What Should My Therapist Actually Be Doing in Counseling Sessions?
You've been going to therapy for a while now. Your therapist seems nice enough. They ask how your week was. They nod and say "mmhmm" a lot. Maybe they give you some general advice. But you're starting to wonder: Is this actually therapy? Or is this just an expensive conversation?
This is a completely normal question to ask. Therapy costs real money—anywhere from $100-$150 per session at most quality practices. It also costs time. You're taking time off work, arranging childcare, or driving across town to Lee's Summit or wherever your therapist's office is. Of course you want to know if your therapist is actually doing something that will help.
You came to therapy with a problem. You deserve a therapist who has a plan to help solve that problem.
Why Didn't My Last Therapist Help?
If you've tried therapy before and it didn't work, you're not alone. Many people come to Aspire Counseling after having disappointing experiences with previous therapists. Sometimes they feel like they wasted months or even years just talking about their problems without anything actually changing.
Here's what's important to understand: It's probably not that therapy doesn't work. It's that not all therapy is the same. Some therapists are trained in specific, research-backed methods for treating particular problems. Other therapists use a more general "talk therapy" approach that can be helpful for some things but isn't very effective for others.
If you had serious anxiety, trauma, OCD, or depression and your last therapist just asked "how was your week" every session, that explains why it didn't help much. Those problems need specialized treatment approaches. Just talking about them isn't enough.
The good news? Effective therapy exists. You just need to know what to look for.
What Is Evidence-Based Treatment?
Evidence-based treatment means using therapy methods that research has proven actually work. These aren't just techniques that sound good or that a therapist invented on their own. They're specific approaches that have been tested with hundreds or thousands of people and shown to create real, lasting change.
At Aspire Counseling, evidence-based treatment means balancing three things. First, we use methods supported by research. Second, we apply our clinical expertise and experience. Third—and this is really important—we consider YOUR specific needs, values, and preferences. All three of these pieces matter.
Some examples of evidence-based treatments include:
CBT (Cognitive Behavioral Therapy) for anxiety and depression
EMDR (Eye Movement Desensitization and Reprocessing) for trauma
ERP (Exposure and Response Prevention) for OCD
CPT (Cognitive Processing Therapy) for PTSD
DBT (Dialectical Behavior Therapy) for emotion regulation and self-harm
IFS (Internal Family Systems) for complex trauma and inner conflict
Your therapist should be trained in at least one of these approaches for the problem you're dealing with. If they're not, that's a red flag.
Should My Therapist Have Specific Goals for My Treatment?
Yes. Absolutely yes. Your therapist should have clear goals for your treatment. You might not see the actual written treatment plan (though some therapists do share it). But you should definitely be able to tell that your therapist knows where you're headed together.
Good therapy goals are specific and measurable. "Feel better" is too vague. Better goals sound like:
Reduce panic attacks from 3 per week to 1 or less
Sleep through the night at least 5 nights per week
Attend social events without avoiding them due to anxiety
Process trauma memories so they no longer cause flashbacks
Use coping skills to manage anger instead of yelling at family
In your first few sessions, your therapist should talk with you about what you want to achieve. Then together you create a plan for getting there. This doesn't mean every session is rigid or scripted. But there should be an overall direction.
If you've been in therapy for months and you have no idea what you're working toward, that's a problem.
What About Homework Between Sessions?
Most effective therapy includes work outside of sessions. Your therapist might call it homework, practice, or skills application. Whatever they call it, you should be doing something between appointments.
This might include:
Practicing specific coping skills you learned
Completing worksheets that help you identify thought patterns
Tracking your mood, anxiety, or other symptoms
Doing exposure exercises to face fears gradually
Journaling or reflecting on session topics
Therapy isn't magic that only happens in the therapist's office. Real change comes from applying what you learn to your actual life. Regular attendance at therapy combined with between-session work creates the best results.
If your therapist never gives you anything to do between sessions, that might mean they're not using evidence-based treatment methods.
How Do I Know If My Treatment Is Working?
This is a really important question. And it's one your therapist should help you answer with actual data—not just their gut feeling or your vague sense that maybe things are a little better.
At Aspire Counseling, we use something called measurement-based care. This means all of our therapists send clients at least one assessment per month to track symptoms and progress. Most of our clients complete these through an app or website before sessions. Sometimes we complete them during sessions.
These assessments give your therapist actual numbers to track over time. Are your depression scores going down? Is your anxiety decreasing? Are you sleeping better? Measurement-based care helps answer these questions with facts, not just feelings.
Your therapist should periodically review these results with you. Sometimes you might not feel like you're making progress, but the numbers show that you actually are. Other times, the numbers might show that something needs to change in your treatment approach.
This data helps make sure your therapy is actually working. You deserve to know if you're getting better—not just hope that you are.
