Sunday, June 5, 2011

Goals of therapy - practical

Kahless says:

Well I look at where I am at the moment. I am in my early 40s. I exist in a state of not happy and not unhappy thanks to the medication propping me up. I am thankful to the anti depressants that I am not in that low point of nothingness that I felt earlier this year.
I don't know what I want not what I don't want. You suggest a don't get my needs met injunction, but I don't even know what my needs are. I am by most people's standards, successful. I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.
But I am not happy. I do not know what will make me happy.


Her comment raises three interesting points for me.
I will address the first one here and do the other two at a later time.

I saw a piece of research once that outlined the best predictors of the outcome of psychotherapy. Or the importance of things in psychotherapy. It isolated three aspects of it
1. the techniques employed
2. the relationship between client and therapist
3. the practicalities of one’s life at the time

The results were something like
1 = 20%
2 = 40%
3 = 40%


However you can’t quote me on this because I can’t find it so these may not be fully accurate. I recall looking at it and being a bit surprised about the practicalities of life being that influential, but after some consideration it does make sense. This includes things like having a decent income, having relationships in life that are reasonable, living circumstances are OK such as having a home that is reasonable, diet that is OK, having a social life and so forth.

The more one has of these the better the prognosis when the client enters therapy. This is a bit sobering because it is easy for therapists to get lost in their fancy therapies and fancy techniques and so forth. It notes that therapists should initially at least focus on such practicalities in the treatment plan. This may seem a bit basic, and it is, but it is most important at least at times.

Man leaf

Many years ago I recall working in drug rehab with this guy who had a long term heroin problem. He was a nice guy and we established quite a good working relationship over some time. I recall we used to laugh a lot together. At one point he came into quite some money. Of course I did not ask how he came across the dollars, I just noted that he did.

Since our first meeting I had noted that his top front teeth were not too good, being quite discoloured and somewhat decayed. He had never mentioned them as a problem. I was the one who brought it into therapy. I suggested that he use some of the money to have his teeth repaired, whitened and so forth. He responded that he did not care what his teeth were like and he was unconvinced by my suggestion. I persisted with the suggestion through a couple of sessions and he finally did seek out the appropriate dental work, had it done and it did look decidedly better. Whilst I did think it was a good idea, one reason I suggested the dental work in the first place was because if he did not spend the money on his teeth it is highly likely that it would go on drugs.

However the surprising thing was the therapeutic results that it caused. He said that after it was done he felt so much better about himself. He reported that when ever he looked into the mirror he saw a reflection of himself that he liked. He had not not even aware of how this had effected him for so long. That he had disliked the image of himself every time he looked at it almost everyday.


I have never forgotten that. I could have spent my time doing fancy relationship building and fancy techniques to assist him to express his anger at his mother and so forth, when one of the things which turned out to be significant in the therapy was getting his teeth fixed. Something that simple. One of the simple practicalities of life turned out to be a significant factor in his recovery.

And my point is?

When Kahless says:
“I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.”

I know this is a good prognostic sign should she ever decide to take up therapy with a male therapist



  1. Well G, my doctor referred me for "talking therapy" and I have an appointment this Thursday at the local hospital. The person I am seeing is a man, but I suspect it is just an initial assessment. I am not sure where this will lead me and I am somewhat sceptical.

  2. Hi K,

    I hope it works out well for you in the long run. I note your skepticism and may suggest that you let the therapist know of this feeling you have at the beginning. Only if you want to of course.

    Take care my pommie friend


  3. Yes. I am intrigued myself as to how I will approach this. Whatever I imagine, I suspect a high cc will emerge. But I am enjoying the thought of different rc scenarios. Bottom line is that I felt it was a condition of getting the antidepressants.

  4. Ah! That makes a difference Kahless.

    If you felt it was a condition then that can make the therpay contract a Parent ego state contract and the therapist does need to know about that if you are wanting to get any gain out of it.