The Fifty Minute Hour

Thoughts on therapy and life

Can you measure success in therapy?

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Can you measure therapy?

There is, and has been for a while, a great debate raging about the role of evidence based practice in counselling and psychotherapy.  My own position is that counselling is a very subjective experience which makes it difficult to measure and compare on a like to like basis. However, I also believe that any profession needs to examine its work and monitor it’s progress; how else can we know that we are working effectively?  On top of which, I’m fairly certain that you, as a prospective client, might want some idea of how good I am at my job (which is ultimately what we’re talking about).

So, how do you measure success in therapy?  One way is to use a questionnaire to get an idea of a client’s wellbeing at the beginning of therapy, and then again at the end of therapy, hopefully demonstrating an improvement. I do use this method, but completed questionnaires are not always returned and therefore the data I have is incomplete. Instead, I am proposing to look at ending types, taking a planned ending as a measure of success. A planned ending is where therapy is completed to its logical conclusion, ends when my client and I both feel it is appropriate, and the client leaves feeling better than they did at the start.

Clients starting therapy between Sept 2011 and August 2012

Therapy is still ongoing 17%
Planned ending 50%
Decided not to have therapy after the assessment 3%
Therapy ended due to logistical difficulties 14%
Client felt Therapy was not helpful 16%

So what about the 3% who choose not to continue with counselling after the assessment session? A lot of research exists which shows that the relationship between therapist and client is one of the most important factors in how successful or not therapy is. It is important therefore if you are contemplating therapy to ensure that you feel comfortable and safe with your therapist, and I would support any client who wants to see more than one  before making their final decision. Incidentally the corresponding figure for  NHS Improved Access to Psychological Therapies Programme (IAPT) services is 40% of clients not taking up counselling after assessment.

The 14% who end sessions for logistical reasons include those clients whose life intervenes, they move away, become ill, or often decide to pursue couples counselling with their partner.  Which leaves the final 16%; having talked about the importance of finding the right therapist it is inevitable that some clients will decide after a number of sessions with me that they have made the wrong choice and decide to leave before the work is done. It is also true that therapy is not easy and it can be tempting to walk away when it becomes too difficult.

Over, as a point of comparison, if we remove those clients for whom therapy is still ongoing, the proportion of planned endings rises to 62%, the same figure for the IAPT is 46%

Anxiety and depression are the biggest source of mental ill-health in the UK, and the majority of my clients last year were suffering from these problems. The second largest reason for seeking counselling with me was for difficulties with relationships, be they personal or more general.

It is known that the incidence of depression and anxiety in women is about 4% higher than in men. And although the numbers of men seeking therapy are increasing, women are still more likely to seek help in this way.  My own figures bear this out the gender split of my clients is 78% female to 22% male, which reflects but is disproportionate to the average gender difference in sufferers.   Sadly it seems that failure to seek therapy amongst men can have severe consequences; the leading cause of death in men under 35 in the UK is currently suicide.

So what else can I tell you about how I work? Well, clients often ask me for an idea of how long therapy might take, and my answer is generally, as long as it needs to, there is no formula to predict it. However, I can give you a breakdown of the number of sessions over the last year.

Clients with a planned ending to therapy Sept 2011 to August 2012

Up to 6 sessions 39%
7 -12 sessions 33%
13 or more sessions 28%

I said at the beginning that it is hard to measure the success or not of therapy, because it is such a subjective experience. Each client is unique and the therapy is a different process with each client because of that. However there are some themes I have noticed in why people find it helpful. Broadly speaking the ability to be able to say anything, and to be listened to, without judgement or censure, is a big part of what makes therapy successful. There is also a lot of benefit gained from understanding where feelings come from, and why we behave the way we do.

So, that’s what I’ve been up to in the last year or so, if you are thinking of therapy and have any more questions you want to ask me, please get in touch via the link at the top of this page.

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Author: Johanna Sartori BA MBACP Accred.

I'm just working at finding my way through life, and travelling with those on the same journey

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