In a qualitative outcome analysis studying what clients find helpful in psychotherapy, researchers at U of Memphis describe some interesting phenomena. They asked 26 former clients about significant experiences and moments recalled from prior therapy (therapy had ended between 2 and 12 months prior). The article isn’t the best piece of writing nor the best qualitative work I’ve seen, but here are some interesting tidbits:
1. “On average clients were able to describe only 1.6 discrete significant moments that occurred across their therapy experiences…” [This may mean clients remember feelings and sensations from therapy more than the actual things we say. That should keep us humble.]
2. “Clients are needing just enough structure [of sessions] to facilitate reflexivity while needing to feel special enough to risk revealing and to be known.” [Clients seem to know they need to do the exploration of the self and yet it feels quite risky to do so. Therefore they often choose to seek safety and hide. If therapists aren’t careful, they easily collude with this avoidance tendency. Either a counselor can be too structured (which may stop clients from pursuing important issues) or too loose (which may allow client to stay on the surface).
3. “It was noticeable that clients rarely discussed symptomatic change per se as an important outcome of their psychotherapy….Although symptom reduction may be a positive effect of therapy, it may not be the primary benefit for many clients.” [Sample size is a bit small to make much hay with this. And yet, global changes such as feeling better about oneself, being understood, relating better to others, etc. may be more important to clients. Symptom checklists, which might make managed care companies happy, probably don’t really measure the best aspects of therapy success. I suspect that clients dome into therapy looking for symptom reduction but leave realizing that something greater than symptom reduction was gained. For example: normalization of a problem can be just as powerful as its removal.]
I see a parallel in the christian life. We come to God, to the Scriptures, looking for relief from some sort of problem. Often we leave with the comfort of having met God and knowing that he is with us–and less focused on whether the particular suffering is actually reduced (notice I said less focused, not uncaring).
Levitt, H. et al (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change. Journal of Counseling Psychology, 53:3, 314-324.
Musings on Faith and Psychology 