new tools
• Feeling hopeless or stuck long-term

In these cases, feedback, reassessment, or a referral may be appropriate.

How Progress Is Measured in Modern Psychotherapy

One of the most important developments in psychotherapy over the last 30 years is this realization:

Talking alone is not enough to accurately measure psychotherapy outcomes.

Even skilled, well-intentioned therapists can miss signs of stagnation ,or early deterioration without structured feedback systems. This is where routine outcome monitoring (ROM) and patient feedback therapy become essential.

What Is Routine Outcome Monitoring (ROM)?

Routine Outcome Monitoring is the systematic use of brief, validated questionnaires throughout therapy to track emotional, behavioral, and relational change over time.

Instead of guessing, ROM allows both therapist and client to see:

• What is improving
• What is stuck
• When intervention adjustments are needed

Michael Lambert’s research demonstrates that ROM significantly improves therapy effectiveness, especially by identifying clients at risk of poor outcomes early (Lambert, 2013).

Common ROM Tools Used in Evidence-Based Therapy

Some of the most widely researched tools include:

• Outcome Questionnaire-45 (OQ-45)
  Measures distress, interpersonal functioning, and social role performance.
• Session Rating Scale (SRS)
  Assesses the strength of the therapeutic alliance.
• Outcome Rating Scale (ORS)
  Tracks overall well-being across life domains.

These tools are not about judgment.
They are about clarity.

Patient Feedback Therapy: Why Your Voice Matters

Patient feedback therapy is built on a simple but powerful idea:

The client is the best source of information about whether therapy is helping.

Robert Lueger found that client satisfaction with progress is a better predictor of therapy outcome than therapist judgment alone (Lueger, 1998).

When clients frequently provide structured feedback:

• Therapy becomes more collaborative.
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• Outcomes are improved

Feedback is considered information, not an evaluation at Heal-Thrive.

Why This Matters to Clients

Without structured feedback:

• Therapy may feel confusing
• Peasy progress can remain unobserved
• Problems may remain for a longer period

With ROM and feedback-informed treatment:

• Progress is observed
• Expectations are realistic
• Adjustments occur earlier

This practice is consistent with Carey’s Method of Levels, which focuses on allowing naturally occurring changes rather than mandating insights or solutions (Carey, 2006).

A Real Client Example

One client mentioned feeling “stuck” even though sessions seemed productive.

Data from ROM indicated that emotional distress was lessening, but relational functioning was slower to improve.

This realization brought about a change in focus.

Within weeks, the client observed changes outside of therapy as well.

Perhaps without this controlled observation, the change never would have occurred.

How Clients Can Track Their Own Progress

While tools like ROM and patient feedback therapy are invaluable, you don’t need to wait for formal assessments to notice change. You can monitor your own progress in therapy using some direct, research-based techniques.

It’s a good idea to follow these steps:

1. Maintain an Emotion Journal

• Moments of noticing strong emotions
• Your reaction
• Any patterns you notice

In time, changes will be observed:

• Feeling emotions sooner
• Lower level of intensity
• Improved regulation

Even small steps, like breaking the habit of reacting to situations, show the significance of taking action.

2. Behavioral Changes Tracking

Weekly Questions to Ask Yourself:

• Have I reacted in any way that is not typical of me?
• Have I set or maintained a boundary?
• I practiced and applied new coping skills independently.

Writing down these observations will enable you to track the progress you are making.

3. Reflect on Relationships

Psychotherapy may also work in an indirect manner through the modification of how the individual relates to others. Notice:

• Are arguments shorter or less intense?
• Do you feel more heard or understood?
• Are you practicing healthier communication? The improvements in relations rank amongst the most positive indications of the success of therapy.

4. Analyze Your Thoughts and Self-Talk

Self-awareness plays an important role.

• New information about patterns
• Instances of self-compassion or patience
• Decreased automatic negative thoughts

Carey (2006), as well as Weiss (1993), has emphasized the importance of observing patterns manufactured internally.

5. Seek Feedback from Trusted Individuals

In other cases, people around you will notice changes before you are aware of them:

• Have you ever received any comments from a friend or companion concerning your activities?
• Are colleagues recognizing more tranquil behavior in work situations?

Both external observation and internal reflection are needed for a complete understanding.

Self-Assessment Questions After Every Session

After each week or session, the question to ask is:

1. Have I noticed some kind of subtle change in emotion or behavior?
2. Did I approach a tough situation in a different way than I did before I began
3. Did I learn something new about myself?
4. Did I feel safer or more understood in sessions?
5. Have I applied insights in real life?

These answers provide a means to measure progress, despite it being incremental and hence appearing to be so.

