Is My Therapy Working? Why Feeling Heard Is Only the Beginning
By Sarah El Nabulsi, M.Sc., M.A., M.A. | DHA Licensed Clinical Psychologist, Dubai
This post expands on my opinion piece in Gulf News, "Why so many people leave therapy disappointed", published 15 October 2026 and listed with my other articles on my In the Media page.
A man sits down in my office and tells me he has "done therapy" before. Eight sessions, every Thursday, with someone he liked. He felt lighter walking out each week. Then, a month after he stopped, he was back where he started: the same short temper at home, the same 3am waking, the same sense that he was holding everything together with his teeth. "It was nice," he says. "I just don't think it did anything."
I hear a version of this often enough that I no longer treat it as a complaint about one therapist. When someone asks me whether their therapy is working, the honest answer usually starts with a different question: what was the therapy trying to do? Feeling heard is real and it matters. But in my experience, feeling heard is where treatment begins, not what treatment is.
Relief is real. It is not the same as change
Being listened to closely, by someone trained not to judge you, brings genuine relief. Many of the people I see have spent years managing other people's moods: a parent's, a partner's, a team's. The first time they say something out loud and nobody flinches, something in the body settles. I never want to talk anyone out of that experience.
The difficulty is that relief fades between appointments. You leave on Thursday feeling clearer, and by Sunday the pattern that brought you in is running exactly as before, because nothing in the week has changed. The anxious mind still scans for danger. The avoidance still feels safer than the alternative. The argument at home still starts the same way. Relief soothes the pattern for an hour. It does not, on its own, teach the pattern anything new.
So when people tell me therapy "didn't work", I rarely hear that the therapist was unkind. I hear that the sessions had warmth and no direction. Nobody named what they were working on, and so nobody could tell whether it was moving.
Warmth is the foundation, not the building
I want to be careful here, because the research on the therapeutic relationship is some of the strongest we have. A large meta-analysis of 295 studies, covering more than 30,000 patients, found a consistent link between the strength of the alliance between client and therapist and how well therapy went, across different treatment approaches and countries (Flückiger et al., 2018). A relationship in which you can say difficult things is not a luxury. Without it, very little else is possible.
But look at what the alliance actually includes. In the research it is not only the bond. It is also agreement on the goals of therapy and on the tasks that will get you there. A separate set of meta-analyses found that goal consensus between client and therapist, and active collaboration, were each related to better outcomes (Tryon et al., 2018). Those studies show an association, not proof of cause, and the authors say so. Still, the direction is clear enough for me to work by it: the relationship carries the work, and the work needs a destination.
This is the paragraph I would most want someone to keep: good therapy is warm and it is specific. It starts with a shared account of what keeps your problem going now, not only what caused it years ago. That account produces a target you both understand. The target makes it possible to practise something between sessions and to check, honestly, whether anything is changing. Warmth without that structure can feel supportive and leave the pattern untouched.
What keeps the problem going now
Most people arrive with a story about where their difficulty came from, and the story is often accurate. A critical father. A move to a new country at fourteen. A first panic attack in a car park. The origin matters and we will often talk about it.
But the origin is not what keeps the problem alive this week. Something in the present does that. For one person it is the habit of checking their phone for bad news before they are fully awake. For another it is saying yes to every request at work and then resenting it at home. For someone with panic, it is the small escapes: sitting near the door, carrying water, leaving early. Each one brings short relief and quietly teaches the brain that the danger was real.
When we can describe that present-day cycle together, in plain words, the treatment has something to aim at. Without that description, sessions tend to circle the history, and circling feels like work without being work.
One hour a week, and the other 167
A weekly session is one hour. The week has 168. If everything that matters happens inside the hour, the other 167 hours are left to the old pattern, which has years of practice behind it.
That is why structured therapy asks you to do something between sessions: notice a thought and write it down, stay in a situation a little longer than usual, try a conversation differently, practise a short skill daily. Some clients hear the word "homework" and feel they are back at school. I understand the reaction. But the evidence is fairly consistent. A meta-analysis of 17 studies of cognitive behaviour therapy, with 2,312 clients, found that doing the between-session work, and doing it with real skill rather than going through the motions, was related to better outcomes (Kazantzis et al., 2016).
The practice does not need to be large. It needs to be connected to the target, and it needs to be reviewed the following week. An exercise that nobody asks about is soon an exercise nobody does.
How you know whether anything is moving
If there is a target, progress can be checked. That can be as simple as rating how many evenings you avoided going out, how many nights you woke at 3am, or how intense the dread felt before a meeting, week by week. It can also mean short standard questionnaires that track symptoms over time.
This matters more than it sounds. A meta-analysis of 24 studies on routine outcome monitoring, where client progress is measured and fed back to the therapist during treatment, found that feedback reduced the rate at which clients got worse and nearly doubled the rate of meaningful improvement among clients who were predicted to do poorly (Lambert et al., 2018). Measuring is not about grading the client. It tells both of us early when the plan needs to change.
It also protects against the quiet drift that ends so many courses of therapy. Across 669 studies with more than 83,000 clients, about one in five people left therapy before it was finished (Swift & Greenberg, 2012). People leave for many reasons, and not every early ending is a failure. But I suspect a share of those endings belong to people who could not see where the work was going, and decided, reasonably, that it was not going anywhere.
