Improve Therapy Outcomes For Poor Relationship Patterns — The Takeaways
A. Get better data — from other people
As a therapist, ask to hear from other people close to your client — their family, partners, friends. As a client, ask if your people would support you by offering their perspective to your therapist. You need this to check the veracity and the completeness of the description of personal events you will use for symptoms and diagnosis. This seems to be common practise for private therapy or school-based counseling for children, not so much for adult therapy. If you don’t do this, you have a single instrument , a single projection of a multi-dimensional reality— a single source of data , biased at that— and reliance on a single source of data is bound to lead to failure.
B. Validate your diagnoses
Check your hypothesized set of diagnoses against the symptoms you’ve gathered from past personal events. You are not just looking for a diagnosis to “make sense” or that each diagnosis explains a symptom. That is a very weak criteria. Given our tendency towards confirmation bias, don’t latch on too quickly to a diagnosis. The process for evaluating hypotheses has to be much more rigorous:
- Are almost all the important symptoms explained by the set of diagnoses? Are there symptoms or behaviors left out that need additional diagnoses
- Are there diagnoses that are unnecessary, in that the symptoms they explain are adequately covered by other, more powerful, diagnoses?
- Less critically, do the hypothesized diagnoses predict other behaviors that should be looked for, even if they haven’t manifested?
C. Do practise problems
The goal is to improve future performance, right? And theory isn’t enough — not in the physical sciences, not in athletics, not in music nor in art. You need deliberate practise. In therapy, unlike in the physical sciences, you can’t set up experiments in unexplored domains to test your hypotheses or predictions; you can’t solve large banks of problems, or do drills or repeatedly play or sing music. Unlike in the social sciences, you can’t even set up Randomized Control Trials or A/B tests on yourself or your client. So how do you develop the skills you’ve learned about, and need ingrained but for which you don’t yet possess muscle-memory? In the words of Rebecca Solnit, “It would be really meaningful to review the personal events of August 1997 in the light of what you know now.” (From her July 2013 essay We’re breaking up in The Encyclopedia of Trouble and Spaciousness, pg 262.) What this means: For every personal event in the past, given the same external situation, the choices you faced, the outcome of your past actions and your desired outcome, analyse what you would do differently in the light of your diagnosis, and what outcome your hypothetical actions would lead to. Is this your desired outcome or not? Remember, this is deliberate practise, so “look in the back of the book to see if you got the right answer”, namely, get feedback from the therapist or from your (the client’s) people!