Over the years, I’ve often found myself wondering “Is this even helping?” Sometimes it’s hard to tell. Despite five years of therapy, there’s a part of me that still expects therapy to magically fix everything. But the truth is, therapy doesn’t make your problems disappear, especially not right away. So if you can’t judge based on actual improvement, how are you supposed to tell if it’s helping? And how can you tell when it’s not helping? You need to know how to spot the Good Signs and Red Flags.
Even if therapy is going extremely well, you probably won’t come skipping out of the office after each session. Instead, you might notice these signs:
- You’re learning.
The biggest sign that therapy is helping is that you’re learning something. This doesn’t necessarily have to be some big “breakthrough.” Sometimes it’s as simple as realizing what your main coping mechanisms are and how much they’re actually helping you. You can learn more about how you’ve developed your current patterns of thought, any potential triggers for your anxiety, psychotic episodes, mood fluctuations, etc., the biases you hold about the world and yourself, and plenty more. Not all of your learning even has to be about you. If you’re learning more about the mind in general, healthy interpersonal relationships, and coping mechanisms, that’s a great sign that therapy is helping too.
- Things are getting (a little) worse.
This “good sign” is a bit tricky, because it’s only a sign that therapy is working if things are getting worse in a very specific way. Obviously if we’re in therapy, we want things to get better, not worse, but sometimes the best way to fix something is to take it apart, find the broken bits, give them lots of love and attention and care, and then put it back together. The problem is, taking something apart means it goes from sort of working to not working at all. If you feel like you’re finally acknowledging some really tough stuff in therapy, and it feels good in a really depressing way in the moment, but the dysfunction in your life is only getting worse, that might be a good sign. It means you’re finally dealing with some things that have been causing troubles for you. However, if you feel frustrated in therapy, like you aren’t getting anywhere or your therapist isn’t listening, or if therapy is hugely triggering for you and you feel completely unequipped to deal with the emotional fallout, this is not a good sign. See Red Flag #2.
- You feel validated.
If you walk out of therapy feeling just as hopeless and depressed as when you walked in, but you walk out with a sense of being heard, then therapy is probably helping. Even if your therapist didn’t convince you that everyone doesn’t hate you, if they listened and seemed to understand how certain you are that everyone hates you, that can make a huge difference. The people who love us are not qualified therapists, so when we express thoughts that might not make sense to them, especially self-deprecating thoughts, they might brush them off or even get upset with us. If you go to therapy and feel like those thoughts are finally being heard and taken seriously, this can help in unimaginable ways. Even if you don’t necessarily feel much better, don’t underestimate the power of validation.
The signs that therapy is going poorly can be just as confusing and counterintuitive as the signs that therapy is going well, so here are my top three therapy Red Flags. These aren’t necessarily signs that you need to change therapists right away, it just means you may want to reevaluate your therapy experience and make sure you’re getting what you need. But if you do decide it’s time to move on, I have a few words of wisdom there as well. I recently decided to “break up” with my therapist, so I thought I’d write a post on how to go about that, coming out next week. But for now, know the red flags:
- You’re being gaslighted.
The term “gaslight” means to undermine someone’s confidence in their reality, and it should never happen in therapy. A therapist could gaslight you by telling you your symptoms are “all in your head,” or that you’re causing them for attention; they could also gaslight you by denying what was said in a previous session, by you or by them, in a way that makes you question your own recollection of the events. Unfortunately, those of us dealing with mental health obstacles are especially vulnerable to gaslighting because our realities are constantly shifting and we typically have cognitive difficulties, often including memory troubles. If your therapist insists that you’re remembering things incorrectly, start recording all of your sessions. This will help you determine if your memory is causing issues or if your therapist is gaslighting you. Other forms of gaslighting like not taking your issues seriously can cause a huge breach in trust and may actually deter you from going back to see the therapist. That’s a good instinct, because you don’t want to open up to someone who clearly isn’t open to what you have to say, but don’t let one bad therapist stop you from getting help. If a therapist says something is “all in your head,” they are, frankly, terrible at their job, and it isn’t true. I understand how hard it is to finally reach out, only to have your worst fears confirmed, but I hope you’ll try again, because there are wonderful therapists out there who want to help, and you deserve help.
- Things are getting (a lot) worse.
Sometimes things get worse before they get better. But other times, things just get worse. Therapy should never make things worse without the benefits outweighing the costs, and this balance is constantly shifting. Some weeks, it might be more important for you to investigate how your childhood has affected you, even though it brings back a lot of feelings of loneliness or anger and impairs your quality of life. But other weeks, for instance, weeks where you have to spend a lot of time around your family, those discussions might not be so helpful. If your therapist insists on talking about topics you’ve said you’d rather not discuss that day, that’s a red flag. Even if they believe it would be more helpful to investigate your feelings on a particular subject, it’s more important that they listen and respect your needs. Another red flag in this arena is being triggered by therapy in an unhealthy way. Some specially trained therapists purposefully trigger trauma memories in order to help you work through that trauma, but if you haven’t expressly stated that you would like to do this, or if your therapist isn’t trained in this type of therapy, this is a red flag. Triggering traumatic memories can be incredibly painful, distressing, and potentially dangerous, and you shouldn’t have to go through that without a solid coping gameplan.
- You’re incredibly anxious before each session.
While this may be somewhat normal in the beginning, it shouldn’t continue for months. If you’re anxious before each session, your needs are likely not being met. Your therapist may not be conducting sessions in a way that’s helpful for you, things may be moving too quickly for you, you might not be ready to open up as much as your therapist seems to expect, or you might be worrying about what you’re “supposed” to do or say in therapy still. All of these come back to a lack of communication between you and the therapist. They should be facilitating this communication and making it as easy on you as possible, but you also have a responsibility to share your needs with them, even when it’s difficult. It sounds so simple, but many of us forget: you can’t have your needs consistently met if you haven’t communicated what those needs are. If you feel that you have shared your needs with your therapist and things aren’t improving, it might be a bad fit, and it may be time to move on to another therapist.
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Have more questions about starting therapy? Totally understandable. Please feel free to ask your questions in the comments below, send me a message via my contact page, send me an anonymous ask on my tumblr, or just call/text/email me if you know me in real life. I mean it when I say I think everyone can benefit from therapy, and I want to help.