Who Gets to Decide If Therapy Is Working?

When people begin therapy, they are often looking for relief from something painful. They may be struggling with anxiety, depression, grief, relationship difficulties, trauma, stress, or a persistent sense that life is not meaningful.

Naturally, one question follows: How will I know if therapy is working?

At first glance, the answer may seem obvious. If symptoms improve, therapy is working. If depression lifts, anxiety decreases, or panic attacks become less frequent, most people consider that meaningful progress.

And they would be right. Reducing emotional suffering is one of the most important goals of psychotherapy. Yet there is a deeper question worth considering. Who gets to decide what success looks like for you?

Who Gets to Decide Whether Therapy Is Successful?

For researchers, successful therapy is often defined by measurable changes in symptoms and functioning. For insurance companies, symptom improvement is frequently an important consideration because treatment is generally funded to address identified mental health concerns. These measures serve important purposes. They help researchers evaluate treatments, compare approaches, and determine whether care is effective. They also help insurers determine whether treatment remains medically necessary.

At the same time, the way therapy is measured is influenced by the systems in which therapy takes place. For some people accessing care through insurance, the definition of progress may be shaped, at least in part, by what can be documented and measured, often through changes in symptoms and functioning. Those measures are important, but they represent only one part of the picture.

At Medipsy, we recognize and work within these realities. We understand that insurance requirements can place limits on how progress is defined and documented. Within those limits, we work collaboratively to focus on the changes that matter most to you.  Your therapist can help you make meaningful use of the financial support available while staying connected to your personal goals and what you hope to gain from therapy.

What do clients often want?

One person may come to therapy hoping to reduce panic attacks. Another may want to improve a relationship, recover from a painful loss, become a more present parent, develop greater confidence, or better understand patterns that have shaped their life.

These goals are not less important because they are harder to measure.

In fact, research increasingly suggests that many people define successful therapy in ways that extend beyond symptom reduction. A recent study by Lam and colleagues examining recovery from depression among young adults found that people often described recovery as involving hope, meaningful relationships, a stronger sense of identity, pursuing goals, and being able to participate more fully in life.

Similarly, the Psychotherapy Networker article The Tyranny of Time draws on psychotherapy outcome research, including the work of Michael Lambert and colleagues, to highlight an important tension in the field. While symptom change is important and easier to measure, many of the outcomes people value most—such as greater self-understanding, improved relationships, self-acceptance, and living more authentically—may develop gradually and are not always captured by traditional measures.

This does not mean symptoms are unimportant. For many people, reducing anxiety, depression, trauma symptoms, or emotional distress is a central goal of therapy.

Rather, it means that symptom relief is often part of a larger picture.

The Importance of Collaborative Goal Setting

If successful therapy is ultimately defined by meaningful change in a person's life, then goals cannot simply be prescribed by a therapist or inferred from a diagnosis. They need to be developed collaboratively.

At the beginning of therapy at Medipsy, clients and therapists work together to identify the concerns that brought someone to treatment and the changes they hope to achieve. Sometimes these goals are straightforward: reduce panic attacks, improve sleep, or manage symptoms of depression. At other times, goals are broader and more personal, such as improving relationships, building self-confidence, finding direction in life, or learning to navigate emotions more effectively.

Importantly, these goals often evolve.

If you begin therapy because of overwhelming anxiety, you may eventually discover that their deeper concerns involve perfectionism, self-worth, or difficulty setting boundaries. Another person might start treatment during a crisis and later become interested in questions of identity, meaning, or personal growth. These shifts are not signs that therapy has lost direction. They can be signs that therapy is helping clients understand themselves more fully.

For this reason, effective therapy involves regularly reviewing goals and discussing whether treatment continues to focus on what matters most to you. The therapist brings clinical expertise and knowledge of evidence-based interventions. You bring expertise about your own values, priorities, relationships, and lived experience. Meaningful goals emerge by drawing on both perspectives.

How Do We Monitor Progress?

At Medipsy, we believe that both objective measurement and personal experience are important sources of information. All our therapists have access to the Outcome Questionnaire-45 (OQ-45), one of the most widely researched measures of psychotherapy progress. Developed through the work of Michael Lambert and colleagues, the OQ-45 helps track changes in psychological distress, interpersonal functioning, and everyday life functioning over the course of treatment.

Research has shown that routinely monitoring outcomes can improve treatment effectiveness by helping therapists and clients identify when progress is occurring and when adjustments may be needed. The OQ-45 provides useful information about patterns of change that might otherwise be overlooked.

At the same time, no questionnaire can fully determine whether therapy is meaningful for a particular person. A measure can show improvement in symptoms while a the client still feels disconnected from their values or goals. Conversely, someone may be making profound changes in their relationships, self-understanding, or sense of purpose before those changes are fully reflected in symptom scores.

For that reason, we believe that outcome measures are most useful when they are part of a larger conversation. They inform treatment, but do not replace ongoing discussions about what you hope to achieve and whether therapy is helping.

How Will I Know If Therapy Is Working?

Sometimes progress is easy to recognize. People may sleep better, feel less anxious, experience fewer depressive symptoms, or find it easier to manage daily stress.

Often, however, progress appears in more subtle ways. You might notice that you recover more quickly after setbacks, communicate more openly, establish healthier boundaries, or respond differently in situations that once felt overwhelming. You might become less self-critical, more self-compassionate, or more willing to take risks that align with their values.

People tend to describe progress not as a dramatic breakthrough but as a gradual shift in how they relate to themselves, their emotions, and the people around them.

What If I'm Still Anxious Sometimes?

One common misconception is that successful therapy should eliminate anxiety, sadness, or other difficult emotions altogether.  But psychological health does not mean never experiencing distress. Anxiety, grief, disappointment, uncertainty, and sadness are a part of being human. The goal of therapy is not to eliminate these normal experiences.

Instead, therapy can help you develop a different relationship with these human difficulties. Difficult emotions may become less overwhelming, less controlling, and less likely to dictate important decisions. Many people find that they are increasingly able to pursue meaningful goals and maintain important relationships even when uncomfortable emotions are present.

Life continues to bring challenges, losses, transitions, disappointments, and uncertainty. Recovery is feeling more capable of navigating these inevitable difficulties. If you become more resilient, more connected to others, and more confident in your ability to respond to challenges without becoming overwhelmed by them, that might be success for you.

A Broader View of Success

At Medipsy, we care deeply about symptom relief because we know how much suffering anxiety, depression, trauma, and other mental health concerns can cause. We also recognize that meaningful change looks different for different people.  There is no single definition of successful therapy.

Research findings, outcome measures, diagnostic criteria, and insurance requirements all provide valuable information. However, none of them can fully determine what matters most to you. That is why conversations about goals are not limited to the first session. They continue throughout therapy, evolving as people gain insight, encounter new challenges, and clarify what they want for their lives.

Ultimately, successful therapy is not simply about reducing symptoms. It is about helping people move toward lives that feel more connected, meaningful, authentic, and aligned with their values. The person best positioned to determine whether that is happening is the person whose life is changing - you.

References

Lam, J. A., Mulvaney-Day, N., Dobbins, A. R., Aldis, R., Pasricha, I., Amonoo, H. L., & Progovac, A. M. (2024). What outcomes matter in recovery from depression? A pilot study of young adults.

Lambert, M. J. (2007). Presidential Address: What We Have Learned From a Decade of Research Aimed at Improving Psychotherapy Outcome in Routine Care. Psychotherapy Research, 17(1), 1–14.

Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th ed.).

Miller, S. D. (2024). The Tyranny of Time. Psychotherapy Networker.