There are two main challenges in determining whether therapy is working: first what exactly does therapy working mean for you as an individual and secondly how can this be measured. The challenge of course is different people want different things. Some people want to escape depression, some people fight anxiety, and there are others who want something more specific, to have more friends, or to cope with a difficult boss, or to make a key decision.
You could possibly argue, however, that what unites all clients is they want something to change, and thus this notion of change can be what is measured. Of course unlike the medical model, testing for emotional or psychological change is far more problematic. It was relatively easy to test if a vaccine for measles worked; if you take the vaccine, then get measles, it hasn’t worked. But there are no medical indications for depression or anxiety, or any of the range of emotional disorders.
The response of researchers and especially CBT, the model most associated with evidence-based practice, was the use of what are known as self-assessment or self-evaluation forms, such GAD-7, PHQ-9, CORE-32. These typically consist of a series of questions which include what is known as a ‘weighting’ element. For example, from the GAD-7, ‘In the last two weeks how often have you felt nervous?’, and you select from four options, ‘not at all, several days, more than half days, every day’. These questions will be asked at regular intervals, and the therapy will be classified as effective if you report your anxiety is occurring less frequently.
In theory this is a reliable measure of the effectiveness of therapy. But there are a few caveats that can be difficult ignore. How do we know the therapy is working, as opposed to patient getting better naturally? How reliable is self-valution? Is there any influence from the therapist, and a willingness to comply with the programme? And additionally some clients feel if their symptoms aren’t improving it is because of their failure to implement the techniques as opposed to accepting that it simply isn’t working for them. And for others these self-evaluations forms are arbitrary and have little relevance to you as an individual.
In many ways the setting of goals avoids some of these difficulties. You set what you want from the therapy and then after a fixed number of sessions you can judge whether this has worked. Some therapists and some modalities, for example CBT, believe it is important to set goals within the first few, or even the first session, and that this will be the focus for the remaining sessions. A client might arrive with a goal to be more social. And the goal may be to meet up with at least one person over the weekend. And of course part of the therapy could include exploring any anxiety that stems from meeting others, some sort of behavioural desensitisation with exposure to regular group-based activity, exploration of roots of social isolation, for example patterns learnt during childhood, or unconscious feelings of inferiority, or repeated negative thoughts about others judging you.
The challenge with this approach is that often the changes we say we want we actually don’t. Perhaps during therapy we realise we actually prefer time on our own, have an introverted personality, and thus the thrust of therapeutic intervention would work more is it is based is acceptance of who we are; and that we don’t have to go to every party to be liked, and then the work is about building self-esteem.
With regards evidence-based practice however it can be difficult to quantify how a goal has been achieved. Unlike the self-evaluation forms it can make it difficult to have harmonised data as each person's goals will be different, and also each person will have a different idea of how well their goal has been met.
The bottom line is despite all the research there is really very limited credible scientific evidence to suggest therapy works and also that setting goals, or indeed any other approach, is better than others. But then again there’s no evidence to suggest is isn’t working either. So the question may be why is it important for you to see evidence therapy works. Are you someone who is results based, who needs clarity, avoids confusion and finds emotions overwhelming ?
Ultimately it all comes down to you and how you feel. If you think it’s working, if you think you’re getting something out of it, continue, if not stop. For more information on leaving a therapist, read the article ’When to quit therapy’
The following articles are written to help you understand what is this process of
therapy, what actually happens in the room, from finding a therapist to leaving one,
from understanding what a counsellor can help you with and what they can't.
It includes topics on the different types of therapy, to couples therapy, and about the role of diagnosis in mental health.