Why is therapy so slow to change?

Let’s face it, if you’re going to spend eight years going to school you’re going to want to use what you learned. Even if the material is 30 years old or your schooling was 10 years ago. For some reason we understand that we’re constantly learning new things and technology and even in medicine. And yet we don’t seem to expect that of psychology. This is really erroneous thinking on our part. There’s new research being done on the brain, DNA, nature vs nurture, and various techniques used in psychotherapy.

One of the most researched techniques, cognitive behavior therapy, shows some real promise in areas of therapy we thought wasn’t possible to fix. There are certain mental illnesses that were thought incurable, as if they were some kind of brain deformity. Now we’re learning even if the brain has had issues, or there has been trauma, we can teach coping skills to provide a more fulfilling and rewarding life. But the industry itself is slow to change. You don’t have to go back very far when people just shut away those with a low IQ or mental illnesses that were treatable.

It grieves me to hear people talking about how long, or even impossible it is to recover from traumatic events or years of abuse. It does take effort, and it can be painful.  It does take time, even with brief therapy your brain doesn’t change instantly, but certainly there is hope for recovery. I don’t believe in some magical formula. What grieves me is the idea it is going to take years and years and there are only little changes, little advancements. I’ve not found to be the case in my experience. And I have colleagues who’ve found that’s not been their experience with their clients either.

So why aren’t all new therapists doing things differently? Many are. That’s the good news. Every week I meet new colleagues who are embracing a more effective way of doing therapy. There are more and more people going into the field who want to see their clients get better quickly. Who believe that there’s a lot of labels in the mental health industry that are not useful and possibly even wrong.

Unfortunately, not all therapists are trained the same. Unlike other professions where there is a very specific set of diagnostic and treatment tools, in psychotherapy and psychology there are many of theories, many ways to do “therapy” and much subjective debating. Even the DSM-V is under fire by some experts. The general public is not always aware of all this. First of all we can get in trouble with our associations if we say things that make others in our profession look bad. But it’s important we not hide from the facts. We need to embrace change and propel this industry into the future with success. Peoples lives are at stake. So I’m willing to take the risk because I think it’s unethical not to make a stand. Our profession needs to change. There needs to be more accountability. And regulations and associations are not cutting it. I get that that’s a starting place but without some kind of unifying documentation to show what works and what doesn’t we’re all sitting around a table arguing theory.

What does this mean to you as an individual? It means don’t give up. Don’t fall for the rhetoric you see on TV and don’t be afraid to try more than one therapist or counsellor if you’re not finding recovery and success. That being said your therapist can only provide so much without you investing in a willingness to change yourself. That leaves me to number three.

Of course I don’t have all the answers, nor am I the perfect therapist. I don’t even have a doctorate like many others in psychology.  I only know that without awareness we can’t move forward. We have to be able to analyze what’s going on right now. What’s working? What isn’t working? And the only way to do that is to have data. The only way to have data is to do testing. Many aren’t ready to go that route. They think it will interrupt therapy, cause a break in empathy. The evidence I have seen so far is the opposite. Testing actually brings us closer to the patient. (burns podcast) We can’t read minds.

No matter how skillful therapist is they can’t possibly know what a patient is actually thinking and feeling 100% of the time. If one thinks they know something they don’t improve. They think they’ve got it figured out. In school we are told if the client is not improving that’s transference and it’s some kind of psychological issue the client has. Or the client has some incurable mental issue. The reality is more likely if a client isn’t improving it’s likely the therapist who has the problem. Either they’re not creating enough empathy and therapeutic regard, or they’re jumping into methods too soon, or they’re using the wrong methods for that client, or they haven’t dealt with the clients resistance to change, or the pushing the client to change something the client is not willing to change.

Mental Health does have many subjective components so how do you collect data? What is happiness? How do you define that? What does the client mean when they say I feel desperate? In medicine it was thought pain was too subjective to measure. For years pain management was done by doctors analyzing the source of pain and use a calculated average based on nerve endings, function, non-verbal cues, etc. But we’ve learned that, while pain is subjective, it is relevant to the person who’s going through it. And now pain scales are used in hospitals all over the world on a regular basis to test patients and collect data to determine a course of action. Yes, observational tools are still also used but medicine did just throw up its hands and say, it’s too subjective to test and treat, so each doctor can just do whatever they feel is right.

This is totally doable in the Mental Health industry too. Dr Beck started it with his depression inventory in the late 70’s. There’s been some other surveys and assessments out there and there’s new ones coming out. They’re not always done with skill. Anyone can write a survey, but unless you understand how statistics work, you can create questions that skew the data. This leads to conflicting information and the conclusion we really can’t understand the brain so we have to go by instinct alone. But in my mind this is unacceptable. We can go over data, we can see where we’ve made mistakes, and we can continue to refine it and prove it. We can combine the art of therapy with a more trained, objective process.

Let’s continue to explore and learn. We don’t want to get stuck in the dark ages when it comes to mental health. Let’s embrace analyzing what works and what doesn’t. We don’t have to be tricked into thinking it’s not possible. We really can put a number on it and find healing.

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