You are showing up. What is changing?

You attend your appointments. You talk about difficult things. Sometimes you leave relieved; sometimes you leave tired or unsettled.

But when someone asks whether therapy is helping, you are not sure what to say.

Perhaps you understand yourself better. You like your therapist. You have had sessions that felt important. Still, you want to know whether the work is making a difference beyond the appointment.

That is a reasonable question to bring into therapy.

Begin with what you hoped would become different

“Feel better” is an understandable goal, but it can be difficult to evaluate.

What would feeling better allow you to do? Sleep more comfortably? Speak during disagreements? Enjoy time alone? Receive affection without immediately becoming suspicious?

Choose a few examples that matter to you. They need not capture everything you want from therapy.

You might say, “When someone sounds disappointed, I want to be able to listen without immediately apologizing.” Or, “I want a difficult conversation to stop occupying the rest of my week.”

These examples give you and your therapist something recognizable to revisit.

Look for changes in ordinary moments

Progress sometimes becomes apparent in a situation that used to unfold predictably.

You notice anger before agreeing to something. You ask a question instead of assuming rejection. You recover from an upsetting interaction sooner. You can feel sadness without deciding that it means something is wrong with you.

In The Satir Model, congruence includes acknowledging your inner experience while honoring yourself, the other person, and the context. Greater freedom to communicate from that position can be one meaningful sign of change.

Ask yourself: Am I more able to recognize what I experience and choose how to respond?

You can still have difficult feelings while gaining more room to live and relate as you intend.

A meaningful session needs a connection to your life

An emotional session can matter. So can a quiet one. The intensity of the appointment, by itself, does not establish its effectiveness.

With Deep Brain Reorienting (DBR), for example, you might notice changes in bodily responses during the work. It is also useful to examine what happens later when you encounter the situation being addressed.

Does the same tone of voice still produce the same fear? Does a reminder remain overwhelming? Has anything changed in your ability to stay present?

A randomized controlled trial of Deep Brain Reorienting for PTSD assessed symptoms after treatment and again three months later, finding improvement compared with a waitlist. The researchers evaluated change over time rather than relying on how individual sessions felt.

Your own review can similarly connect the experience of treatment with its effects afterward.

Can you talk honestly about the work?

A meta-analysis of the therapeutic relationship and psychotherapy outcomes found a consistent association between a stronger working relationship and better outcomes.

That does not mean liking your therapist guarantees improvement. Consider whether you can discuss the purpose of therapy, the way you are working, and concerns about either.

Can you say, “I don’t think that helped”? Can you correct an interpretation? Can you tell the therapist that you feel misunderstood?

Your therapist may see something differently. What matters is whether the conversation helps both of you understand the difficulty and decide how to respond.

Make progress a regular conversation

You do not have to wait until you are considering leaving to ask how treatment is going.

A meta-analysis of progress feedback in psychotherapy found a small average benefit for symptom reduction when progress information was fed back during treatment. Tracking is useful when the information informs the work.

That might involve a questionnaire, brief notes, or revisiting specific examples together. Ask your therapist what they recommend and how the information will guide decisions.

If little is changing, discuss the approach, pace, goals, and whether other assessment or care is needed. If you are becoming persistently worse or struggling more with daily functioning, bring that forward promptly. Distress should not automatically be treated as evidence that therapy is working.

A useful review can begin with three questions: What has changed? What remains difficult? What will the next phase of the work address?

You deserve a thoughtful conversation about all three.

About the Author

Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the experiential therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.

This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.

This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.

These blog posts are drafted with the support of ChatGPT. All posts are reviewed and edited by the author for accuracy, and consistency with the values of the author and this practice.

References

Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir Model: Family Therapy and Beyond. Science & Behavior Books. Chapter 4, pp. 66, 68. https://bit.ly/SatirModel1stEd

Kearney, B. E., et al. (2023). “A Randomized Controlled Trial of Deep Brain Reorienting: A Neuroscientifically Guided Treatment for Post-traumatic Stress Disorder.” https://pubmed.ncbi.nlm.nih.gov/37581275/

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). “The Alliance in Adult Psychotherapy: A Meta-analytic Synthesis.” https://pubmed.ncbi.nlm.nih.gov/29792475/

De Jong, K., et al. (2021). “Using Progress Feedback to Improve Outcomes and Reduce Drop-out, Treatment Duration, and Deterioration: A Multilevel Meta-analysis.” https://pubmed.ncbi.nlm.nih.gov/33721605/

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Taking Care with Anne Lindyberg

What does it mean to take care of yourself? Join Anne for the first Taking Care with Anne Lindyberg, a free weekly interactive livestream exploring presence, being yourself, and caring for yourself and others.

Monday, October 19, 2026, at 6 PM Central, live on YouTube.

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