I was stimulated in a conversation with colleagues recently to give thought to how value can be measured in psychotherapy. How is it that we know we are doing a good job? Is it enough that clients keep returning?
I trained as an outcome-oriented psychotherapist. This means that at the start of the therapeutic process I assist clients in identifying what it is that they would like to have happen. Not just a broad statement like 'I want to feel better' but a specific understanding of what their goals are, how they will know when they have reached them, and what will be different to what is happening now.
Having clear goals makes the measurement of value relatively simple. For me it is not about using standardised questionnaires to check out symptoms, although they can sometimes be helpful. The most useful guide I find is to I regularly review with clients how are we doing in working towards what they want to change?
Psychotherapy is not a linear, straight-forward process. We may be metaphorically sailing from point A to point B, and yet we might appear to be moving in a tangential direction. I think of these tangents as vectors, like a sailing boat tacking across the water to make best use of the wind and move gradually towards the destination. As a therapist I feel accountable for knowing what vector we are on, and being able to explore this with the client should they wish so that they are clear how the therapy is working in their interests.
Oftentimes in therapy we are sitting with deeply uncomfortable thoughts and feelings. We frequently go on voyages of discovery into the unknown where neither of us know the answers or where the exploration will lead. All of this is entirely congruent with working in an outcome focused way. Having a sense of why we are exploring, to what end, supports motivation and willingness to let go and dive in.
No therapist can guarantee any particular outcome from the process, nor can we take sole accountability for what happens. Like any joint endeavour, the process of therapy arises between the client and therapist, they both impact it and it touches and changes them both. I believe that the important thing for measuring value is holding in mind the outcome, even when clients mid-process may be feeling worse. As Victor Frankl powerfully once indicated, having a strong why can make any how more bearable.