Psychotherapy is a proven treatment for depression. According to the American Psychological Association, reviews of hundreds of research studies have shown that about 75 percent of people who engage in some form psychotherapy benefit from it. In addition, the average person who receives psychotherapy treatment is better off by the end of treatment than 80 percent of those who don’t receive any such treatment.

But, as with any medical treatment, psychotherapy doesn’t work for everyone. And, for unclear reasons, one form of therapy may work for one person but not another. With several psychotherapy methods to choose from, patients and their physicians often have to explore more than one type of therapy until they find the results they are looking for. So how do patients and doctors know when therapy is working and when it isn’t?

[See: 10 Mistakes People Make Living With Depression.]

The easy answer is, if you’re feeling better, it’s working. But with depression, it can take time to notice any change in feeling or mood, and those changes may be incremental at best. As Americans, we want to simply take a pill and fix the problem. Mental health doesn’t work that way. Yes, antidepressant medications are effective, but they take time as well and work best when used in conjunction with psychotherapy. Talk therapy, as it is also known, is a longer process, and involves “building a trusting, therapeutic relationship with your psychologist,” the APA states.

Choosing the right therapy, and the right therapist, is a very personal decision, says Dr. Sue Varma, a psychiatrist and clinical assistant professor at the NYU Langone School of Medicine. “The type of disorder or issue you are facing, the severity, cost, time commitment, level of insight and self-reflection and recent life events are some of the important factors that will inform the type of therapy you choose.”

An Active Collaboration Works Best

“Psychotherapy is different from medical or dental treatments, where patients typically sit passively while professionals work on them and tell them their diagnosis and treatment plans,” the APA explains. “Psychotherapy isn’t about a psychologist telling you what to do. It’s an active collaboration between you and the psychologist.”

In fact, success often hinges on a strong, collaborative relationship between psychotherapist and patient, which the APA calls a “therapeutic alliance.” One important study has shown that when patients and their therapists engage in constructive feedback with one another, treatment lasts longer and results in improved outcomes. “I think the stereotype of the aloof, silent, ‘blank screen’ psychoanalyst continues to inform most people’s images of what an analyst or a psychodynamic therapist is like. While there are some who still practice in this traditional fashion, most psychodynamic clinicians would consider this approach old-school and outdated,” says Alison Ross, a psychologist and adjunct associate professor at City College of New York. “Most analysts — myself included — are actively and warmly engaged with their patients and do not adhere to the notion that the analyst is some know-it-all who bestows his or her ‘knowledge’ on the patient.”

[See: Am I Just Sad — or Actually Depressed?]

Another misconception is that psychotherapy involves years and decades laying on a couch talking about your mother. Modern forms of therapy are designed to provide actionable steps toward a fairly quick relief of symptoms. In one often-cited study, about half of all psychotherapy patients were “measurably improved” after just eight sessions, and 75 percent had improved by 26 sessions. “I am personally a big believer in getting results in a timely manner,” Varma says. “When somebody comes in to see me for the treatment of depression, generalized anxiety, obsessive-compulsive disorder, ADHD, couple’s issues, I want to help them get better relatively quickly.”

Expect Some Results in Six to 12 Sessions

Of course, “relatively” is, well, relative. The APA says that when beginning psychotherapy, the patient and therapist should work together to develop goals and a general timeline for treatment. Patients can expect to feel better in about six to 12 sessions; if that isn’t happening, it should be brought up, either by the patient or the therapist. That can be difficult for a patient with depression, who often feels overwhelmed and helpless. It may even increase feelings of anxiety — but that may be a good thing. “A small amount of anxiety can be helpful in therapy as a motivational tool,” Varma says. It may also signal that the patient is being pushed “to face difficult truths or do the hard work of making changes,” the APA writes. “In such cases, these strong emotions are a sign of growth rather than evidence of a standstill. Remember, sometimes things may feel worse before they get better.”

[See: How to Find the Best Mental Health Professional for You.]

But things should feel better eventually. Exactly when that is depends on many factors, Ross says, including the severity of the problem, the person’s commitment to and investment in the treatment process, and whether biological issues are also at play. “But with all that said, I think after a couple of months of once-weekly therapy, something positive should be happening to suggest that the fit between patient and therapist is a good one and that things are on track,” she says. Within that time frame, she expects a deepening and more trusting relationship between patient and therapist to develop. And with that should come some relief in the intensity of the person’s distress, or at least some increased clarity about the different factors in the person’s life that are causing distress and some ideas about how to manage them. “I’m not suggesting a cure by any means,” she says, “but some evidence of progress being made.”

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How Do I Know if My Therapy Is Working? originally appeared on usnews.com