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In Reply to: What and how do you think things need to change? posted by JSP on February 28, 2006 at 10:11:16:
"One way I see psychotherapy as helpful is that people who need medications for mental illnesses often feel better and then stop taking their medications leading to relapses."
What you're describing is not what I'd call psychotherapy. I call it psychoeducation and mental illness self-management through wellness recovery action planning (WRAP). Both of these approaches have measurable outcomes in terms of increased knowledge about medication properties & side-effects, symptom monitoring & reduction, crisis planning, stress management, alternative therapies, etc. The first (psychoeducation) is done with a trained professional; the second (WRAP) is done on your own steam or with a peer counselor.
As far as talk therapy is concerned, everyone is entitled to participate in an individual treatment planning process where they set measurable goals. What does "feeling better" mean? It totally depends on the individual. For someone with PTSD, "feeling better" might mean learning how to manage stress to reduce the number and intensity of the nightmares (e.g., symptom reduction). Or learning how to identify triggers and not go emotionally out of control when the switch gets flipped (e.g., increase social functioning). The role of the therapist is to help the client identify what a better, healthier life looks like and to set measurable treatment goals. Therapy aims to help the person work through barriers and find facilitators to reaching those goals. This is outcomes-based treatment in a nutshell.
Despite what the writer of the article said, good therapists DO give people personal assurances of positive treatment outcomes. I was at a conference last week on children's mental health services. I listened to a family therapist and CBT practitioner talk about how she helps parents get anxious, tantrum-throwing, emotionally and behaviorally disturbed children under control.
The CBT technique she teaches parents is MUCH easier said than done, but this particular therapist also tells the parents that if they follow her instructions as prescribed, and they fail to get the desired results, she will give them her practitioner's license to tear up. (Her license is still intact.) As part of the treatment regime, the therapist also agrees to come into the home and/or be "on call" to help the parents as they're learning to manage the problem behavior until the desired outcome is achieved. I don't see that as bullying. It's sheer hell to live with an out-of-control emotionally disturbed kid.
A major point to my story is that 50 minutes once a week in the therapist's office isn't going to cut it for some people. Particularly where some seriously emotionally disturbed kids are concerned, home-based treatment services are a much better approach that (when done properly with the appropriate clients) produces much better outcomes than office-based treatment.
On the adult side, there are programs like "Doc in a Box," where a psychiatrist, nurse, and social worker go out as a mobile unit in a van and provide services to seriously mentally ill persons who live on the streets and in homeless shelters. In this case, getting beyond "one size fits all" means getting therapy out of the clinic and into people's everyday lives.
Whether or not the therapy involves an adult or parents or kids, a major therapeutic goal is to empower the individual(s) to better manage their illness and personal problems. You can't do a heck of a lot about changing the past; you CAN do something about improving the present and future quality of your life.
