How Do You Know You're Making Progress in Psychotherapy? Part I

Around this time of the year, some of you may be looking back at your journey in therapy and wondering how you've changed. Each person's process is different, and trusting your own self-attestation is key because you know yourself best. I'll share and explain a list of capacities that indicate growth in therapy to guide your reflection, starting with the first few from Dr. Mark Winborn's list, Outcomes of (Psycho)analysis Central to Individuation. I'll discuss the rest of the list in upcoming posts. Let's begin!

1. Increased capacity to tolerate complexity, ambiguity, and not knowing.

"Can I trust this person?" "Will I get the job offer?" "Am I making the right choice to move to a different city?" "Should I leave/enter the relationship?" "Will my spouse's biopsy result come back positive?" We seem to share the desire to penetrate the mysterious fog of life and alleviate our existential anxiety.

Yet if you're focused on living a life without uncertainty and anxiety by demanding immediate answers, you might feel frustrated or overwhelmed. This is like trying to get glue off your hands by rubbing them, but a moment later, you realize you not only haven’t got it off your hands, but you also get it on your sleeves and your face now!

In situations where answers and clarification aren't available right away, tolerating the glue while it dries over time may be a more effective approach. So, instead of anxiously asking someone else's opinions about what you should do, you choose to let your anxious feelings settle, take time to gather information, or take the risk to plunge into the unknown.

2. Increased capacity to symbolize, including the capability to adopt an "as if" relationship to your own experience

This may feel abstract, but one way to understand the "capacity to symbolize" and the "as if" attitude is to intuitively pick up on mental images that represent your emotional experience before you know what they mean, and then become curious about them. Before you start therapy, you may not know how you feel, but after a while, you can say things like, "I feel like I was drowning," "I feel like there's a tight knot in my gut," "I feel as if my mom was still breathing down my neck about my weight when I sit down and eat," and explore these experiences.

This is no small deal, as the process of symbolizing requires you to develop the capacity to register and recognize that you're experiencing something internally. This allows you to share your experience with your therapist for sense-making and to better understand yourself. Take this made-up scenario as an example:

A woman comes to therapy because, though she has a seemingly happy life everyone else envies, with a family, well-paying job, beach vacations multiple times a year, she feels something is missing. Assuming the therapist accurately picks up on the patient's somewhat flat and removed presence and says, "You seem to keep a distance from how you really feel, and I wonder if this is underlying your feeling that something is missing." At the beginning of therapy, the woman may answer, "No, I don't think so. I talk a lot with my colleagues. I spend all my time with my husband and my two children when I'm not working. I'm not distant from them at all."

But after a while in therapy, the woman may be able to recognize something different: "I realize that even though I'm friendly at work, and I do a lot for my husband and my children, I feel as if I'm constantly wearing a mask, and I can't show others who I really am."

At the beginning, the woman takes the "distance" the therapist refers to literally and concretely, as if verbal engagement and physical closeness equaled emotional closeness. This shuts down the opportunity of exploring what's missing. Later, the woman registers and recognizes her tendency to detach from her emotions, behaving one way while feeling another, evoking the image of a "mask." This creates an opportunity for the patient and therapist to explore what the mask is for, what's behind it, and how the patient may navigate it and change the tendency.

3. Increased capacity to imagine

The capacity to imagine is closely related to the capacity to symbolize, which we discussed above. For you to have mental representations of your experience, you need the capacity to imagine. For example, for someone to use "wearing a mask" to describe their tendency to be emotionally distant and hidden, they must be able to capture and intuit a mental image of a mask. This is a type of imagination.

I also want to explore the capacity to imagine as a capacity to envision. Envisioning how you are when you're not operating from habitual emotional and psychological patterns can be a powerful way to create the changes you want.

Sometimes, after an emotional and psychological pattern is identified in therapy, patients have difficulties navigating out of their patterns. I get questions like, "I know I'm in the loop of beating myself up right now, but I don't know what's out of the loop and how to get there." When someone lives with a tendency to self-criticize, it's hard for them to see themselves as good and worthy. The capacity to envision how they would be (i.e., "I'd be kind to myself and trust I have something to offer") can be a key to navigating these habitual patterns.

4. Increased capacity to reflect on one's own experience

In Mark Winborn's paper, Working with Patients with Disruptions in Symbolic Capacity (2022), he quotes Fonagy's (2000) definition of reflective function as someone's capacity to reflect upon, understand, and make inferences about one's own experience and motivations, as well as the experience and motivations of others.

Before therapy, you may operate unconsciously from your emotional and psychological tendencies, repeating the same themes, like "wearing a mask." After spending time in therapy, you may recognize that you wear a mask to prevent yourself from being seen and protect yourself from getting hurt, but deeper down, you crave closeness; you become aware that wearing the mask makes it difficult for others to understand and reach you, which compromises the quality of your relationships, and you decide to change.

I'll stop here today, because this is plenty of information to digest. This list is intended as a guide for self-reflection rather than a set of criteria for evaluation and judgment, meaning, please don't grade yourself. You have a distinct path and will change only at your own pace. Most importantly, changing and growing require time. As we’re arriving at the threshold between the past and the future, the old and the new, I hope you find this post a helpful anchor.