What speeding tells you about the effectiveness of therapy
I remember when discussing the topic of driving I’d often tell people “I don’t speed”. Often with a tone that reflected my confidence in this fact and that I wore it with a badge of honour. This was a belief I held for years until I recently got a new car…..
“I couldn’t understand how my belief was so wrong”
IThe first day I drove that car it told me that I went over the speed limit 11 times. Mostly in small roads and back routes. Initially, I was convinced something was wrong with the car’s performance but, inevitably day after day, my car told me I was going over. I realised it was my mental performance that was lacking. My brain had concluded, “I don’t speed” by calculating my experience of no speeding tickets and a general intention to stick to the speed limit. I couldn’t believe how my belief was so wrong. The fact of the matter was I did speed and this occurred often. My brain had fallen victim to the cognitive error of generalisation. It had identified that when I was intentionally monitoring my speed I did not break the speed limit but it had generalised that I intentionally monitor my speed all the time which was incorrect. Only through practice of intentionally monitoring my driving speed did I have the power to adapt the way I drive and reduce the frequency of my speeding (although it still sometimes happens).
This parallels my experience in supporting people with psychological treatment. I’ve always held the belief that “I provide effective treatment”. The fact of the matter is I have the intention to provide effective treatment with all my clients but not everyone improves. The first time I evaluated how many of my clients had an improvement in distress I was shocked to find it was 89% rather than the 100% that I assumed. Then I more strictly re-evaluated the data looking at those that saw a larger improvement due to treatment (i.e., reliable improvement) and the results were more surprising with 67% of clients experiencing reliable improvement. In the words of a leader in the field of effective treatment, Dr Jason Seidel: “Sure, using a harder grading system might not make us look as good. But if we don’t apply tough standards, how real are our results?”
I have thought a lot about how I provide treatment to clients since this time. While research suggests that these rates of improvement are better than average performance (benchmark rates for reliable improvement are often cited as above 50%). Average performance is not enough when clients have to navigate the challenges of finding a Psychologist by visiting their GP, getting a referral, searching endless websites, reading many acronyms (CBT, ACT, DBT the list goes on) and then bravely choosing someone that “seems to fit”. Clients do all this all while feeling at their worst, the least we can do is to provide the most effective treatment possible.
I have changed the way I monitor client progress to include clients feedback about how effective they feel treatment is. I have included one question each session for clients to rate how close they are to achieving their goal. I no longer assume all of my clients are improving and when I identify those that aren’t improving I work with them to adapt the treatment, get them more support or include specialists. I am practising intentional monitoring of each individual client, their goals, their progress and how to adapt treatment. Much like my change in driving, I’m finding out quickly when the treatment is speeding towards a client not improving, the client and I then adapt and increase the chance of the client reaching their goals. Just like speeding, old habits of ineffective treatment are being broken.
