What Does It Mean To "Get Better" in Therapy?

What does it mean to "get better" in counseling or psychotherapy? While this question may seem evident the answer is not always clear. There is an unfortunate tendency for many therapists to not spend enough time getting clear and specific understanding about the goals they are helping their clients to reach. In my decades working as an Atlanta counselor and psychotherapist I have learned that when important expectations and assumptions about therapeutic goals aren't agreed upon, the change process is likely to take longer and be less productive than necessary.

Some counseling goals are so vague that they are almost guaranteed never to occur. One example is someone who says that they “just want to be happy". On the surface this seems like a reasonable and worthwhile goal. After all, "the pursuit of happiness" is even listed in the Declaration of Independence. Of course, no reasonable person expects to be happy all the time, and even if this was actually possible most people do a poor job of predicting what will keep them consistently happy.  As Eleanor Roosevelt wrote, “happiness is not a goal, it’s a by-product of a life well lived.”

I also try to help my clients make vague or elusive goals more attainable by framing them in concrete and quantifiable terms. Unclear goals often result in a frustrating lack of progress that neither of us wants. I tend to ask questions like "what kinds of things will you be doing when you're happier?" and "what will other people notice about your increased happiness?" These kinds of clarifying questions can bring the desired therapeutic goal into greater focus, which immediately improves the likelihood that it can be attained.

I also think it’s preferable to frame goals in positive rather than negative terms. For instance, instead of focusing on doing less of something, I like to help clients consider what positive developments will take its place. For instance, the goal of "having less arguments with my spouse" is improved by specifying the desired outcome, such as "having more fun with my spouse." Therapists can mistakenly assume they know what a client considers to be a positive outcome, and even subtle differences of direction can be a tremendous hindrance to true progress.

My decades of experience have taught me the importance of measuring progress toward goals along three dimensions: frequency, intensity and duration, because these three independent measures help to chart progress and eliminate unrealistic perfectionism. This ongoing three-dimensional assessment can help to reveal gains that are actually taking place even when progress toward an outcome seems slow or difficult to appreciate. 

• Frequency is simply the number of times an event occurs in a certain time period. If a person unsuccessfully tries to stop smoking but reduces the number of daily cigarettes from 30 to 10, this is a definite improvement in the midst of the larger challenge.

• Intensity is a subjective experience of relative power of an event or emotion. For example, a person struggling with chronic depression may begin to feel and function in a somewhat healthier manner even in the midst of sustained periods of sadness.  The depression may not be eliminated but improvement has happened.

• Finally, duration measures how long a situation lasts. Feelings of anxiety that go away in a few minutes are much better symptoms lasting all day.

When bad situations happen less often, resolve quicker or seem to be less intense, progress is taking place. This can bring an important sense of hope and encouragement that helps a person to keep going to achieve more improvements. The ability to track therapeutic gains along the dimensions of frequency, intensity and duration can reveal subtle distinctions that allow me to help clients fine-tune their efforts in order to bring about the outcome they are seeking to attain. No matter how it is measured, progress is likely to vary, just like the stock market does or how the temperature can fluctuate from day to day as the seasons change. Ups and downs are going to happen.

This is not to say that all progress can (or even should) be defined so specifically. Therapy does not have to lead to measurable benefits to be successful.  As D. H. Lawrence wrote many years ago:

I am not a mechanism, an assembly of parts; And it is not because the mechanism is working wrongly that I am ill. I am ill because of wounds to the soul–to the deep emotional self.

Exceptional therapy experiences will almost always include some spark of the intuitive, the unplanned, the revelatory, and unexpected shifts and turns of direction will often occur as ever-deepening aspects of a person's true spirit and life path are revealed. But good essential therapeutic structure is necessary to best elicit these wonders, and a proper focus on goals and measurements of progress are essential to that successful journey.

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Bill Herring LCSW, CSAT provides psychotherapy, counseling and consultation on a private basis to adults in Atlanta who have had issues related to sexual behavior conflicting with their promises, their values and/or their self-control.  Appointments can be scheduled by calling or using this contact form..