Judge therapy by function, not by how sessions feel: sleep and concentration improving, re-engaging with people, shorter spirals after triggers, skills showing up uninvited in real life.
Progress is a slow slope with bad weeks, not a staircase - a flat month is not failure. By about three months of consistent work, you and your therapist should be able to name concrete changes. Months with no goals, no skills, and no change - or a therapist you cannot be honest with - justify a direct conversation or a switch, which is normal.
What to do
Common questions
How do I know if therapy is working?
Judge it by function, not by how sessions feel. The reliable signs of working therapy: you sleep, eat, and concentrate a bit better; you re-engage with people and activities you had dropped; triggers still fire but the spiral is shorter or shallower; and you catch yourself using the skills between sessions without being told. Expect the shape of progress to be a slow slope with bad weeks, not a staircase - a rough session or a flat month does not mean failure, and "I cried the whole hour" is sometimes the breakthrough, not a setback. Timeframe: many people notice something within the first month or two of consistent weekly work; by about three months you and your therapist should be able to point to concrete changes. The red flags on the other side: months of sessions with no goals, no skills, and no change, or a therapist you cannot be honest with - those justify a direct conversation, a reset of goals, or a switch, and switching is normal, not a failure. If things are getting worse or you are in crisis: 988 in the US, or your local crisis line. Pymander, a free AI doctor available 24/7 by text, can help you review the trajectory.