I got a question via email last week about how to tell when therapy is working. Here it is, along with my answer:

I have been in psychoanalysis to treat emotional abuse for 4 years now, and am still in a really bad place. I exploded in anger and stopped talking to my mother, father, family and friends only writing to them to wish them dead in horrible ways. Then I burst into tears a few times realizing my friends do care and love me. But I am still feeling bad despite having been crying a lot in the past year and having a much better relationship with friends and family. I feel confused and lost. I wonder whether I should change therapists as after 4 years I still feel "like shit" and cannot work properly. Many thanks.

Thanks for your question; I'll do my best to give you an answer based just on the little bit that you've told me. I get that at the moment you feel "like shit" as you've had 4 years of psychoanalysis and still cannot work properly, so you're wondering if your therapy is going right or whether you should change therapists.

How do you know if therapy is really working?

How do you know if therapy is really working?

The first thing I'd say is it sounds as if you've made a lot of progress over those 4 years: You got in touch with your inner rage when you exploded in anger; then you set a no-contact boundary when you stopped talking to your mother, father and family; then you communicated to them honestly how you felt as best you could; then you released some grief when you burst into tears a few times realizing that your friends do care and love you. You healed more grief about your family too, so you have been crying a lot in the past year. After all of that you have a much better relationship with your friends and family.

These are core issues that you’re dealing with. Family dysfunction and abuse are some of the toughest stuff for a human being to deal with. Abuse cuts to the core of who we are, right down to how our brain and biology function. No wonder you feel confused and lost. While you don't yet have the results that you want, I want to acknowledge you for doing all this hard work which has resulted in much better relationships with the people who are important to you.

So my first question for you is: Are you able to acknowledge yourself for what you've accomplished, even though it's not yet perfect?

That said, I don't know what style of psychoanalysis you've been having, so it's hard to say whether more of the same is what you need right now to move forward in your life. Perhaps it's time to move on to another therapist, or perhaps you're just about to have the breakthrough that you've been longing for. Therapy is a unique type of relationship because it's time-limited: right from the beginning you know that eventually, you want to "break up" with the therapist and seek intimate relationships with other people; and I get that you want to know if now is the right time.

All effective therapy has something in common: the therapist creates a non-judgmental space where you feel safe enough to share your deepest feelings with them, and they respond empathically with love and acceptance. This empathy is ultimately what heals the brain, and what you’re really paying for.

So my second question is: Do you feel safe enough with your psychoanalyst to share your deepest feelings with them? In other words: When you have a session, do you actually feel some of the pain that you've experienced which didn’t feel safe to express in the past?

You will know if the therapy is working because you will feel terrible for much of the session, but by the end you should feel a sense of lightness and relief. If you don’t feel bad at all during a session, it’s not working; but if you’re left still feeling upset at the end then the therapist may not be setting good boundaries either. It’s normal to have painful emotions arise between sessions when you get triggered by real-world events too, and to talk them through in your next session.

I'm a little wary of old-style psychoanalysis because it tends to get you to talk around your feelings, and that will leave you stuck in your head rather than connected to your heart and body. That's why people used to see Freudian psychoanalysts for years and years without getting anywhere. It’s not enough to just talk about what happened to you, or even to talk about how you felt about it: you have to actually allow yourself to feel the pain to heal it, and highly analytical therapies don’t tend to do that.

But that doesn't sound entirely like your experience since you've clearly been tapping into your buried pain and releasing it. However you're not fully where you want to be yet. It’s possible that the reason you feel “like shit” is that you’re still processing the trauma of the abuse. It’s also possible that you feel this way because you don’t really feel safe enough with your therapist and his process to fully feel, express and release your true feelings of rage, anger, sadness and fear. Then it’s also possible that you feel the way you do because you’ve actually healed the abuse, but your therapist isn’t coaching you on moving forward in building the life that you want.

Only you can tell which it is for you. So my third question is: What did you feel when you read that last paragraph? I’m curious which possibility resonates most with you? Or is in something else entirely?

Four years is a reasonably long time to be in therapy with one therapist. In my healing journey I’ve seen many, many therapists over the years. They’ve all contributed to my life in a massive way. I’ve had the experience of getting to the point where I just didn’t seem to be getting what I needed, and looked around for another therapist who “got me” on a deeper level. Sometimes I realised that I had moved on too quickly and went back for more. There have also been periods where I just took a break, because frankly effective therapy can be emotionally and physically exhausting! Sometimes the unpleasant feelings get worse for a while before they get better. There are benefits in staying with one therapist long term, and benefits to moving on as you grow, like we do with school teachers, say.

I have an advantage over many therapists in that I’ve studied both emotional healing and life coaching; which means I can help clients not only heal their past, but design their future. I do therapy over Skype, and I’d be happy to have a half hour chat with you at no charge to find out more about your circumstances, let you know how I help my clients and leave you empowered to make the best decision for yourself. If you’re interested, please let me know your city/timezone and what time of day would suit you best.

Healing abuse and building the life you want takes time and patience, and I acknowledge you again both for hanging in there over the last 4 years, and for reaching out to see if there is an alternative that will get you where you want to go faster.

Graham Stoney

Graham Stoney

I struggled for years with low self-esteem, anxiety and a lack of self-confidence before finding a solution that really worked. I created The Confident Man Program to help other men live the life of their dreams. I also offer 1-on-1 coaching via Skype so if you related to this article contact me about coaching.