Thoughts About Therapy

More thoughts about what makes a good therapist.  When you are trying to lose weight, your scale can tell you if your plan is  working.  Not so easy with therapy.  Sometimes you don’t think you are changing when you are.  Despite the difficulty,  research shows a good therapist needs to be asking “Is this helpful?”  “Is my advice working?”  “Are things changing the way you want to change?”   Doing so improves the effectiveness of the therapy.

Far too many mental health professionals don’t ask, particularly about whether the clients feels the therapist is on their side.   Parents often struggle because the child’s therapist seems allied with the child.  Good child therapists are allied with both the parent and the child.

If you or your child are in therapy and the therapist doesn’t get feedback, start doing it yourself. or insist the therapist do so.   Ask me for a sample 10 question therapy rating scale.   Send an email to [email protected] Rate 6 or 7 sessions; if things aren’t getting better or you don’t feel the therapist is on your side after  and you are doing things like seeing that your child takes  medication when prescribed,  you may need to ask for a change of therapists.  Minimally, you need to talk with the therapist about the fact that things aren’t changing.   Below  is an article that supports the need for therapists to get feedback.

When I ran a mental health program for families and children, I developed a  form that the therapist, preferably in collaboration with the client.  The narrative part of the form stated the  goal of the session, progress toward the goal and  including any homework tasks the family and child or therapist.  The form  also contained two quick rating scales.  The first was used at the beginning of the session to rate progress in terms of  “presenting problems”  i.e. why the child was seeing a mental health professional, and the  child’s general behavior and mood since the last appointment.   The second scale rated the session and included questions like “We talked about what I felt we needed to talk about.”  “I felt listened to.”   “I felt respected.”  “I feel the therapy  is helping my child.”   On these scales 5 meant totally agree, 1 meant totally disagreed.

The  forms were completed during the session, preferable in collaboration with the client,  and clients were given a carbon copies of the completed form.  Having copies was particularly useful for parents when they needed to let other professionals working with the family and child,  know what was happening in therapy.  For those parents being charged with neglect or abuse, the copies were used by lawyers to show compliance with court orders.

Most of the grown ups gave high ratings,  and I did have a good staff.  We also found that  a slip from a 5 to a 4 or a 4 to a 3 meant something had to be talked about.   Kids had to read at a third grade level to be involved in the ratings.  The younger the child, the better the ratings, but once the child became an adolescent, his or her ratings became much more open and more 3’s than 4’s or 5’s were given.  Teens hate have to get therapy.

Feed back is important.   You tell your car mechanic if he solved the problem, you tell your barber if you like his haircut.  Sadly, in the therapy field, too many therapists are reluctant to seek such feedback and too many clients don’t know how or what to look for.   I suspect that since I left that job,  my feedback progress note has been retired.  Families loved them, some staff loved them, the supervisors found them helpful,  but some staff  also found them a burden and preferred the old way of writing private progress notes in the quiet of their office after the clients had left.  So it goes.

Anyone reading this wanting to see a copy of the form, can email me at [email protected] and I will send a sample.

This article talks about the importance of feedback and links you to several other articles of value whether you are a client or a therapist.

Bringing up Baseline: The Effect of Alliance and Outcome Feedback on Clinical Performance « Top Performance Blog.

P.S.  What I learned from my forms would be called soft information, not hard core research.  That takes time and money to implement.   Nevertheless, most who use them find them useful, even the staff who didn’t particularly like completing them.

Agree or disagree, comments are always welcomed.

This site uses Akismet to reduce spam. Learn how your comment data is processed.