And in terms of measures of psychological well-being as a result of therapy, the outcome research shows comparable and modest gains for clients, regardless of the therapeutic method used. So on average, we help clients get past some problems and improve their well-being, with some fading of effects over time from a single dose of therapy.
Is therapy worth the cost? Guardian readers weigh in | Society | The Guardian
Our yearning for transformative impact has also run into the realities of the medical model we got into bed with in the s. Most therapy now starts with a medical diagnosis and treatment code. Therapists still seem attracted to models that promise deeper healing, for clients and themselves.
Others accept the requirements of employers and insurance companies to offer therapy with more circumspect goals. Some walk away from the pursuit of therapy as a kind of personal quest and take up the more practical-minded approach of coaching, which disclaims goals of deep transformation entirely. Are we more like shamans or family doctors? Are we explorers of human depths or more like Siri on your iPhone, just directing you from one place to another?
Is therapy worth the cost? Guardian readers weigh in
Do we represent a wisdom tradition for the modern age—with something important to say about human suffering and human flourishing—or are we orthopedic surgeons of the psyche? Any goal in psychotherapy beyond relief of suffering and dysfunction is infused with personal and cultural values that are usually not explicitly articulated by the creators of therapy models themselves.
And since psychotherapy is a thoroughly Western invention, most images of the good life are individualistic, rather than communitarian. Family life is a venue for individual development more than a place of dedication for its own sake, as it is in many other cultures. It embodies many Western cultural values and ideologies. The problem, of course, is that our clients are usually clueless about where we might lead them. Does the therapist believe that deeply attached relationships are the key to human flourishing, or maybe differentiation is more important? Bowlby vs.
Bowen as a human ideal. Is family worth staying connected to despite the pain it causes? And what about the tradeoff between civic commitments and a balanced personal life? At least with religion, the various stances on morality and human destiny are made explicit.
With therapy, clients would have to be cultural anthropologists to decipher what a therapy model says about the big questions of life—even though these assumptions are embedded in every model of therapy—and detectives to figure out where a particular therapist stands. The therapy outcome research and my own experience have made me a skeptic about whether any clinical approach is good at getting clients consistently to the promised land of transformation.
Contemporary neuroscience-informed therapies aim to help quickly at the level of everyday functioning, and then some people go much further toward mind—body—spirit integration. Different forms of acceptance therapies emphasize change and then the acceptance of what may never change—which paradoxically can open up new vistas for growth. LuAnn was verbally abusive to Laurie—which led to Jeff stepping in and huge subsequent family meltdowns.
Laurie was befuddled about how to handle her daughter and keep her marriage intact. I liked this couple very much, felt bad for them, and had to keep myself from demonizing the daughter in my mind. In fact, I told myself that she was the one in the family who was most at risk. I helped them clarify boundaries with each other and with LuAnn—with each other by being clear who was the parent here, and with LuAnn in terms of setting limits on her moving in and out of the household and insisting on financial emergency payouts when she was in trouble.
I also helped Jeff and Laurie stay present during disagreements, rather than him either intellectualizing or shutting down, and her telling him what he was thinking and feeling. Please double check your mobile number and click on "Send Verification Code". Enter the code below and hit Verify. Free Shipping All orders of Cash on Delivery Pay for your order in cash at the moment the shipment is delivered to your doorstep. Log In. Don't have an account? Sign Up. Update your profile Let us wish you a happy birthday!
Add your birthday. Buy it Again. Make sure to buy your groceries and daily needs Buy Now. Let us wish you a happy birthday! Date of Birth. A small mountain of clinical research shows that therapists—that is, anyone who provides talk therapy, from psychologists to social workers—vary widely in effectiveness. One study, led by John Okiishi of Brigham Young University, compared clinical outcomes from 91 therapists and found that the highest-performing among them helped clients improve 10 times faster than the overall average. On the other end of the spectrum, a study led by the psychologist David R.
Kraus found that clients of the lowest-performing therapists were significantly worse off in the areas of violence and substance abuse at the end of treatment. A decade and a half later—after many adventures and odd jobs in my 20s and early 30s—I entered graduate school with this same perspective on psychotherapy: that it was an art too nuanced and complex to be measured. A quarter or more of my clients dropped out without explanation a few weeks or months into treatment. And at least 10 percent were deteriorating. Psychotherapy, on the whole, can be very effective. This bears emphasis, because many people are still skeptical that it is a bona fide treatment.
There is no shortage of empirical evidence demonstrating that psychotherapy helps patients with a wide range of problems, from the relatively simple fear of flying, for example to knotty and treatment-resistant conditions such as borderline personality disorder. It may not help everyone, but neither does a whole host of medicines for physical ailments. The point is, it does help a lot of people. That said, as in any profession, there is still considerable room for improvement.
