You can ask your therapist to review how the work is going, including what feels useful, what remains difficult and what you do not understand. Bring a few concrete observations and ask how they relate to the goals you agreed. You do not need to prove that therapy is succeeding or failing before having the conversation.
This guide is about discussing an ongoing therapy relationship. It does not set a deadline for improvement, evaluate a particular treatment or tell you whether to stay with a specific therapist.
Begin with the question you actually have
Try to name what prompted the review. Perhaps you cannot explain what the sessions are working towards, a suggested exercise is difficult to use, or the practical arrangement is becoming hard to sustain. Those are different questions and may need different answers.
An opening can be simple: “Could we spend part of today reviewing our goals and how we will know whether this approach is helping?” If you have a more immediate concern, say that first rather than waiting until the last minute of the session.
The National Institute of Mental Health’s psychotherapy guidance identifies goals, assessment of progress and what happens when improvement is not occurring as useful topics to discuss. It also emphasises trust and comfort in the therapeutic relationship. Those are grounds for a conversation, not a universal checklist that produces a yes-or-no verdict.
Revisit the goals in ordinary language
If you have a written treatment plan or goals from earlier sessions, use them as a starting point. Ask the therapist to explain unfamiliar terms and how the work in sessions connects to what you want help with. You should not have to invent that connection on your own.
If you do not remember agreeing on goals, say so. “I know why I came, but I am not clear about the current focus” gives the therapist something specific to address. It does not mean you have done therapy incorrectly.
Your priorities may also have changed. A concern that seemed urgent at the beginning may now sit alongside a new difficulty. Mention that shift so you and the therapist can discuss whether the focus needs adjusting.
For a broader introduction, see how to think about whether therapy could help. An ongoing review is a more specific question about this work, its goals and your experience of it.
Bring observations rather than a score you must defend
Choose one or two examples from everyday life. You might describe a situation that felt different, a problem that remains unchanged or something that became harder. Include the context you remember without trying to reconstruct every detail.
For example, “I used the approach we discussed during one difficult conversation, but I could not remember it during another” gives more information than “I failed the exercise.” The therapist can explore the difference with you rather than receiving a verdict about your ability.
You do not need to monitor yourself constantly between sessions. If keeping notes increases pressure or feels unhelpful, bring that concern too. A brief recollection can start the discussion, and “I am not sure what I have noticed” is a valid answer.
Avoid borrowing someone else’s recovery timeline as your benchmark. The question is what a reasonable review looks like for your circumstances and the approach being used, which you can ask the therapist to explain.
Name what is not working clearly
Separate the part you do not understand from the part you disagree with or cannot manage. “I do not understand the purpose of this exercise” is different from “I understand it, but I do not have privacy to practise it at home.”
You can also describe how a session interaction affected you. “When we moved on quickly, I felt that the concern I raised was unfinished” is a concrete starting point. You do not need to decide in advance what the therapist intended.
If a suggestion feels overwhelming, ask about its purpose, alternatives and how its pace can be discussed. Do not conceal difficulty to appear cooperative. Accurate feedback gives the conversation more to work with than agreement you do not mean.
There is no requirement to phrase concerns perfectly. You may read a short note, ask for time to find the words or explain that bringing the subject up is itself difficult.
Use a small review note if it helps
This original worksheet is a conversation aid, not a clinical outcome measure. You can use one row, several rows or none.
| Prompt | Example wording |
|---|---|
| Goal I understand | “I think we are working on this situation; is that still the focus?” |
| Something useful | “This explanation helped me understand one reaction.” |
| Something difficult | “I am not managing the between-session task as planned.” |
| Question about progress | “What changes would we look for, and how would we review them?” |
| Practical issue | “The appointment time is becoming difficult to sustain.” |
Keep notes private and as short as you prefer. You do not have to send a detailed account in advance, especially if you have not agreed how the therapist handles messages between sessions. Ask about the appropriate channel if you want to raise a topic before the next meeting.
Ask what happens after the review
Discuss what the therapist proposes in response. That might include clarifying the current approach, revisiting goals or discussing other options. Ask what the proposal means in practice and how you will return to it later.
If the therapist uses questionnaires or other measures, ask how they are interpreted alongside your own experience. A number can be part of a discussion without becoming the only way you are allowed to describe how you feel.
If you have been attending for what feels like a reasonable period without improvement, NIMH advises talking with the therapist and considering other professionals or approaches. That does not require an abrupt decision during one session. You can ask about options, continuity of care and any practical steps involved in a change.
Therapy review should not be used to change prescribed medication on your own. Medication questions belong with the appropriate prescriber as part of coordinated care.
Work through a fictional conversation
Imagine that Morgan has been attending sessions and is unsure how a suggested exercise relates to the reason they sought help. Morgan has sometimes completed it and sometimes avoided it, then felt embarrassed about mentioning the difference. This is a fictional communication example, not a treatment case or outcome claim.
Morgan brings one sentence: “I am not clear about what this exercise is intended to change, and that makes it hard to use.” The conversation can now address the rationale, the difficulty and whether another explanation or approach is appropriate.
Morgan does not need to submit a complete diary to earn that discussion. Nor does the fact that they raised the concern establish that the approach will work. The practical result is that an unanswered question becomes something the two people can discuss openly.
Include practical barriers without minimising them
Cost, scheduling, access, language or privacy can affect whether the arrangement is workable. Raise those issues as real parts of care rather than treating them as excuses. Ask what alternatives or support the service can offer, without assuming that a particular option is available.
If arranging help is the main obstacle, see what to do when seeking help keeps getting postponed. For manageable everyday support, self-care when overwhelmed addresses another part of the picture. Neither replaces a needed conversation about treatment.
Leave with an understood next step
Before finishing, summarise what you think was agreed and ask for correction if needed. You might confirm the current goal, a question the therapist will return to or the plan for another review. It is acceptable if some uncertainty remains, as long as it is named.
If you feel unsafe with a provider or believe a professional boundary has been crossed, you can seek independent advice through the service or relevant professional body; you do not have to resolve it alone in a session. If you need urgent help, use the appropriate local urgent-care route rather than waiting for a planned progress review.
A useful review leaves you better able to describe the work and raise questions about it. It does not require a promise to improve by a certain date or a performance score for being a good therapy client.