What the Heck Are We Doing Here? How to Track Your Progress in Therapy

When you invest time, money, and energy into therapy, it’s completely normal to wonder: “Is this actually working? Am I getting better?” Sometimes progress can feel slow, and other times it’s hard to tell if you're actually moving forward or just talking. Today, we’re going to look at what the research says about tracking progress, what makes therapy different from just venting to a friend, and what you can do if you feel stuck.

The 8-Session Baseline and the "Quick Relief" Trap

Research shows that 8 sessions is widely considered the "minimally adequate treatment." This means 8 sessions is generally the baseline needed to start seeing real, longstanding change. That’s not to say you can’t get a boost from fewer appointments, but the data continues to show that longer-term therapy always beats out shorter-term therapy when it comes to lasting outcomes.

So, one thing to consider right off the bat is: How far along am I on my therapy journey? Have I discussed my expectations with my therapist?

On the flip side, there is a very common trap people fall into. Often, when someone starts therapy, they experience a quick relief from the immediate stressors that brought them through the door. Because they feel better, they discontinue therapy after just a few appointments…only to wonder a month later why they are feeling the exact same way again. Experiencing early relief is super common, but it doesn't always equate to longstanding change!

You Need a Roadmap (The Treatment Plan)

A huge component of therapeutic change is the therapeutic alliance (you can read more about what is in our previous blog post here). A big part of the alliance, both at the beginning and throughout your care, is collaboratively creating and updating your goals and figuring out how to get there.

To know if you are seeing change, you have to know where you want to go and how you and your therapist plan to get you there. You need this baseline and plan to know if you are moving anywhere!

Good therapists always have a plan for your care and work collaboratively with you on it. You should be taken along on the journey! You deserve a treatment plan that you like, believe in, and understand. Overall, the plan should just make sense to you.

Think of a treatment plan as a living document. A good therapist will update it as your work updates together. They will make sure you know how the plan translates into your actual sessions, so you always know, "What the heck are we doing here?"

Venting vs. Real Therapy: The Need for Structure

Take a moment to reflect on your sessions. Do they involve structure and hard work?

When I say structure, I don't mean a worksheet or a rigid plan. I mean the framework that you and your therapist work within.

• Do you know what your goals are?
• Do you know where you are going and why you are doing what you're doing?
• Is there structure in how often you meet?
• Do you spend time each session working toward your goals?

These are the exact things that differentiate therapy from just talking with a friend!

A good therapist will also talk with you about specific markers of change to notice on your journey. They won’t just leave it at a vague goal like, "I want to lower my anxiety." Instead, they will really comb through what that looks like. They will ask: How does your anxiety show up? What needs to change about it and what would that look like? What will be different in your everyday life when that change happens? These deep conversations help you identify the exact signs that show you are actually getting better.

Continuous Calibration: Feedback-Informed Care

There are many, many scales and measurements available to show your meaningful change over time. If this is something you are interested in, talk to your therapist! They can help you find scales and measures that reflect the specific areas you want to grow in.

Some of our therapists here at Cultivate Mental Health use a super short pre-session survey called the Outcome Rating Scale (ORS) to check in with where you are at. At the end of the session, we use another short survey called the Session Rating Scale (SRS).

These scales are great for tracking progress over time, but they do something else that is in many ways more important: they help catch stuck points in therapy early.

Don't look at these scales as a test or a measure of how well you are "performing." Instead, look at them as a way to identify patterns and trends. It allows your therapist to pivot and adapt your treatment plan to your actual needs. Sometimes there is a blind spot that leads to a stuck point in therapy. We look at it as a continuous calibration approach, where we make many small adjustments over time.

The truth is, therapists are actually not good at determining how therapy is going on their own! This is why benchmarks, measures, feedback, and identifying indicators of change are so incredibly important.

What Does This Mean for You?

If you are new to therapy:

1. Get clarity: Make sure you are clear on your goals and how you and your therapist will get to them together.
2. Check the steps: Make sure the next steps make sense to you and you genuinely believe they will help. In the first few sessions, you should leave with some hope and a small but mighty sense of control.
3. Ask for tools: Ask your therapist if they use outcome measures like the Outcome Rating Scale and Session Rating Scale.

If you are in the middle of therapy and feel stuck:

It might be time to go back to the drawing board!

I regularly "hit the drawing board" with clients I have been working with for a while. It can be super useful to see how far you’ve come in your work, and it helps carve out a clear path forward. It is also incredibly useful to check in on your goals, because goals change and evolve over time. When they do, we just need to re-calibrate.

Don't be afraid to ask your therapist if they would be interested in integrating outcome measures into your care. They are a fantastic tool to constantly tinker, calibrate, and tailor your care to your updated needs! If you work with us here at Cultivate Mental Health and are interested in these measures or would like a therapist who incorporates these things into your care feel free to email us at hello@cultivatemh.ca to get started. 

References

1. Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329-343. (This research supports the concept of a minimum number of sessions—like the 8-session baseline—needed for clinically significant change).
2. Lambert, M. J. (2010). Prevention of treatment failure: The use of a lab-based outcomes management system. American Psychological Association. (Demonstrates that therapists are statistically poor at identifying failing or stuck treatments without objective outcome tracking tools).
3. Miller, S. D., Duncan, B. L., Brown, J., Sorrell, R., & Chalk, M. B. (2006). Using formal client feedback to improve retention and outcome. Journal of Brief Therapy, 5(1), 5-22. (Provides the scientific backing for using the Outcome Rating Scale and Session Rating Scale to identify patterns, prevent dropouts, and continuously calibrate care).
4. Swift, J. K., & Greenberg, R. P. (2012). Premature termination in psychotherapy: A meta-analytic review. Psychotherapy, 49(4), 547–581. (Discusses the phenomenon of early termination when clients experience rapid initial symptom relief without achieving long-term structural change).