Therapy progress reflection worksheet

Reflecting on progress in therapy can help clients and clinicians see what’s working. However, clients may not recognize the progress they are making, which is why therapy progress reflection worksheets can be a helpful intervention for clients to see how far they have come in their treatment journey. 

This article explains how to measure progress in therapy and offers reflection prompts clinicians can use to discuss progress with clients. 

We’ve included a free downloadable therapy progress reflection worksheet to save to your electronic health record (EHR) and use in your practice.

How to measure progress in therapy

Measuring treatment progress can be complex for clinicians. Many providers track progress to understand how treatment is going and decide on next steps.

There are standardized instruments that track and monitor progress, including:

• Patient Health Questionnaire (PHQ-9)

• Generalized Anxiety Disorder 7-item screening (GAD-7)

• Alcohol Use Disorders Identification Test (AUDIT)

• Posttraumatic Stress Disorder Checklist (PCL-5)

However, these measures are a snapshot in time and often lack context. For example, a client who slept poorly or had a fight with their partner that morning might feel especially hopeless and score higher on the PHQ-9 than they would have the day before. These measures are also often administered when clinicians or clients remember rather than at specific intervals. 

While measures are an important part of the picture, they are not the only measure of progress. Each client has their own specific goals, and progress may be more effectively measured against those individual goals and objectives. For example, if a client wants to reduce their symptoms of depression, the PHQ-9 could be helpful. However, therapy may also uncover situational factors contributing to their depression. Thus, addressing underlying stressors and noticing improvement in day-to-day functioning can also be meaningful measures of treatment progress. 

Progress reflection prompts 

The following reflection prompts can help clients recognize their progress in therapy:

• During the last month, how do you rate your ability to cope with stress?

• What are the coping skills you have used most often?

• What have you learned about yourself in the last year?

• How has your self-talk changed?

• In what ways have you shown yourself more compassion?

• What are your top three insights from therapy?

• What are you most proud of?

• Can you think of a situation where you responded differently than you might have before therapy?

• How would you rate your symptoms of depression compared to the beginning of therapy?

• How have your relationships changed?

• When was the last time you had a conflict with someone close to you?

• When you have a conflict now, how long does it take to resolve, compared to the beginning of therapy?

• How have your boundaries changed? 

• Reflecting on your initial challenges, identify three strengths you used to overcome them.

• What habits or routines helped you to succeed?

• What are you most grateful for?

• How have your values and priorities changed in the last year?

• Reviewing your initial treatment goal, how would you rate your progress?

• What is something easy for you to do that felt impossible when you started therapy? 

‌

How to use the therapy progress reflection worksheet

You can download and use the therapy progress reflection worksheet in several ways:

• Use the worksheet in session to discuss the client’s progress in therapy.

• Provide psychoeducation on how treatment works and measures of progress. 

• Ask the client to reflect on the therapy progress reflection worksheet, complete the reflection questions between sessions, and report their findings at their next therapy appointment. 

• Use the progress discussion prompts in group therapy sessions to encourage clients to share more about what progress looks like to them.

• Combine this worksheet with other strengths-based and self-reflection resources, such as our looking back, looking forward worksheet, values worksheet, assertive communication worksheet, positive traits worksheet, strengths worksheet, and positive experiences worksheet.

Sources

• Guttman, M. E. (2023). Rethinking how we measure progress in mental health treatment. National Alliance on Mental Illness. 

• Jensen-Doss, A., Haimes, E. M. B., Smith, A. M., Lyon, A. R., Lewis, C. C., et al. (2018). Monitoring treatment progress and providing feedback is viewed favorably but rarely used in practice. Administration and Policy in Mental Health. 

• Owings-Fonner, N. (2019). Research roundup: Monitoring treatment progress. American Psychological Association. 

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.

‌