The Art of Getting Better From Therapy
In the modern era of therapy, measurable goals are the key to success.
Posted February 9, 2021
Therapy is about as precise a term as "medicine."
So imagine if someone said, "I tried medicine, and it didn't work," and someone shot back with, "Medicine is great, I took some and it's done wonders." Another could very well say, "I did medicine once and my hair fell out." They'd all be right. Imagine how scary and weird it'd be to not know what medicine was, to hear all these conflicting stories about it, and then have someone suggest you try it. No thank you.
Details make all the difference. Like medicine, it encompasses many different practices and methods with vastly different goals and very different outcomes. When considering therapy, it's important to know what method they're using. There's Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Art Therapy, Play Therapy, Primal Scream Therapy—each of which might fit a particular problem better than others.
Some are more freeform, and they help people feel heard and cared for. Others are more precise and regimented, with clear techniques for identifying problems and dealing with them. More "boutique" offerings might involve sensory deprivation chambers, nutrition and exercise guidance, hypnotism, or even hallucinogenic drugs.
However suspect these methods might sound, I've met people who've benefitted from each and every type of therapy just mentioned. And I believe the key is just that: There is an explicit method.
Your Therapist Should Have a Method
Good therapy offers a method. For example, Cognitive Behavioral Therapy (CBT) builds up one's ability to recognize and categorize negative thoughts, from which there are methods to neutralize those thoughts. So if a therapist who offers CBT spends the entire session looking at their laptop while people air their dirty laundry, it's easy to say that therapist is not a good option for CBT. Another popular variation of CBT is Dialectical Behavioral Therapy, or DBT, which is a more focused method for dealing with specific subtypes of psychiatric disorders like borderline personality disorder or chronic suicidal thoughts.
One of the more traditional methods is psychoanalytic therapy, with its roots in the works of Sigmund Freud. In psychoanalysis, we encounter many of the "classic" theories of the suffering mind: constructions of the self stemming from Ego, Id, Superego, "defense mechanisms" like projection, the role of the "unconscious," repressed feelings towards parents that drive seemingly unrelated adult behaviors, dream interpretation.
Psychoanalytic therapy is time-intensive and less popular nowadays than it was before. In a similar vein is Psychodynamic therapy, which incorporates the tradition of psychoanalysis with more contemporary concepts from other practitioners like Carl Jung and Melanie Klein. Together, psychodynamic therapy still focuses on identifying and resolving inner, often subconscious, conflict.
Another common approach is humanistic therapy, which prioritizes affirmation and actualization of one's true self. By identifying and fundamental needs of the patient, and where needs are not met, the hope with humanistic therapy is that working towards meeting those needs and affirming patient agency will allow for an improved sense of self—which humanistic thought assumes will bring about a better quality of life. Humanistic therapy focuses on affirmation and non-judgment and encourages the patient to come about their own conclusions and direct their own treatment.
The Importance of Outcomes
The beauty of studying and treating the human mind is the diversity of approaches to getting better. Because our minds are so complex, any number of these different approaches out there might work, and it's important to be open-minded and optimistic about your personal journey towards healing. However, there is one area in therapy where things need to stay business-like and impersonal. Therapists, just like doctors, need to be accountable for their actions.
Most approach therapy with one goal: getting better. That's not enough. In the era of evidence-based practice, good goals must be well-defined and measurable. Bad therapy can hurt more than it can help, and the only way to understand the difference is if you can measure your progress. Bad therapy—characterized by little progress and wasted resources—thrives when there are no goals, or if neither therapist nor patient keeps track of these goals.
Now, where do we start? Measuring anything having to do with the mind is a tricky business. But we can begin by comparing what a hypothetical miserable person might look like, and compare them to a happy person. What are the first things that come to mind, and how can we measure these differences?
- Miserable people are chronically unhappy and stressed. Thankfully, you can measure your own "misery" (so to speak) with a simple daily 1-to-10 scale. Yes, it's simple, but evidence proves that this is a valid way to track wellbeing. To keep yourself and your therapist accountable, see if your numbers improve over time. If not, it might be time to reconsider another therapist.
- People who don't feel good have trouble enjoying things. If therapy opens new avenues of enjoyment or helps you better enjoy what you already have, that's a good sign. And it's measurable. Ask yourself how often you've engaged in an activity and enjoyed yourself. Again, if you experience increased enjoyment, or if the existing activities become more enjoyable, therapy could be working.
- Poor wellbeing might involve unpleasant thoughts or feelings of dread. Ask yourself how often you have traumatic or unpleasant episodes throughout the week or within the past day. If they become more manageable, less unpleasant, or less frequent, that's progress.
- Those who are unwell neglect themselves. That means eating less well, not exercising, skimping on personal hygiene, missing medical and dental appointments, giving up hobbies, etc. Take stock of how much self-neglect there is in your life, and see whether therapy increases your ability to care about yourself.
- Do you feel like crap after a session? Some people, after sorting through traumas or stressors during a session without helpful direction from a therapist, exit a session in tears or rage. Recognize that there is a subtle but important distinction between exploring traumas and fixating on them. If therapy gives you little enhanced understanding of trauma and no new perspective or tools to handle that trauma, you've wasted your time and money.
Now those therapists out there with less-defined methods can still work—by virtue of intuition, or interpersonal skills, or perhaps telepathy—but those people are unicorns, subject to the luck of your draw. Granted, those drawn to becoming therapists often have a knack for these soft skills, but the consequence of finding, and getting attached to, a therapist who has neither knack nor method can be severely damaging.
The Attachment Trap
It's inevitable to feel connected to someone who you've shared private details with. In some forms of therapy, that bond is seen as inevitable and potentially useful. However, if measurable goals are not met, and you are reluctant to move onto another therapist, you've been trapped.
When a therapist has clients airing their inner demons and repressed traumas, week after week, month after month, without offering an explicit method or outcome, the bond between client and therapist cements, thus blocking one of the last conduits for reaching someone who might be going down the tubes.
The Art of Getting Better
If there's one thing I'd recommend for good therapy—something I'd tell myself, my loved ones, and my patients—it's that you should set measurable goals. Doing so requires you commit to what your therapist asks of you, and stay mindful of whether your therapist helps you reach your measurable goals. However, all advice can be misused. Therapy takes time. Looking for improvement after a mere two or three sessions may not be helpful.
Finally, if you're in the middle of a short-term stressful life event, give yourself permission to feel bad, even if you're trying your best. But when things stabilize, and therapy still isn't cutting it, perhaps it's time for a change.
To find a therapist, visit the Psychology Today Therapy Directory.