Discussing whether therapy is helping starts with shared goals, examples from daily life and an agreed way to review progress. A good conversation can include improvement, things that have not changed and concerns about the sessions themselves. There is no single number of visits or online score that can tell every person whether to continue, change or end therapy.
This guide helps adults prepare a conversation with their therapist. Its examples and worksheet are editorial discussion aids, not validated symptom measures, treatment advice or rules for judging a clinician. Support resources. NIMH’s help guidance.
Start with what you are hoping will change
NIMH recommends discussing therapy goals, the proposed timeframe, how progress will be assessed and what happens if improvement is not beginning. It also emphasizes comfort and trust in the therapeutic relationship.
A goal in your own words gives that conversation somewhere to start. “I want help” can become “I want to understand what happens when I avoid an important conversation.” You and the therapist can then discuss whether that goal fits the approach and what useful progress might look like.
Keep the goal open to revision. An early goal may have been chosen before the therapist understood the situation fully, or it may no longer be the most pressing concern. Ask how a change in priorities affects the plan instead of assuming the original wording must stay forever.
Bring examples, not only a verdict
Try describing an event since the last visit: what happened, what you noticed and what you did. This provides material for discussion without requiring you to rate the whole treatment as a success or failure.
In an invented example, someone still felt anxious before a meeting but attended and spoke once. The anxiety and the participation are two separate observations. Neither should be erased to make the account uniformly positive or negative. The therapist can help discuss how each relates to the agreed goal.
Choose a manageable amount of information. A few specific notes can be more useful than a detailed daily record that becomes another burden. Ask the therapist what, if anything, would be helpful to track and how it will be used.
| Starting statement | More specific observation |
|---|---|
| “Nothing changed.” | “I still cancelled the two plans I wanted to keep; can we discuss what happened before each cancellation?” |
| “This week was better.” | “I handled one difficult conversation differently, but sleep was still a problem.” |
| “The sessions feel unclear.” | “I leave unsure what we are working toward or how the activity connects to my goal.” |
Understand the role of questionnaires
MedlinePlus notes that mental-health screening can also be used to check whether treatment is working. If your therapist uses a questionnaire, ask what it measures, what period the answers should cover and how the result will be interpreted with the rest of the conversation.
A score and your description should be discussed together. Ask about a change you do not understand or an item that does not fit your circumstances. Do not substitute an unvalidated website quiz for the measure your clinician uses, or choose answers to produce the result you think is expected.
The worksheet here deliberately does not produce a score, threshold or recommendation. Its purpose is to help you remember questions. Decisions about diagnosis or treatment need more than a self-created tally.
Agree on a review conversation
Ask when you and the therapist will pause to review the work explicitly. The answer can take account of the treatment approach and your needs. This guide does not assign a universal deadline for improvement.
An agenda can be simple: the goal, changes noticed, ongoing difficulties, the therapist’s assessment and the next step. If you disagree about progress, describe the difference. For instance, the therapist may be noticing a change that does not yet address your main daily difficulty.
Leave the review knowing what is being tried next and why. If the plan stays the same, ask for the reasoning. If it changes, ask what will be different and how you will revisit whether that change helped.
Raise discomfort or lack of progress directly
NIMH advises talking with your therapist if you have been in therapy for what feels like a reasonable period and are not getting better; exploring other professionals or approaches may be appropriate. That is an invitation to discuss the concern, not a fixed instruction to leave after a certain number of appointments.
You can distinguish the content of therapy from the way the sessions are conducted. “This subject is difficult” and “I do not understand why we are doing this exercise” raise different questions. Ask for an explanation and discuss the effect on you.
If you feel dismissed, pressured or unable to raise a concern, take that seriously and seek an appropriate second opinion or the practice’s complaint route if needed. You do not have to label every uncomfortable experience as either proof of benefit or proof of harm. Describe what occurred and get help evaluating it.
- “I would like to review whether this approach is addressing the goal we agreed on.”
- “I am having difficulty using what we discuss between sessions. Can we examine that?”
- “I have a concern about how a session felt, and I want to understand my options.”
Separate access problems from the clinical question
Cost, scheduling, travel and video privacy can make a plan hard to use even when the approach appears relevant. Tell the therapist which barrier is interfering and ask what options exist. A session missed because a bus did not arrive is not the same observation as a session attended without finding it useful.
Check the full practical burden before assuming you can simply add appointments. That includes travel, childcare and preparation as well as the billed session. The right response to a clinical need must be discussed with the clinician, while payment or scheduling staff may help with a different part of the problem.
If another professional is also involved, ask how the plans fit together. Therapy progress and medication effects may be discussed with different people, but you should not be left trying to resolve contradictory instructions alone.
If you are considering a different therapist or approach
Ask what you would want the next arrangement to do differently. A clearer goal, a different area of expertise, a practical schedule or a better way to discuss concerns are more specific starting points than searching for a generic “better therapist.”
If you decide to change care, discuss continuity and records with the professionals involved. Find out whether the next appointment is an initial consultation or ongoing treatment and how questions will be handled during any gap. Changing therapists does not itself supply instructions about medication from another prescriber.
Keep the decision separate from a judgment about yourself. Needing a different arrangement is something to discuss and organize. It does not make an unanswered question or an unsuccessful first fit a personal failure.
A progress conversation you can prepare
This fictional example is not a recommended therapy goal or a clinical assessment. It shows how to keep an observation and a question together.
| Part of the record | Example entry |
|---|---|
| Goal discussed | Handle a difficult work conversation more deliberately. |
| Observation | Attended the meeting and spoke once; still avoided a later conversation. |
| Question | How do these two events relate to what we are practicing? |
| Session concern | I am unsure how to use the exercise between visits. |
| Next agreement | Ask the therapist to explain the plan and agree on when to review it. |
Download the therapy progress conversation record (CSV). Open it in a spreadsheet or print it. Keep your completed copy privately; this site does not collect your answers.
Continue with the next question
- Preparing for a first conversation about care
- How to read a treatment outcome claim
- Planning your next steps after treatment
For public contacts and geographic questions, browse our local care guides.
Sources and editorial scope
This guide combines published source guidance with original preparation examples. No named clinician has reviewed this guide. The worksheets are not diagnostic tests, validated measures or assessments of a provider. No interviews or individual care arrangements were verified.
Sources checked September 8, 2026. Read our editorial standards.