My training experience was typical of broader trends: Across the field, dropout rates are estimated to be about 25 percent or more, and, most disheartening of all, 5 to 10 percent of clients deteriorate during treatment. In recognition of this challenge, psychotherapists have been working hard to boost outcomes. During the past three decades, much of this effort has focused on studying and debating which models of therapy are most effective. However, the results of these initiatives have been largely disappointing.
Plenty of models—such as interpersonal therapy, emotion-focused therapy, and cognitive behavioral therapy—have performed well in studies. But larger meta-analyses suggest that most models are not consistently more successful than any other. Certainly, some models may be better or worse for individual clients. For example, a recent study in Britain examined the results of a major effort to train psychotherapists in cognitive behavioral therapy.
Despite a massive investment of time and money, client outcomes did not improve. Can they encourage patients to face their deepest fears? Can they treat clients with warmth and compassion while, when necessary, challenging them? Doctors rely on a wide range of instruments—stethoscopes, lab tests, scalpels. Therapists, by contrast, are the main instruments of psychotherapy. But this merely brings us back to the central question I faced after Grace died: How can those instruments—the therapists themselves—be improved? Most fields have experienced dramatic advancements over the past century.
The story of how they moved forward often involved two closely related phenomena, both of which were brought about by technology. Consider the recent impact of slow-motion video technology on professional dance. The newfound affordability of slow motion has enabled them to improve their technique, spruce up their audition reel, and isolate aspects of their performance that were once intangible. Unfortunately, perhaps no field faces higher barriers to incorporating performance feedback than psychotherapy.
Because of the personal, sensitive nature of our work—which is protected by laws, regulations, and the general norms of the profession—therapists function largely in private, sheltered from objective feedback. Try to imagine a surgeon, a dancer, or any type of athlete learning without someone observing their work, but instead by simply sharing with their boss reflections on their recent performance. However, asking only helps if clients are forthcoming with their answers.
And many clients withhold critical feedback, especially when therapy is unhelpful.
Clients as Teachers: Reciprocal Influences in Therapy Relationships
Which leads to the other 20th-century development that spurred many professions forward, while largely bypassing psychotherapy: the use of metrics to forecast likely outcomes. From this, he developed statistical tools for predicting the performance of baseball players. Ultimately, those tools transformed how baseball teams are managed. Lambert and his team have also been at the forefront of developing psychotherapy metrics. Drawing on historical data from thousands of cases, they created algorithms predicting when clients are at risk of deterioration.
- Human Evolutionary Biology.
- The New Weird;
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- The Client Who Changed Me.
If, based on their answers to survey questions, clients appear to be at risk, their therapists are sent alerts that are color-coded for different concerns: red for risk of dropout or deterioration, yellow for less-than-expected progress. In an initial test, the algorithms were able to predict—with 85 percent accuracy and after only three therapy sessions—which clients would deteriorate.
Today, these surveys and algorithms are known as feedback-informed treatment, or fit. The system aids therapy in two primary ways. First, it provides an element of blunt performance feedback that therapists too often lack. Many clients are more willing to report worsening symptoms to a computer—even if they know that their therapist will see the results—than disappoint their therapist face-to-face. The second benefit comes from the metrics: Risk alerts allow therapists to adjust treatment, and can help them compensate for natural overconfidence and clinical blind spots.
A strong therapeutic alliance can lead to real change.
Notably, this therapist was a trainee. Only three clients were predicted to get worse, despite therapists being informed by the researchers that the clinic-wide deterioration rate hovered around 8 percent—and despite the fact that 40 clients, or about 7 percent of those in the study, ultimately did deteriorate. At that point—inspired by talks given by Scott D. Miller, who co-founded the International Center for Clinical Excellence and helped develop a fit system that uses algorithms built from , completed cases around the world—I was using fit as part of my approach to therapy.
June, who had recently dropped out of a local community college, was seeking help with anxiety, depression, and social isolation. She told me that she had been experiencing these symptoms her whole life. Her parents, with whom June still lived, were religious fundamentalists and very controlling.
Our therapy sessions seemed to start well. June was shy and quiet, and never made eye contact with me. But she seemed genuinely interested in learning skills to reduce her anxiety and reported practicing the skills between sessions. When I asked June for feedback at the end of each session, she told me the therapy was helpful. After a few sessions I finally checked the graph—more because I felt like I should than because I thought it would be helpful.
Her symptoms had not improved since our first session. The algorithms reported that she was actually at a high risk of deterioration and suicide. There must be a mistake in the software , I thought. June had repeatedly told me that therapy was helpful.
At the beginning of our next session, I asked her how she was doing. I felt my own anxiety rise, and resisted the urge to change the subject. My experience mirrors that of therapists around the world. As the systems have spread, they have accumulated ever larger banks of clinical data. Studies have shown that metrics significantly improve the effectiveness of psychotherapy, including reducing dropout rates and shortening the length of treatment.
Unfortunately, in profession after profession, metrics have not been received with open arms. The history of the thermometer provides a classic example.
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