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How Do You Know Therapy Is Working/ David McMillian, LPC, LMFT

Posted by: admin - October 13, 2014

Dear David,

Iím 35 years old and have recently started to see a therapist after many years of struggling with anxiety and depression.  I donít have terrible symptoms, but Iíve grappled with them now for many years. I first talked with my primary care doctor, and we decided together that I should seek therapy before he prescribes an antidepressant medication. He explained that, even though he has many patients taking antidepressants, his policy is for the patient to be seeing a counselor in addition to the medicine, which Iím comfortable with.  My question for you is how will I know whether counseling is working for me, and how will I know, if I should start taking meds, that itís not the pills alone working? Also, how can I gauge progress along the way? Iíve met with my therapist three times now and plan to continue weekly.  The counselor says she uses a method of therapy that focuses most on my current thoughts, feelings, and behavior, and not so much on dredging up the past. I always thought you had to talk a lot about the past in therapy, so is this OK?

Gauging Therapy

 

Dear GT,

Iím very glad you have selected the steps youíve already taken, especially talking with your family doctor, and beginning therapy.  It takes a lot of courage to start the process, so congratulations.  The specific question that youíve asked is rather complex, individualized, and hard to generalize, but IĎll take a stab at it. Therapy can be uncomfortable and exhausting work, and like other things in life, what you get out of it is often determined by what you put into it. You know how it feels when youíve worked very hard at a project at work or home, and even though you may be very weary, there is a sense of accomplishment and satisfaction?  Oftentimes, I think we have that kind of overriding feeling when therapy is progressing and succeeding; in other words, weíre growing.  It is important to point out however, that frequently real growth can be painful. As your therapy progressesí, often starting an antidepressant provides added strength to push forward, perhaps dealing with issues youíve struggled with for years, so perhaps another visit to your doctor is in order. The truth is that for mild to moderate depression, the use of antidepressants is largely a personal decision, so consult your doctor and listen to his advice. 

 

There are some widely used measures for depression and anxiety, so you may want to ask your therapist if she uses any particular measure.  If she does, taking that measure now early in your counseling could become a baseline, and you could perhaps take the same measure several weeks from now to determine your progress. Sometimes others who are close to us may pick up on subtle changes and growth even before weíre consciously aware of it, so be aware of what close friends, colleagues, and family share with you. 

 

As for your counselor telling you she focuses on the present, be aware that this does not necessarily mean that your past will be ignored but instead you will be emphasizing how you are feeling in the present, and the present is where we live now.  The old image that many of us have of lying on a therapistís couch talking about our mother is just a clichť. Our past and our future need to relate to the here and now, so place trust in your therapist and in the therapeutic process. There's really no single method for determining if therapy is working, and progress looks different for everyone. You might even find it helpful to consult journals, emails, or text conversations you sent prior to therapy and compare them to things you've written since therapy, which may also give insight into how you're changing.


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