Rate Your Therapy? Here’s How to Know If It’s Truly Working

Understanding the Journey of Psychotherapy: What Makes It Work?

Psychotherapy is a deeply personal experience. Each individual brings their own struggles, hopes, and strengths to the process, while therapists contribute their unique methods, personalities, and expertise. Together, they engage in a dynamic exchange—talking, listening, learning, and sometimes even clashing along the way.

Given its deeply subjective nature, it’s difficult to compare one person’s therapy journey with another’s. However, many people seek clarity on what makes therapy effective, how to determine if their therapist is a good fit, and when it might be time to make a change or end treatment altogether.

The Structure of Therapy: From Initial Consultation to Progress

Therapy typically begins with an initial consultation where patients receive an assessment of their mental health concerns. During this phase, they explore whether self-help strategies are sufficient or if professional support is needed. They also learn whether psychotherapy is an appropriate path forward.

Following this, patients may attend up to three trial sessions. These sessions serve as a mutual evaluation period—both the patient and therapist gauge whether they feel comfortable working together, whether the chosen therapeutic approach aligns with the patient’s needs, and what expectations each has for the process.

Therapy doesn’t always aim for a complete "cure." In some cases, especially when dealing with chronic or severe conditions, progress can mean maintaining stability or developing better coping mechanisms. Once this foundation is established, the real work begins: exploring the root causes of problems, breaking harmful patterns, managing conflict, and experimenting with new behaviors.

For example, therapy might involve confronting long-standing emotional issues, having difficult conversations, addressing recurring relationship problems, or reframing negative thought patterns such as excessive self-blame.

How Effective Is Therapy?

According to Antje Gumz, a medical psychotherapist at the Berlin School of Psychology, about one-third of patients report significant improvement from therapy. Around a quarter discontinue therapy early, and in 5% to 10% of cases, symptoms may actually worsen during the process.

There are several recognized forms of therapy, including behavioral therapy, depth psychology-based psychotherapy, analytical psychotherapy, and systemic therapy. While all have proven effectiveness, certain approaches may be more suited to specific conditions. For instance, cognitive behavioral therapy (CBT) tends to be more effective for obsessive-compulsive disorder or anxiety, whereas depression or personality disorders respond well to any of the four standard models.

The key is finding a method that resonates with the individual. A mismatch between the therapy style and the patient's needs can lead to premature dropout. For example, someone seeking practical solutions might not benefit from deep-rooted psychoanalysis, while others may find behavioral therapy too surface-level for their emotional history.

Signs That Therapy Is Working

Ralf Dohrenbusch, who led the outpatient clinic at the University of Bonn for nearly two decades, identifies several indicators of successful therapy:

• You feel understood by your therapist.
• You look forward to sessions and feel motivated to grow.
• You gain insights you wouldn't get from friends or family.
• Your symptoms begin to improve or become more manageable.

Dohrenbusch emphasizes that progress in therapy isn’t linear. There will likely be setbacks and periods where symptoms seem to worsen temporarily. This can be part of the healing process, especially when confronting past trauma.

For instance, someone struggling with low self-esteem rooted in childhood criticism may benefit from exercises like writing a letter to their parents or role-playing scenarios to challenge those damaging messages. Although emotionally challenging, these experiences often lead to meaningful breakthroughs.

When to Consider Changing Therapists

If therapy feels unproductive or uncomfortable, it’s important to speak openly with your therapist. If they’re unable or unwilling to address your concerns, it may be time to consider a change.

Gumz advises that if therapy feels superficial or overly easy, that could be a red flag. Good therapy should encourage emotional engagement and foster a sense of being truly seen and heard.

Other signs it might be time to switch include:

• Feeling like sessions are a chore.
• Struggling to open up due to discomfort or distrust.
• Lacking hope or a sense of progress.

Changing therapists doesn’t mean failure—it can be a necessary step toward finding the right match. As psychologist Gerhard Zarbock notes, addressing tension or misunderstand in therapy can actually strengthen the therapeutic alliance and lead to better outcomes.

Qualities of an Effective Therapist

Proper training is one of the most essential qualifications for a therapist. Licensed psychological or medical psychotherapists have undergone years of postgraduate education and supervised practice. This distinguishes them from life coaches, counselors, or alternative healers, who may lack formal credentials.

While every therapist brings their own personality and style to the process, research shows that around 10% of the outcome depends on the therapist themselves. Other factors—such as the severity of the condition and the strength of the therapeutic relationship—are equally, if not more, important.

A strong therapeutic alliance is built on mutual respect, shared goals, and emotional connection. Small things like similar communication styles or body language can enhance the bond. Patients benefit when therapists are warm, empathetic, confident in the process, and culturally aware.

Specialization can be valuable, particularly for complex conditions like trauma, borderline personality disorder, or psychosis. However, most therapists are trained to treat common issues such as anxiety, depression, stress, and burnout without needing a specialized focus.

Interestingly, factors like age, gender, or professional background don’t significantly affect therapy outcomes, despite what many patients assume.

Boundaries and Ethical Standards

Therapy must remain focused on the patient. Therapists may share relevant experiences or emotions to deepen the connection, but sessions should never revolve around the therapist’s personal life.

Clear ethical boundaries must also be upheld. These include:

• Maintaining confidentiality
• Avoiding flirtation or inappropriate physical contact
• Not suggesting private meetings outside of sessions

Any violation of these boundaries is grounds for ending therapy immediately. Patients who feel something is amiss can report concerns to local regulatory bodies, such as regional Psychotherapists’ Chambers in Germany.

Knowing When to End Therapy

Ending therapy is a personal decision that should ideally come after achieving the original treatment goals. Before concluding sessions, patients should reflect on:

• Whether their initial goals were met
• How their symptoms have changed
• Their current quality of life, relationships, and emotional resilience
• Confidence in sustaining progress
• Awareness of steps to take if symptoms resurface

It’s perfectly acceptable to stop therapy before completing all scheduled sessions if the patient feels better. However, discussing this with the therapist ensures the decision is based on genuine improvement rather than avoidance or premature optimism.

If old challenges return, therapy can be resumed. Fortunately, studies show that the positive effects of therapy often last for years—even indefinitely.

Ultimately, psychotherapy is a collaborative journey. When done well, it fosters growth, self-awareness, and lasting emotional well-being.