When being heard is the treatment
There are times when listening is exactly the right treatment. Someone in the first weeks after losing a person they love does not need a target and a worksheet. Neither does someone who has spent decades holding everyone else's feelings and has never once been asked about their own. For them, being heard comes first, and structured work may only make sense later, if at all.
What matters is that the choice is deliberate and said out loud. A good clinician can tell you which approach they are using with you and why, and can tell you when that might change. "Right now we are making space for grief, and later we can decide whether there is a specific pattern to work on" is a clear plan. So is "We are working on the avoidance that keeps your panic going." Both are honest. What leaves people disappointed is not knowing which one they are in.
The question worth asking in your next session
In the Gulf, many of the people I see are the first in their family ever to sit with a psychologist. They have no template for what therapy is supposed to look like, so they assume that whatever happens in the room is simply what therapy is. Men in particular often arrive because someone else sent them, and leave after a few sessions because it felt like a conversation they could have had with a friend. I have answered more of these practical questions, about sessions, timing and what to expect, on my therapy FAQ page.
So here is one question I would encourage anyone in therapy to ask, gently and directly: what are we working on, and how will we know when it is done? A good clinician will have an answer, or will tell you when you will have one together. If the answer is vague, that is not a reason to give up on therapy. It is a reason to ask for the structure that makes it worth your time.
Feeling heard is the beginning of the work. It was never meant to be the whole of it.
Client details throughout are composites and do not describe any individual.
References
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755–772. https://doi.org/10.1016/j.beth.2016.05.002
Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537. https://doi.org/10.1037/pst0000167
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226
Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy, 55(4), 372–383. https://doi.org/10.1037/pst0000170
About the Author
Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist based in Dubai and UAE Director of the Transcendental Meditation Organization. With over 15 years of experience supporting adults and couples across the UAE and GCC through anxiety, stress, burnout, and relationship challenges, she is a regular contributor to MBC, Sky News Arabia, Dubai TV, and BBC Arabic, and the creator of the online courses Anxiety 101 (Level 1) and Master Yourself (Level 2).
Frequently asked questions
How do I know if my therapy is working?
You can usually tell if you and your therapist can name what you are working on and see some movement on it over a few weeks. Movement does not mean feeling good after every session; it means a specific pattern, such as avoidance, sleep, arguments or panic, is shifting in daily life. Ask your therapist to agree a target with you and a simple way to track it, even a weekly rating out of ten. Progress is rarely a straight line, and some weeks feel worse before things settle. What should concern you is not a hard week but months with no shared sense of direction. In that case, raise it directly in the session. A good clinician will welcome the question and adjust the plan rather than take it as criticism.
Is it normal to feel better after sessions but nothing changes?
Yes, it is common, and it usually means the sessions are giving relief without changing the pattern that keeps the problem going. Feeling understood calms the body for a while, which is valuable. But if nothing different happens in the rest of your week, the old habits, thoughts and avoidance carry on as before. This is often a sign that the work needs more structure rather than that therapy cannot help you. Ask what the plan is, what you could practise between sessions, and how you will both know if it is working. Sometimes the answer is that listening is the right approach for now, for example after a recent loss. That is fine too, as long as it is a deliberate choice you understand.
How long should therapy take before I see results?
There is no single number, because it depends on what you are working on, how long it has been there, and how much practice happens between sessions. Focused, structured work on a specific problem such as panic or avoidance often runs for a defined number of sessions agreed at the start, then reviewed. Longer-standing difficulties, or work on grief and relationships, can take longer and change more gradually. What you can reasonably expect early on is clarity: within the first few sessions you should understand what is being worked on and why. If several weeks pass without that, it is worth asking. Cost matters too, so it is fair to ask your therapist for an estimate of how many sessions they expect before a review.
What should I ask a therapist in the first session?
The most useful question is simple: what will we be working on, and how will we know when it is done? You might not get a full answer in the first hour, because a good assessment takes time, but you should hear when you will have one. It is also reasonable to ask what approach they use and why it suits your difficulty, what you will be asked to do between sessions, and how progress will be checked. Ask about their licence and training, and about how often sessions will be reviewed. If you are considering medication alongside therapy, ask how they work with psychiatrists. A clinician who answers these clearly is giving you the structure that makes therapy worth the time and the cost.
Should I stop therapy if it is not helping?
Not before you have said so in the room, because the conversation itself often changes the work. Tell your therapist plainly that you are not sure it is helping and ask what the plan is from here. Often the work can be redirected by agreeing a clearer target, adding practice between sessions, or changing the approach. If, after that conversation, there is still no direction, it is reasonable to look for a different clinician or a different form of help, such as a structured programme, group work or a psychiatric assessment where symptoms are severe. Leaving quietly is common, but it leaves you with the belief that therapy does not work, when the real problem may have been the absence of a plan.
Would you like to talk to someone?
Have you been in therapy, felt understood, and still found the same pattern waiting for you each week?
Structured, evidence-based support can make a real difference, often sooner than people expect.
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