Five Signs Therapy is Working

Therapy is a process. I should get that tattooed on my head.

My favorite poster in one of my offices says, “I’m not telling you it’s going to be easy, I’m telling you it’s going to be worth it.”

I’ve had clients not even notice that poster until about three or four months in. Then they smile and say something like, “Truth.”

My ideal therapy client has trauma, low self esteem, and likely some anxiety and depression to top it off. Through therapy and often medication management combined, we explore painful memories which have led to current behavior and communication patterns which lead to challenges in life. The point of therapy is to recognize unhealthy behavior patterns and undo them.

This is generally how I know therapy is helping my clients about six months in.

  1. They are now happy to see me and actually come into my office smiling. The first couple months when we really get into heavy work clients will come in looking angry and irritated and tell me that they really didn’t want to come to see me because it’s so damn draining and they don’t know why they put themselves through this every week. I calmly smile and congratulate them for coming and promise to go easy this week. After two-six months of this heavy work though the load should start to lighten. Clients may start to look forward to seeing me because they are starting to feel better. They are recognizing positive changes and we may even be able to cut down to every other week. This is a gross generalization, but I’d say most people could start noticing improvements around the six month mark.
  2. Whatever brought them to therapy, when I ask them how it’s going, is not even on their radar. It could have been a break-up, ongoing stress in their marriage, stressed relationships with parents or children, addiction, work stress. Whatever was identified as the initial problem has taken a back seat because the work they’ve done on themselves has started seeping into other aspects of their life in a positive manner.
  3. They’ve achieved a goal. Perhaps when they started seeing me they didn’t know how to drive as a young adult (it’s more common in these days of Uber than one might think) or they didn’t have a passport, they were flunking out of school or not even enrolled, or they had never filed taxes. Intense tasks that are part of life that had been continuously put on the back burner or seen as unattainable. Now six months later perhaps they are enrolled in driver’s education classes or they have their permit, or their grades came up to B’s this semester, or they are enrolled for next year. Usually not all of these things, but at least one area has seen a large step taken.
  4. Relationships with others are noticeably improved to my client and to the people around them. Or on the flip side for the first time in their lives they have cut a toxic person out and it feels good to them. If a client is doing the work inside and outside of our sessions then they are seeing chronic unhealthy communication patterns and working actively on changing them. This is being modeled within therapy and being utilized in their every day lives.
  5. My client says they feel better and the person sitting in front of me today is a far cry (sometimes literally) from the person who sat there six months ago. That’s not to say our work is done. But the client feels and presents as lighter. I can challenge them more intensely on behaviors and communications without them falling apart. I can push them more in session and they can push themselves more outside of session. Then comes that glorious moment when I say, I think we can cut down to every other week.

This is probably the only job where the goal for the therapist is to be “Fired” by our clients. The goal is for a person to improve so they need less treatment, and more time in their healthy and happy lives. Therapy is not easy and anyone who has been through it can tell you that it downright sucks at times but the light at the other end is gratifying for both the therapist and the client.

The Power of Hope

Recently a client said to me they read something online, “Are you still fighting your demons or have you embraced them?” It was disturbing to my client because they realized in many ways what they thought was coping was actually a defense mechanism to continue maladaptive behaviors.

I am not a DBT therapist, but there are many concepts of DBT that I appreciate and pass onto clients. One of which is embracing the opposite behavior. When one feels they can’t get out of bed dialectics would say, do exactly the opposite of that behavior. Get out of bed. Commit to getting out of bed. It may be painful but that is an aside. Focus only on getting out of bed.

We all have demons and we all have dark holes that we wish we could just crawl into and never leave. What is it that allows you to crawl out of the dark and into the light? I have seen time and again in my clients that hope is sometimes all that get us through each minute and each hour.

What is hope? “A feeling of expectation for a certain thing to happen. A feeling of trust. A feeling of desire for something to happen.”

I would add to this definition and say, a feeling of trust that something we desire will happen. Human beings often have trust in the world or fate or God or whatever higher power you believe in, that something better will come. That the depression will ease, the anxiety will improve, that love will enter dark spaces.

Therapy unfortunately tends to lead clients through dark spaces, but it is with the intention of reaching the light on the other side. Harnessing hope through therapy can be incredibly powerful to witness and experience. I always tell clients, it may get worse before it gets better, but it will get better. I’ve had people tell me they hate coming to see me every week, but they still show up. Because on the other end, they do see improvement in their lives.

The idea of therapy is not just to work through problems and past trauma. The goal of therapy is to heal and to feel hope that today will be a better day.

To quote one of my heroes, Martin Luther King Jr.

“If you lose hope, somehow you lose the vitality that keeps life moving, you lose the courage to be, that quality that helps you go on in spite of it all. And so today, I still have a dream.” 

I like to think of therapy as helping guide people back to their own vitality and courage. Hope lives in us all, some people just need help accessing it.