Should My Therapist Teach Me Specific Skills?
Yes. A good therapist doesn't just listen sympathetically. They actively teach you new ways of thinking, feeling, and behaving. You should be learning concrete skills you can use when your therapist isn't there.
Depending on what you're working on, you might learn:
Grounding techniques to manage panic attacks
Ways to challenge anxious or negative thoughts
Communication skills for difficult conversations
Mindfulness practices to stay present
Emotion regulation strategies
How to gradually face fears through exposure work
By the end of therapy, you should have a toolbox of strategies that work for you. You should feel more confident in your ability to handle difficult situations. You shouldn't feel like you need your therapist forever just to function.
If you've been in therapy for months and you haven't learned any new skills, something is wrong.
What If My Therapist Just Listens But Doesn't Do Much?
Some people find supportive listening helpful, especially if they don't have anyone else to talk to. But if you came to therapy for a specific mental health concern like anxiety, depression, trauma, or OCD, listening alone isn't enough.
Your therapist should be actively involved in your healing. They should suggest specific techniques. They should challenge you (gently) to try new approaches. They should explain why they're recommending certain strategies based on research and their expertise.
Good therapy feels collaborative. You and your therapist are working together toward your goals. Your therapist brings their training and knowledge. You bring your experience and commitment to change.
If your sessions mostly consist of you talking while your therapist occasionally says "how does that make you feel," you might not be getting evidence-based treatment.
Does the Type of Therapist Matter?
Sometimes yes. Different mental health professionals have different training and can do different things. But what matters most is whether your therapist has specialized training for YOUR specific concern.
A therapist with a master's degree in counseling or social work who specializes in OCD treatment will be much more helpful for OCD than a therapist with a PhD who doesn't have that specialized training.
When choosing a therapist, ask about their training in treating your specific issue. Ask what methods they use. Ask how they typically help people with problems like yours.
A good therapist will happily answer these questions. They want you to feel confident that they can help you.
How Often Should I See My Therapist?
The frequency of therapy sessions matters for effectiveness. For most people starting therapy, weekly sessions work best. This gives you enough time to practice skills between appointments while maintaining momentum in treatment.
Some problems require more intensive treatment. For example, if you're doing trauma therapy or working through severe anxiety or OCD, you might need to meet twice a week initially. We even offer trauma therapy intensives where you meet twice a day for a week because research shows this approach works incredibly well for PTSD.
Whatever frequency your therapist recommends, try to stick with it—especially in the beginning. Inconsistent attendance makes it much harder for therapy to work.
What Should I Expect in the First Few Sessions?
The first few sessions are usually focused on assessment and planning. Your therapist should ask detailed questions about:
What brought you to therapy
Your symptoms and how they affect your life
Your goals for treatment
Your history and background
What you've tried before
You'll also probably complete some questionnaires or assessments. These give your therapist baseline data about your symptoms so they can track your progress later.
By session 3 or 4, you should have a clear sense of the treatment plan. Your therapist should be able to explain what approach they're using and why. You should understand what the work will involve.
If you're several sessions in and still have no idea what the plan is, speak up and ask.
What If I Think My Current Therapy Isn't Working?
If you've been in therapy for a while and you're not seeing progress, talk to your therapist about it. A good therapist will want to know if you're feeling stuck. They should be willing to review your goals, look at any symptom tracking data, and discuss whether a different approach might help.
Sometimes therapy takes longer than expected. Other times, you might need a different type of treatment or a different therapist altogether. Both possibilities are okay. What's not okay is continuing to invest time and money in something that isn't helping you.
Trust your gut. If something feels off, it probably is. You deserve therapy that actually works.
The Bottom Line
Good therapy is active, structured, and goal-directed. Your therapist should be using research-backed methods, teaching you specific skills, tracking your progress with data, and helping you work toward clear goals. You should feel like you're learning and growing, not just venting week after week.
If your current or past therapy didn't look like this, that's probably why it didn't help as much as you hoped. The good news is that effective therapy exists. You just need to find a therapist who practices it.
At Aspire Counseling, we specialize in evidence-based treatment for anxiety, trauma, depression, and OCD. Our therapists are trained in specific, proven methods. We track progress with measurement-based care. We teach concrete skills. And we always have clear treatment goals.
If you're tired of therapy that just involves talking about your problems without solving them, we'd love to talk with you. Reach out today to schedule a free consultation and learn more about how evidence-based therapy can help you actually get better.
Aspire Counseling offers evidence-based therapy at our Lee's Summit and Columbia, MO offices, as well as online throughout Missouri. Our therapists specialize in anxiety treatment, trauma therapy, teen counseling, and more. Contact us at 573-328-2288 to learn more or schedule your free consultation.
