Is your therapy working for you?

“So,” I ask, as Suzanne and I both settle into our seats in my office, “how was your week?”

“Oh, I forgot!” she exclaims, and pulls out her phone.  I pull mine out too.

This isn’t the 21st century getting in the way of therapy, it’s taking therapy to the next level.  We’re both opening up MyOutcomes, a secure online system for tracking therapeutic process.

“I had a bad week,” Suzanne says, sliding her thumb along the “individual” bar to one side to indicate that her mood is low, but the “interpersonal” bar the other way to show she’s been getting a lot of support from her friends. “I’ve been feeling sad a lot this week, thinking about everything, and I took a day off from work. But I managed to talk about it better with my friends, so at least there’s that.

Her score—a measure of how she feels she’s doing in four different areas of her life—shows up when I refresh my own screen.  It’s part of a graph showing how our work together has gone. Before she comes into my office to talk with me, Suzanne gets a cup of tea in my waiting room and uses this app on her phone to record how she’s feeling. This our fourth session; the line rises from the first time we met to our second and third meeting, where she felt she had more of a handle on her emotions and was finding ways to communicate her struggles to the people who care about her.  But it’s down now, almost to where she was after we first met.  We’ll have to talk about that today, to make sure she keeps up the new habits we’ve started to develop.

This is a far cry from how I saw therapy depicted on TV when I was growing up—a psychologist peering inscrutably over their notebook while the patient squirms and nervously wonders if they’re crazy or not. As a therapist, I’ve discovered that the best way to practice is to be clear and collaborative about what’s going on. I don’t see the people who come to me as sick and needing a cure—they’re people stuck in a problem who need a way out.  That means that instead of me defining what’s “wrong” with them and setting the goal for “healthy”, we talk about the problem together and they tell me what their goal is.

Then when clients ask me, “Is it working? Am I getting better?” they can answer for themselves. We can pull up their graph and see if there’s been any long-term improvement—this simple questionnaire, asking people to decide how they’re doing in different areas of their life, is an amazingly accurate guide.  We also revisit their goals for therapy on an ongoing basis, to see if they’re getting what they wanted out of the process. Sometimes they’ve completely achieved their goals and decide to move on without therapy, and I only hear about them if they send me a card or recognize me on the street and decide to say hello.  Other times, they add new goals to the list and we keep pushing forwards.

Asking your therapist about your progress can be intimidating for some people. Some of my clients come to me with the idea that I’m completely in charge—that their job is to sit back and do the work I I assign for them.  I’ve always found, however, that we do the best work when clients can ask me directly, “What can I expect from this therapy? What will it involve?  How fast will I see improvement?” It’s their therapy.

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