Aces for (Some) Cases

PSYCHOTHERAPY

Report cards are not just for kids anymore. Now, both patients and therapists can use them to abet the course of psychotherapy.

Psychiatrist David Burns, M.D., developed a simple report card that allows patients to rate the warmth and understanding their therapists deploy each session. The report card is an outgrowth of studies he conducted demonstrating that the quality of the relationship between therapist and patient may be as critical to relieving such disorders as depression and anxiety as methodology and possibly medication.

Burns, a clinical psychiatrist and researcher at Philadelphia's Presbyterian Medical Center has patients rate their therapists from zero to three on some simple measureS:

o "I felt that I could trust my therapist during today's session."

o "My therapist was friendly and warm toward me."

o "My therapist did not always seem to care about me."

The negative reports are the most difficult, says Burns. But therapists who swallow their pride can use the empathy report to help forge more genuine patient relationships.

Burns finds that almost all therapists are rated lower by their patients than they had anticipated. "But a bad report card," he says, "can help a therapist understand what has to change if a patient feels uncomfortable."

To up their empathy grades, most therapists will have to unlearn a few things. Like responding to criticism with defensiveness and hostility. Although therapists like to view themselves as warm and objective, research indicates the opposite. They frequently respond to patient criticisms with interpretations that are accusatory and negative.

The therapist-client relationship is a double-edged sword, comments Burns. When therapists respond with compassion, they can have a rapid healing effect. But they can do damage with a hostile response.