Is Therapy Working—or Am I Just Talking a Lot?
Psychic Change: When Therapy Actually Changes Your Mind
When people ask, “How do I know therapy is working?” it can be hard to explain. Psychoanalyst Betty Joseph offers a framework called psychic change—the idea that therapy helps people shift the way they experience themselves and others, not just reduce symptoms.
What Psychic Change Means
In plain terms, psychic change is about learning new ways of thinking, feeling, and relating. Many of us develop patterns—like withdrawing, over-functioning, or avoiding feelings—that once helped us cope but now limit our lives or relationships. Joseph emphasized that therapy helps people gradually notice these patterns, experience themselves differently, and begin making choices that were previously difficult or impossible.
This is subtle work: change often emerges in small moments, such as recognizing an automatic reaction, feeling a previously avoided emotion, or trying a new way of connecting with someone.
Several other analysts offer perspectives that reinforce Joseph’s ideas:
Wilfred Bion: Learning to process and tolerate difficult emotions without being overwhelmed.
Donald Winnicott: Experiencing your True Self in a safe space, letting go of masks or defenses.
Hanna Segal: Integrating previously split-off feelings and experiences.
Peter Fonagy: Developing the ability to reflect on your own and others’ thoughts and feelings (mentalization).
Sandor Ferenczi: Small moments of authentic connection can reshape inner experience over time.
Together, these insights show that psychic change is gradual, relational, and deeply internal, forming the foundation for lasting shifts in thought, feeling, and behavior.
Progress in Therapy: What It Looks Like in Everyday Life
So, how does this translate into real-life experience? Progress in therapy might include:
Awareness of old patterns: Recognizing habits like overworking, avoiding feelings, or overthinking as patterns rather than facts about yourself.
More flexible responses: Being able to pause, reflect, and make choices instead of reacting automatically.
Expanding emotional range: Feeling and tolerating emotions that once felt overwhelming, without being controlled by them.
New ways of connecting: Interacting with others more authentically and adaptively.
Even small moments of insight—pausing before reacting, curiosity about your feelings, or trying a new way of relating—indicate psychic change taking root. Over time, these subtle shifts accumulate into meaningful, lasting change.
Opening Up New Possibilities
At its core, psychic change is about discovering that your inner world isn’t fixed. Therapy creates space for you to:
See different perspectives on yourself and others.
Respond differently to situations that used to trigger old patterns.
Feel more fully without being overwhelmed.
Make choices that were previously impossible or frightening.
Some people cope with difficult feelings by staying in emotional overdrive—keeping busy or over-productive to avoid low mood or hard feelings. Recognizing these patterns often marks a turning point, allowing energy to shift toward growth and more flexible ways of living.
Why This Matters
Understanding psychic change sets realistic expectations: therapy isn’t about instant fixes. It’s about developing awareness, choice, and resilience, so old patterns lose their power and you can experience yourself and the world in more adaptive, fulfilling ways.
References
Joseph, B. (1990). Psychic Change in Psychotherapy. London: Free Association Books.
Bion, W. R. (1962). Learning from Experience. London: Heinemann.
Winnicott, D. W. (1965). The Maturational Processes and the Facilitating Environment. New York: International Universities Press.
Segal, H. (1973). Introduction to the Work of Melanie Klein. London: Karnac.
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press.
Ferenczi, S. (1932). Final Contributions to the Problems and Methods of Psychoanalysis. London: Hogarth Press.