How to Know if Therapy Is Working

If you’ve recently started therapy, you may be wondering how to tell whether it is working for you. Given the emotional investment, as well as that of time and money, this is an understandable thing to be thinking about. 

Many therapists would say that it can be difficult to answer this question because the definition of “working” varies from person to person. But there are tools and strategies clinicians employ — as well as conversations you can have with your therapist — that can help you better understand the progress you’re making.

As a therapy practice, we believe that you deserve to meet your goals and feel relief from what brings you to therapy as quickly as possible — all so you can feel better in your daily life. One of the most reliable ways to do this is by ensuring clients are matched with the best therapist for their needs and preferences. That’s why care at Two Chairs begins with the matching process, which combines clinical judgment from a trained expert with our matching algorithm to match clients with the right therapist for them. 

After you’re matched with a skilled therapist, they will lead you through a collaborative discussion about your goals for therapy and how you’re going to track your progress. One of the key tools we use for tracking progress at Two Chairs is something called measurement-based care.

What is measurement-based care?

Measurement-based care (MBC) is a key tool for empowering clients to take ownership over their care, and make sure they’re getting what they need out of therapy. Measurement-based care has a few components, one of which is mental health check-ins: short surveys you fill out before each therapy session, designed to help you and your therapist get a better sense of how you’re doing. The questions touch on symptoms of things like anxiety and depression, your quality of life, and your relationship with your therapist. 

The information you share in these check-ins helps identify what’s working in therapy — and what may not be — so you and your therapist can track progress toward the goals you’ve set together, and personalize your collaborative treatment plan. It’s important that therapy happens in an environment that allows for any necessary adjustments to ensure you’re feeling well supported, and feeling better as soon as possible. Yet another benefit of MBC is that it ensures that you’re not a passive recipient of therapy — instead, you’re empowered to be engaged in your own care, which has been shown to help people reach their goals more quickly.

How does measurement-based care help you understand if therapy is working?

There are many benefits of MBC: First, it can help you and your therapist get a better sense of the problems you’re coming to care with, and help you and your therapist set goals around what it will look like to get better. Second, it gives your therapist a consistent source of information about how you’re doing which, over time, can show how far you’ve come from when you started therapy.

You, as the client, also get feedback from these check-ins in the form of mental health snapshots. And finally, MBC is a way for you to feel engaged in your own care. By going through the exercises of understanding and reflecting on your own progress, both on your own and with your therapist, you’ll become an active participant in reaching your mental health goals.

Responses from mental health-check ins

The mental health check-in includes questions from three standardized, clinically validated assessments of anxiety, depression, and quality of life. These are called the Generalized Anxiety Disorder GAD-7 (for anxiety), the Patient Health Questionnaire PHQ-9 (for depression), and Mental Health Quality of Life MHQoL (for quality of life). These three surveys, when used together, do a good job of assessing many of the most common symptoms and concerns that clients come to therapy with. 

When you complete the mental health check-in, which takes about three minutes, you’ll be reminded to answer based on how you’ve been feeling over the past two weeks. Over time, these answers create a picture of whether your symptoms and quality of life are improving, worsening, or not changing. The way your responses are trending can send a strong signal to both you and your therapist about whether or not therapy is working for you. 

Reflection and discussion

The mental health check-ins aren’t just a way for us to gather information that then gets filed away — you and your therapist will discuss the questions, answers, and your overall feelings together. In addition to improved scores, you may also notice that you’re reporting less severe or less frequent symptoms. You might be feeling like your mood or sleep have improved, that you’re having fewer sad or anxious days, or that overall, you’re making progress toward your mental health goals.

If your coping skills have improved, and things don’t bother you as much as they used to — or you feel like you’re handling stress better than you did in the past — these are all indicators that you’re improving. Other indicators of progress that may come up in discussion with your therapist include improved personal relationships, and having an easier time at work or just daily life in general.

The alliance with your therapist

The mental health check-in will also ask you questions about your relationship with your therapist. You and your therapist will discuss these answers together, and it’s important to be honest about how you’re feeling. You should use these questions to communicate with your therapist about any changes you notice in how you are working together, or your satisfaction with how care is going. Our therapists are trained and skilled at open and honest discussion, and are ready to address any issues. One of the best ways to move forward in therapy is to come to a mutual understanding with your therapist about things that are and are not working so you can strengthen the bond together. This ensures that the burden isn’t fully on you to bring up any problems that are impacting your care.

Common concerns about measurement-based care

“The questions in the mental health check-ins don’t capture my full reality.”

The mental health check-in is designed to capture a very specific set of information that helps your therapist understand how you’re feeling from a clinical perspective. The check-in contains questions from three standardized clinically validated assessments:

• GAD-7 – ”GAD” stands for “generalized anxiety disorder,” and this assessment contains seven questions designed to measure the severity of anxiety.
• PHQ-9 – “PHQ” stands for “patient health questionnaire.” This assessment has nine questions, designed to measure the severity of depression.
• MHQoL – This is the “Mental health quality of life” questionnaire, covering topics such as self image, mood, relationships, and physical health.

It’s understandable that the check-ins may not always feel as though they’re capturing your entire experience. The check-in gathers a baselines of common symptoms that enable your therapist to understand progress, or lack thereof, and make adjustments to treatment. It’s also helpful to think of the check-in as a starting-off point for you and your therapist to get into the nuances of your feelings and experiences. You and your therapist may also decide to track and check in on your progress in other ways that are specific to your needs.

“How is my data being used?”

The information you provide in your mental health check-ins is confidential, HIPAA-protected health information and will only be visible to authorized individuals within Two Chairs. Your individual responses are only used to help guide your care and help you understand your progress.

Two Chairs is committed to continuous improvement. Sometimes, we may combine your data with others’ responses to help us learn how to make improvements in the quality of our care, but when we do so we remove any identifying information that could reveal your identity or link the information back to you.

We will never sell or share your data with any outside organization without your consent.

“How will I know how to respond to the mental health check-in questions?”

In these standard questions, you’ll be presented with options to share how often you’re experiencing something, such as a particular symptom or feeling. The answers you have to choose from may not reflect your reality exactly, but remember that these are standardized assessments. Just try to choose the one that feels the closest to your experience, and remember: You can always talk to your therapist about your experiences and feelings in more detail.

It’s also important to remember that the mental health check-ins are meant to help us understand how you’ve been feeling over the last two weeks. This is the best way for us to paint a broader picture of your progress over time. So, no matter when your last session was, try to think about your feelings and experiences over the two weeks prior to the check-in.

Our goal is to make therapy work for you

While our practice at Two Chairs is rooted in science, your unique human complexity is what matters most — not just during care, but after, so you can lead the life you want to live. We strive to provide therapy that’s tailored to you; that’s what measurement-based care and mental health check-ins are all about. By completing the check-ins, and having open, regular conversations with your therapist, you’ll have a solid foundation to work toward accomplishing your mental health goals.