The Fifty Minute Hour

Thoughts on therapy and life

Why does everyone want to measure success in therapy – and what does that even mean?

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Whilst reviewing the traffic to this blog recently, I noticed that “How do you measure success in therapy?” is by far, the most read post I have ever published.  I imagine because the title reflects a common search question (up there with “how to measure progressing in counselling” and “how to


Can you measure therapy?

measure the effectiveness of therapy”).

 The original post was in fact a critique of the  NHS Improving Access to Psychological Therapies (IAPT) programme but it’s high hit rate got me thinking about what people expect from therapy. In some cases it’s more obvious – people with phobias want to be able to go about their life free of the fear that restricts it, the PTSD sufferer wants to stop reliving their trauma and addicts want to be clean and sober. But what about the others?  The people who come to therapy with depression they can’t place the reason for, the vague feeling that life isn’t going as it should and why aren’t they happy or the people who want to explore why they keep repeating the same destructive patterns.  There is a grim irony in the fact  that such clients are so out of touch with their own sense of self that they need Google to tell them what feeling better will look like.

But I guess I shouldn’t be surprised – for all the recent emphasis on mindfulness, wellness and the urging to just “be”, there is  a corresponding obsession with relentlessly measuring every aspect of our lives (I’m no different, my fitbit is probably counting my hand movements as I type and upping my step count for the day.)  Don’t get me wrong, I understand that measuring performance is necessary and to some extent A Good Thing, but the more we rely on data, the more we lose touch with our own felt sense of what is going on. And that sense of self or rather regaining it, is so much a part of what therapy is about, and, it’s not easy to measure, count or record.

I imagine that’s something Selma Gomez recognised when she took three months out of her career earlier this year to look at the anxiety that was plaguing her; in an industry driven by 24/7 social media presence, she gave herself a huge dollop of self care and took the time out to heal.  I feel less certain that Kanye West, bouncing about LA after his reported psychotic breakdown has his priorities quite as straight.

For all the progress made in talking about mental health, the idea still persists  that  humans beings are hugely resilient, but that which we often applaud as coping is actually just deferred or buried pain. We bruise easily and left unattended these bruises spread and blush until they can no longer be ignored. We might have given our painful experiences a narrative, which allows us to assert that we have “dealt with it”, but the narrative is the packaging, the hook on which we hang the thing that happened, it is not the healing. The healing is messy, we have to unpick the narrative, to go back and experience those feelings and reconstruct the story in a way that acknowledges the truth and helps us make new sense of the world and our place in in. This takes time and is not something that can be done in two sessions, which is what IAPT considers to represent “completed treatment”.

Instead therapy is an exploration and a better measure of the success of this, at least in the early stages, is the therapist you chose to do this exploring with. There is no route map,  your therapist might have an idea of the direction you’re heading, but really a good one is just offering to travel alongside you. What’s important at this stage is that they feel like the sort of person you are happy to set out with on those terms. Do you trust them, do you feel like they are listening to you, do you feel that they understand you, or are willing to learn to understand you? Could you tell them when you are angry with them, or when you’re scared or think you’ve taken the wrong path? If the answer to all these is yes, then you’re in a pretty good position to start the real work.

The real work is where it gets messy; this is where you might feel more pain that you signed up for. I often think it is like crossing a wide river, it starts out ok, but by the middle the current is strong and you can’t touch the bottom. This is when you have to keep going, however hard it is and this is when you will understand the importance of the right therapist.

A word about endings. At some point the work is done, or more work is uncovered, you may feel it is time to stop, you may need referring to a practitioner with different expertise. The point is that whilst I believe in open ended therapy, it is important to keep the end in sight. Again, a good measure of success is a therapist with whom you can review where you are, and journey towards that ending together.  

IAPT, as part of the NHS, publish annual figures of their performance against key performance indicators which suggest the provide a comprehensive and responsive service. For some people I am sure they do and there are many excellent therapists within the IAPT Programme. However, therapy, the relationship between client and therapist, that is,

where the work is done, is not definable or measurable and doesn’t fit into indicators. Therapy is a leap of faith, take it and learn about yourself, you’ll know if it is successful or not.


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Can you measure what therapists do?

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measure successWell, that’s a tricky question; just asking it can be enough to divide a room of therapists.  Added to which, there are many different types of therapy, psychoanalysis is maybe slightly out of favour, considered old fashioned and self indulgent, whilst Cognitive Behavioural Therapy (CBT) leads the developing field of new therapies promising effective short term results.  It appears foolhardy to attempt to classify results from different models using a single measure, yet without such a measure how can you compare modalities? View the pictures →

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Agony Aunts – good or bad?

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agony auntsI was doing some breakfast reading recently when I stumbled upon Mariella Frostrup’s advice column in the Guardian. She was replying to a letter from a woman who was presented as having a problem with chocolate. In fact the desperate cravings, secret eating and division of days into “good or bad” (depending on what she had eaten) shouted disordered eating. I read through the response waiting for the bit where Mariella addressed this and gave out details of where the writer might get help – but no, nothing of the sort. View the pictures →

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Rugby, motherhood and therapy.

rugbySo, picture the scene, a bunch of pre-teen girls are playing their first national final in a Rugby tournament. It’s 130 miles away from home and only a handful of parents have made the journey to watch. They win one, lose one, and have to win the third to progress out of the group stages. They are out classed and out sized in this final match, but sheer determination and a refusal to give up see them edge into the lead, and their star player is making a run for the try line that will make victory unassailable when she is tackled and falls awkwardly with her opponent on top. Continue reading

How useful are self-help books for treating depression? (not very)

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self help books

Luisa Dillner asked this question in the Guardian on 28th Jan, quoting from a recent study suggesting that self-help books could treat depression better than antidepressants or therapy, relatively cheaply and without side-effects. View the pictures →

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