In therapy? Here's how to assess effectiveness

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In therapy? Here's how to assess effectiveness

By Alpert, Special to The Times

March 26, 2007

http://www.latimes.com/features/health/la-he-

mind26mar26,1,6227177.story

So, you've been in therapy for several months and aren't sure if

you're improving.

You seem to feel better, getting things off your mind each week, but

how do you know if you're actually gaining from seeing your

therapist? There's a difference between feeling better and getting

better. The former usually brings immediate relief. The latter

results in lasting life change that will lead to healthy behaviors

and new ways of coping with stress and problems. This comes only

when you acquire tools and skills you can apply beyond the immediate

crisis or concern that brought you to the therapist in the first

place.

In psychotherapy, regardless of the school of thought, a

collaborative effort should exist in which the client and therapist

both work hard to achieve the desired outcome.

One of the first things that you should do is make a list of

realistic goals and what you're hoping to gain from therapy. Share

it with your therapist so that a specific treatment plan can be

established. Reviewing the goals every few sessions will give you

and the therapist an opportunity to monitor progress.

Ideally, as insight, support, and direction are provided, you should

move closer to reaching the goals with each session.

Homework should be given, as this bridges what's learned in the

session with what happens in real life. It gives the patient an

opportunity to develop thoughts or concepts arrived at during

sessions, to try out newly acquired skills and to implement

exercises.

For example, if social anxiety is the problem, then homework may be

practicing relaxation techniques and an exercise in which the

patient approaches others casually, asking for the time or

directions. The patient should keep a written record of his or her

reactions to the exercise and bring it back to a session and review

it with the therapist.

As treatment continues, information learned in sessions will be more

accessible when a patient is away from therapy, and come more

naturally. The patient will develop a set of skills that can be

applied with confidence to situations that once proved to be

problematic.

Over time, the patient will find the answers and rely less on the

therapist's guidance, and the need for sessions will be less

frequent, allowing the patient to develop a sense of independence.

Be a good consumer of this personalized service and assess your

progress. One way this is accomplished is to review the notes and

goals that were established at the first session. This will reveal

what progress has been made — or not. It's quite possible that goals

aren't being reached but you're simply feeling better having someone

to talk to. This isn't the healthiest set-up, as it could lead to

becoming dependent on your therapist. An honest and skilled

therapist should recognize this — and either set a new course of

treatment or suggest a different therapist.

What are some signs that you should shop for a new therapist? Beyond

a lack of progress toward your goals, there are some other things

you should check.

Therapy is your time and your opportunity to address issues.

Therefore, you should be the one to choose what's most important to

work on.

You should feel respected in session and not as though your

therapist's values are being placed on you or you're being judged —

otherwise, you'll surely feel uncomfortable and limit or withhold

valuable information.

A feeling of safety should also be abundantly available, as therapy

addresses sensitive and fragile issues.

Don't just accept the therapist's methods. In fact, the talk therapy

model where patient talks and therapist listens, offering an

occasional, " I see " or " tell me how that makes you feel, " isn't

necessarily the gold standard or helpful.

Rather than being a passive participant, take an active role and

question the course of treatment and outcome. After all, with a

physical disorder, if the doctor prescribed medication or physical

therapy and you saw no improvement, you'd probably speak up.

If, say, after a month of treatment for anxiety you still worry

excessively, feel restless or edgy and have difficulty

concentrating, then bring it to the therapist's attention. Share how

you feel and don't assume it's known. A disorder such as anxiety is

treatable and results are measurable. Frequency, duration and

intensity of symptoms can be monitored — and there should be

noticeable, if not marked, improvements after several weeks as you

learn new skills and develop insight.

If you try therapy and don't feel comfortable, chances are it's just

not a good fit — and not necessarily a reflection on you. It's a

very personal service, and comfort has to exist. If it doesn't, keep

trying until you find a therapist you click with: You'll likely know

within the first few minutes. Don't give up.

Although it may be a sensitive matter, word of mouth is probably the

best way to find a good therapist. If someone you know has gained

from seeing one, then he or she will probably be proud to share

those improvements with you and tell you about the person who

helped.