Troubleshooting Common Therapy Struggles

Even well-motivated clients will experience roadblocks along the way. Therapy is never a straight line. This is how to deal with bumps in therapy:

1. Feeling Worse Before Feeling Better

Temporary emotional flares occurring during the first few

• Keep in mind the idea of the “healing crisis”, where increased awareness may actually feel like a kind of
• Action: These feelings should be expressed with your therapist, and often represent the extent to which intensive therapeutic work is taking place.

2. Plateaus and Stopped Progress

Sometimes, nothing seems to happen for weeks.

• this is normal; the changes are building up inside, despite minimal changes on the outside.
• Action: Utilize routine outcome monitoring (ROM) or session checklists to track small victories.

3. Avoidance or Resistance

• Skipping sessions or avoiding topics is common.
• Action: Discuss avoidance patterns; therapists can help make difficult content more manageable.

4. Weak Therapeutic Alliance

If you feel that you are misunderstood, judged, or that you are :

• Take it up with your therapist.
• teamwork increases both emotional and behavioral developments.

5. Unrealistic Expectations

• Hope for overnight solutions can breed disappointment.
• Action: Emphasize progress on a small scale that has to do with emotional or behavioral shifts, as opposed to just “feeling better.”

6. When to Reassess Therapy

There may be times when therapy is not completely successful:

• Progressive deterioration of symptoms
• Old patterns despite improved efforts Being “stuck” or trapped

Action:   Discuss changes, think about methods for feedback, or look for other strategies.

Key Takeaways

There will be setbacks, which are not indicators of success or failure. Providing systematic monitoring, communicating effectively, and setting realistic goals ensures that progress stays on target.

Defining Real Success in Psychotherapy

By this time, you are aware that progress may not be linear or observable. But how can we actually determine whether therapy is effective?

A positive result in therapy would be recognized by changes in functioning, rather than changes in feelings at the end of a therapy session.

1. Emotional Resilience

These include:

Manages strong emotions without feelings of overwhelm

• Emotional awareness and naming of emotions
• Handling discomfort and being able to function effectively

Emotional resilience is a stronger predictor of positive outcomes than mood elevations.

2. Behavioral Improvements

Behavior change represents irrefutable evidence of progress.

• Practicing coping strategies for real-life situations
• Healthier communication and boundaries
• Breaking Repetitive Negative Patterns

Every step, no matter how small, including the step of taking a moment to think before

3. Stronger Relationships

One of the most noticeable consequences:

• It is expected that there will be fewer instances of conflicts
• Feeling better understood and listened to
• More genuine connection and assertion

Improvements in relations typically indicate that therapeutic change is occurring.

4. Enhanced Self-Awareness and Insight

• Pattern recognition in thoughts, feelings, and behavior
• Passing from automatic responses to informed decisions
• Increased capacity for reflection and learning from experiences

Insight, as a facilitator of long-term changes, was described by Carey in 2006 and by Weiss in 1993.

5. Consistent Progress Outside Sessions

True success manifests itself in real life, not just in therapy:

• Differing in stress response
• Using new skills properly
• Observing visible progress at work or within the family and/or personal environment There are routine outcome monitoring processes and patient feedback therapies that enable this progress to be tracked, which motivates the person.

Key Takeaway

Associated with the goal of successful therapy are emotional regulation, behavioral change, relationship enhancement, and the development of enhanced levels of self-awareness.

Take Action: Make Your Psychotherapy Work for You

By this point, you have a plan; you know what success looks like, pitfalls to watch out for, and ways to monitor your own improvement. What’s next is taking action.

1. Schedule a Session with a Trusted Therapist

If you’re feeling stuck, overwhelmed, or unsure:

• Contact a trained therapist who has access to evidence-based methods.
• You can also ask if there is outcome monitoring or feedback-informed treatment available. This will help to monitor your level of improvement.

2. Begin a Personal Tracking System

Even outside therapy:

• Maintain an emotions journal
• Monitor behavioral changes
• Consider the patterns you see in relations with others and self-talk

It provides you with information about the outcome of psychotherapy and it assists with the maintenance of motivation.

3. Download a Practical Guide from Heal-Thrive.com

This guide will assist you in the following ways:

• Understand signs of progress
• Learn helpful exercises in monitoring emotional and behavioral shifts
• Act on research findings and strategies without delay

4. Make a Commitment to Open Feedback

Therapy is most beneficial when:

• You speak openly about your experience
• You talk about the uncomfortable moments, the setbacks, and the
• You actively cooperate with your therapist

Remember, feedback equals data, not judgement. It propels growth.

5. Celebrate Small Wins

Micro-changes matter:

• “Every micro-change counts. A calmer reaction. A boundary set. A negative pattern avoided.”
• Progress is gradual, yet cumulative.

Conclusion Thought

Actual progress in therapy is not determined in a single therapy session, but by emotional strength, behavior, improved relationships, and self-insights developed over time. You are in charge of your path and your development. Take control of your own development and be prepared to ask for help when you need it. Your therapy can, and should, help you Heal & Thrive.