A wave of new research is challenging conventional wisdom about what truly helps people in therapy, revealing that the value clients find in psychotherapy extends well beyond the mere reduction of symptoms. A study highlighted by Mad in America in July 2025 has found that clients consistently report the most meaningful benefits as personal growth, self-understanding, and improved connections with others—shifting the focus away from traditional clinical outcome measures that primarily track symptom relief. This new perspective could have profound implications for how therapy is understood, evaluated, and practiced, both in Thailand and globally (MadinAmerica.com, 2025).
For decades, the efficacy of psychotherapy has largely been measured through standardized scales, focusing on how quickly and thoroughly clients’ symptoms—such as anxiety, depression, or post-traumatic stress—are reduced. However, both emerging studies and first-person client accounts indicate that the benefits of therapy are often far more nuanced and personal. Clients describe “good outcomes” not just in terms of feeling less distressed, but also by highlighting empowerment, self-confidence, deeper relationships, and personal insight as core achievements of their therapeutic journeys (Luiggi-Hernández, 2020).
This shift in understanding is significant for Thai readers because, in Thailand, as elsewhere, mental health stigma and access barriers mean that many people seek therapy only after distress has significantly affected their lives. By only valuing symptom disappearance, valuable, culturally-relevant gains—like greater family harmony, enhanced self-acceptance, and resilience in the face of ongoing life challenges—may be overlooked. These are outcomes Thai clients, who often navigate complex family, social, and work relationships, may find especially pertinent.
Recent qualitative studies have explored the “real-life” consequences of therapy beyond symptom scales. In one influential study, clients who had completed therapy for depression were interviewed about what they considered a “good outcome.” They consistently described a process of personal transformation: gaining empowerment, achieving balance in personal relationships, and cultivating ongoing skills to deal with adversity, even after therapy had ended. Recovered clients reported increased self-acceptance and were more likely to identify the roots of their distress and make positive lifestyle changes, while those who were “improved” often noted better boundaries and an ability to separate from toxic influences.
Quoting the lead researcher in the Mad in America report, “Clients value growth, self-understanding, and connection more than diagnostic relief. They see therapy as a journey, not just a way to stop feeling bad.” Other recent research, such as a longitudinal study published by Roos Verkooyen and colleagues (PMC11220492), reported that while all participants experienced positive outcomes, the most valuable gains were a sense of acceptance and support, as well as a stronger ability to navigate life’s problems—elements closely connected to the therapeutic alliance with their counselor.
Significantly, the Mad in America article cites the development of new self-report tools that measure both the positive and negative experiences of clients. For example, the Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP) incorporates feedback about feeling emotionally supported, understood, and empowered, rather than just tracking symptom shifts. Across studies, clients said the quality of their relationship with their therapist—marked by acceptance, validation, and a shared emotional bond—mattered most for long-term positive change (Flückiger et al., 2018).
While these findings represent a paradigm shift in how the benefits of therapy are framed, Thai mental health care still faces specific challenges. In many Thai settings, therapy is often abbreviated and heavily focused on symptom management, especially in fast-paced urban clinics or under-resourced rural hospitals. Mental health professionals, such as psychiatrists, clinical psychologists, and counselors in hospital settings, typically rely on checklists and rapid assessments to guide treatment and report progress to governmental or insurance bodies. Yet, according to the latest research, this approach may overlook core areas that truly matter to clients (Mad in America, 2025).
Thai culture places a high value on social harmony, respect for elders, and endurance in the face of hardship. Thus, gains like increased self-acceptance, improved communication skills, and the ability to set healthy boundaries often have far-reaching positive effects not captured by Western-style metrics. Family dynamics also play a central role in Thai mental health—clients may seek therapy for individual distress but hope ultimately to restore or enhance family harmony. As such, the robust finding that “personal growth” and “connection” can be the main rewards of therapy should prompt clinicians and health authorities in Thailand to integrate client-centered, culturally relevant outcome measures into both public and private treatment settings.
Historical context also matters for Thailand. Following the COVID-19 pandemic, public conversations about mental health have increased in frequency and visibility, prompting universities, the Ministry of Public Health, and NGOs to expand access to counseling and crisis support services. Despite this progress, stigma remains deeply entrenched, leading many to delay seeking help until their problems become acute. For Thai youth in particular—now reporting rising levels of exam stress, social media anxiety, and career uncertainty—therapeutic outcomes such as self-efficacy, improved peer relationships, and emotional literacy could be especially valuable, even if they don’t directly reduce a diagnostic score (WHO Thailand, 2024).
Expert voices in recent research emphasize that the subjective perspectives of clients should carry more weight in both clinical and academic settings. According to senior psychologists involved in these studies, “Change in psychotherapy is often nonlinear, with clients sometimes feeling worse before they feel better. Improvements in self-understanding, resilience, and relationship skills are durable and can lead to better long-term well-being, even when symptoms fluctuate.” Moreover, increasing research suggests that fostering a strong therapeutic alliance—a relationship marked by respect and collaboration—directly influences long-term outcomes for diverse populations, including in Asian contexts.
Another key insight is that negative therapy experiences, while common (reported by around 70% of clients in some studies), do not necessarily predict poorer outcomes unless they undermine the trust and connection between therapist and client. Instead, negative feelings such as emotional overwhelm may be a necessary part of the process, especially as clients confront painful memories or make difficult personal changes. However, poor communication or lack of information about what to expect in therapy can lead to more negative evaluations, highlighting the need for open, ongoing dialogue and informed consent (Verkooyen et al., 2024; Crawford et al., 2016).
For Thailand, this research has immediate practical implications. Training programs for counselors and clinical psychologists should emphasize listening to client goals, fostering a collaborative relationship, and monitoring both positive and negative feedback throughout the course of therapy. Hospitals and clinics can adapt their evaluation forms to ask clients not only about symptom change, but also about their subjective sense of growth, empowerment, and connection. Community education campaigns can reassure the public that many people seek therapy not just to fix “problems,” but to foster personal development and resilience—especially important for reducing stigma among Thai youth and elders alike.
Looking ahead, if the mental health system in Thailand and across Southeast Asia incorporates these insights, it could encourage earlier help-seeking, longer engagement with therapy, and higher satisfaction rates. In a world where the lines between mental health, well-being, and social connection are increasingly blurred, a more holistic view—embracing the full range of therapy’s benefits—may prove essential, both for individual clients and for society at large.
For anyone in Thailand considering therapy, the latest research carries clear, practical recommendations:
- When seeking therapy, feel free to express your hopes for personal growth, improved relationships, and understanding—not just the wish for fewer symptoms.
- Choose therapists or clinics that value collaboration and ongoing feedback, allowing you to discuss what is and isn’t working as you progress.
- If you encounter difficulties or “negative experiences” during therapy, share them openly with your provider, as these can be important signals for change—not signs of failure.
- For health professionals, prioritize building strong therapeutic alliances, and move beyond checklist measures to capture the real-life benefits that matter to clients.
As Thailand continues to expand mental health care access, recognizing the broader, deeper value of therapy will serve both clients and communities. By listening more closely to what clients say matters, Thai clinicians and policymakers can foster a more compassionate, resilient, and inclusive approach to well-being.
Citations:
Mad in America, 2025
Luiggi-Hernández, 2020 - Mad in America
PMC11220492 - Verkooyen et al., 2024
WHO Thailand, Mental Health
Flückiger et al., 2018
Crawford et al., 2016