Making progress

There are a lot of ways that you can tell whether therapy and the treatment you’re receiving is helping you and it will be very different for each young person. 

You might notice that the problems that you’ve identified at the beginning of your time in treatment start to feel a bit easier to manage.  For example, you might notice that your mood changes. If you were feeling sad a lot of the time, you might notice that your low mood isn’t there all the time and that you start to feel happy or excited about things occasionally.   If you were anxious, you might notice that your confidence increases, and you start to be able to try some new things or go back to doing things which you used to enjoy. You might also feel more comfortable spending time with friends and around other people. 

The therapy sessions themselves might start to feel easier to manage and, if you’ve set some goals for yourself, you may start to notice that some of the things that felt out of reach to you, at the start of the treatment, start to become something you can imagine yourself doing.

A therapist will use a lot of the same clues that young people do to work out if therapy is helping.  For example, they may have noticed a change in your mood or confidence and you may be more open with them about what you’re thinking and feeling. 

To help them measure the things that you’re feeling, a therapist may sometimes use a questionnaire, or you may have agreed some goals that you wanted to work towards which you rate regularly.  This will help both you and them to see what progress is happening for you, which you can also discuss within the sessions themselves.

Therapist will sometimes also be interested in what other people notice, for example your parents or teachers and, with your permission, they may suggest having meetings together to talk about the progress that you are making from different perspectives.  

This might be as simple as noticing that it felt like a good session to you. You might have felt like you were really listened to or understood and that you had a chance to talk about the things that were important to you. You might leave the session with new ideas or understanding that help you day to day. A successful session might have a positive effect right away or the effect might build up more slowly over time and you start to notice the success after a few days or weeks. This might be captured in a steady pattern of reducing scores on questionnaires that ask about how you are feeling or a steady increase in progress towards your goals.

It is also possible that a successful session doesn’t feel easy at the time. You might have spoken about things that are quite painful for you to speak about.  That doesn’t necessarily mean that it’s been a bad session because sometimes we need to talk about things that are upsetting to understand certain situation or feelings and help us move on.

Your therapist should ask you regularly about the progress you feel therapy is helping you to make. This might be measured with questionnaires or ratings on goals but also in the discussion between you. This can allow you both to make small adjustments along the way to get the most out of your time together.  If you feel that little or no progress is being made, it is important and very helpful to tell your therapist how you feel.  It may seem obvious to you, but your therapist might not understand exactly how you feel or whether you think that enough progress is being made.  There is more than one option for how to treat most difficulties that we’ve identified so, having this conversation, will allow you both to review your approach and your goals and hopefully find a new and more helpful way forward.

Outcome measures are tools that can measure aspects of someone’s mental health and wellbeing, for example how they feel or are managing. They are usually questionnaires and can be filled in by a child or young person themselves, by a parent or peer and by a professional like a clinician or teacher.

Feedback measures are usually questionnaires that ask for information about children and young people’s experience. This might be their experience of service in general, or an individual session.

Outcome measures can be helpful in several ways. They might help you to describe what is troubling you, if you find it difficult to put it into words. They can help you to feel less alone in your troubles when you see that other people feel the same way that you do. They can also be used to guide suggestions of treatment options, to make sure they are targeted at what is most important or troubling for you. They can be used to keep treatment on track by measuring how well it is helping you to tackle the problems you have been experiencing and to capture your success when your scores change in the direction you want over the course of therapy.

In 2021, we’ve combined reviews of literature and additional sources, along with consultation with experts by experience, located in six countries (Brazil, Norway, Pakistan, Spain, Turkey, and the UK). The aim was to explore whether collaborative goal setting is a helpful or unhelpful element of relationships between young people and practitioners, for young people experiencing anxiety or depression.

By goal setting, we mean agreements between the young person and the practitioner about specific goals they agree they want to work towards throughout their time in therapy.

We wanted to tap into how goal setting is and isn’t helpful, and under what circumstances (e.g., country, type of support). Young people with lived experience were central to the design and delivery of this research through our team peer researchers and international advisory group, who made sure that all stages of the research were in line with the views and feedback of young people. Youth advisors actively took part in the design, implementation, and the dissemination of findings.

We will report our findings and recommendations by early 2022. This project was funded by the Wellcome Trust and led by the Anna Freud Centre. It forms part of the Wellcome Trust’s mental health strategy, launched in 2020. In the meantime, you can download our research poster and read the latest blog about this project by research lead Dr Jenna Jacob.