What Does It Mean To "Get Better" in Therapy?

What does it mean to "get better" in psychotherapy and counseling? Three dimensions of improvement are invaluable tools that both therapist and client should evaluate on an ongoing basis.

What does it mean to "get better"? While this question may initially seem evident the answer is not always so clear. Unfortunately many therapists don't spend enough time developing mutually clear and specific understanding about the goals their clients are seeking. When expectations and assumptions aren't both clearly evident and explicitly agreed upon, the therapy experience is likely to be more prolonged and less productive than necessary.

Some counseling goals are so elusive that they are almost guaranteed not to occur. One example I often encounter is when a client states "I just want to be happy". On the surface this seems like a very reasonable and worthwhile goal. After all, "the pursuit of happiness" is such a noble ideal that it is one of the "unalienable rights" listed in the Declaration of Independence. Of course, no reasonable person expects to be happy all of the time. Even if consistent happiness was actually possible, a recent book entitled Stumbling on Happiness makes the compelling case that most people do a poor job of predicting what will and won't make them happy over the long term.

I help clients make elusive desires more attainable by defining them in concrete and quantifiable terms. Unclear or diffuse goals often result in a frustrating lack of therapeutic progress. Questions like "what kinds of things will you be doing when you're happier?" and "what will other people notice about your happiness?" can bring the desired goal into greater focus, which immediately improves the likelihood that it can be attained.

I also try to help clients consider goals in positive rather than negative terms. For instance, instead of focusing on doing less of something, I like to help clients consider what will take its place. For instance, the goal of "having less arguments with my spouse" is brought into greater focus by specifying the desired alternative outcome, such as "having more fun together." Therapists often erroneously assume they know what a client considers to be a positive outcome, and this discrepancy can be a tremendous hindrance to true progress.

My years of experience have also taught me the importance of measuring progress along three different dimensions: frequency, intensity and duration. Whenever a person wants to move away from an undesirable situation (such as addiction, sexual dissatisfaction, isolation, etc.) toward a more positive one (sobriety, a more satisfying sex life, more friends, etc.) these three independent measures help to chart progress and eliminate unrealistic perfectionism.

  • Frequency is simply the number of times an event occurs in a certain time period. If a person unsuccessfully tries to stop smoking but reduces the number of daily cigarettes from 30 to 10, this is a definite improvement in the midst of the larger challenge.
  • Intensity is a subjective experience of relative power. For example, a person struggling with chronic depression may begin to function somewhat more effectively even in the midst of sustained periods of sadness. 
  • Finally, duration measures how long a situation lasts. Feelings of anxiety that abate in a few minutes are much more manageable than symptoms lasting all day. This ongoing three-dimensional assessment can help to reveal gains that are actually taking place even when progress toward an outcome seems slow or difficult to appreciate. 

When bad situations happen less often, resolve quicker or seem to be less intense, progress is taking place. This can bring an important sense of hope and encouragement that helps to reinforce efforts to bring forth further healing and growth.

No matter how it is measured, progress is likely to take a variable course, like the stock market or the temperature as the seasons change. Ups and downs are inevitable. The ability to track therapeutic gains along the dimensions of frequency, intensity and duration can reveal subtle distinctions that allow me to help clients fine-tune their efforts in order to bring about the outcome they are seeking to attain.

This is not to say that all progress can (or even should) be defined in empirical terms. Truly transformative therapy is not limited to what can be objectively quantified. As D. H. Lawrence wrote many years ago:

I am not a mechanism, an assembly of parts; And it is not because the mechanism is working wrongly that I am ill. I am ill because of wounds to the soul–to the deep emotional self.

Exceptional therapy experiences will almost always include some spark of the intuitive, the unplanned, the revelatory, and unexpected shifts and turns of direction will often occur as ever-deepening aspects of a person's true spirit and life path are revealed. But good essential therapeutic structure is necessary to best elicit these wonders, and a proper focus on measurements of progress are essential to that successful journey.

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I hope you will take a little time to read some of my many other articles to educate, encourage and inspire you along your journey to a life you richly deserve.  If I can provide more personal assistance to you, either in person, by phone or via Skype, please don't hesitate to contact me.