Sometimes therapy works even when the therapist does not think it leads to improvement.

I worked with a Latin American engineer for a few years who was paralyzed by perfectionism. He only got a fraction of his work done on lucrative projects, wasting enormous amounts of time avoiding his work because he felt terrified of being exposed to the world as mediocre. He often failed to deliver on his commitments, alienating many clients, losing a lot of money in the process. He felt terribly humiliated accepting financial assistance from successful in-laws, to continue supporting his family. 

He had a lot of trouble trusting that therapy could help him. He competed with me and with every doctor he consulted for Narcissistic Personality Disorder, anxiety, and depression. He would often make excuses for not coming to sessions. I feared he would never improve. 

But recently, a couple of years after therapy ended, he emailed me, saying that he felt “constantly thankful for your help all those years. Doing better and more stable, trying to use everything I learned in our sessions. Struggle from time to time. But your help was invaluable, and I’ll always appreciate it.” He was able to maintain steady employment at a job which he initially feared was beneath him and meant he was mediocre and pathetic.

It is gratifying when therapy works. Sometimes it helps even when I fear it is not accomplishing anything.