Wednesday, April 15, 2009

The definition of "effective"

Recently I have been thinking about the term "effective therapist" and trying to figure out what this means.

About a month ago, I teenage girl with whom I had been working working was psychiatrically hospitalized for threatening suicide and trying to run away. I had been working with her for about three months with little progress. She was a transfer from another therapist who left the agency (as is common where I work), and I had just been working on engaging with the client. I would arrive at her home and, week after week, she wouldn't want to talk. I happened to look at her chart and see a note written while she was in the hospital (we have staff who specifically contact the hospitals), and it said "mother is requesting a new counselor, feels current counselor is not effective. Plan: discuss complaint about counselor with supervisor."

I have often thought it and felt possibly clients have made comments to imply it, but I had never seen it written out so bluntly: "counselor (me) is not effective." Before this, I had already talked to my supervisor and the plan was for the client to go back through the crisis counseling program (and thus to another counselor) anyway, but I have to admit to read that took me aback and humbled me greatly. I knew this was a client and a family I hadn't made a great connection with, hadn't really helped to make any progress, so in many ways it didn't surprise me. (I also knew this family tends to look for external sources of their problems, rather than really looking at how multiple issues within their family just might be the reason this girl is having problems). But, overall, it really made me take a look at my own skills and think, what makes a therapist effective?

When I first started working in the field, a veteran therapist wisely told me [regarding working with kids] "you are just walking besides them on their journey." And I truly got that idea, deep down. Another therapist told me, "you might be the only positive adult in their life, and anything you do with a kid is therapeutic." So the days I was sitting playing tic tac toe or Uno I remembered that, that just being there was therapuetic. But was it effective?

The term "effective" seems to be up for interpretation. In everyday terms it means something like "getting the job done." I suppose it goes back to what is the goal of counseling/therapy, the job we are to do. And with kids, that is tricky. It often depends on who is saying the kid needs therapy, and usually that person is hardly ever the kid. Usually it's a parent, sometimes it's their school or family doctor, sometimes it's a by-product of a legal issue or crisis situation and not necessarily the kid or family's choice. Sometimes a parent just wants their son or daughter to "have someone to talk to", maybe because they are dealing with changes, losses, difficult times. Generally these parents feel anything I do is helpful and supportive. I play games or draw or just talk with the kid, hopefully they learn to trust me and talk to me about whatever...if it's how they miss their grandma, great, but if it's how they love their puppy, great too! Just get them talking, I heard someone else say once.

However, then there are cases where parents (or teachers, etc.) are looking for change, and looking for it NOW! These are cases where there's been a problem for awhile, and it's gotten bigger and bigger and more out of control. These are the kicks flipping desks or joining gangs and we are trying to intervene, but it's a little late. For these kids, if change doesn't happen in 2 or 3 sessions, or 2 or 3 months, then "counseling isn't working" and often they quit. Yet another wise co-worker told me to think of it this way, "if the child has been having emotional and behavioral problems for X number of years, it's probably going to take at least X number of years to correct, if not more. So we have to help them with baby steps, little miracles." But parents who are stressed want big miracles. I can understand this. We live in a world of instant gratification, pop a pill for this and that, quick fixes. I never promise big miracles.

I heard recently on the John Tesh Radio show "Intelligence for your Life" (which I often listen to on the way home from work and highly recommend, it's very interesting and helpful! that animal trainers don't blame themselves when an animal doesn't correctly perform a trick, that behavior is behavior, and they just work on continuing to train them. I think, I can know all kinds of facts about psychology, behavior, therapy, interventions, and execute them perfectly under ideal circumstances and it still may not make a huge difference. Sometimes I feel like I fight losing battles daily against the bigger influences of society, socioeconomic hardship, genetics, generations of dysfunction and substance abuse. When I look at it that way, it makes it seem pretty impossible, and depressing! How on earth could a person be an "effective therapist" dealing with all of that??

Back to the story of my client, I decided that the most accurate way to state what was going on with her was that therapy was not effective; therapy, which included me as the therapist, but also includes her as the unwilling 16 year old who is not invested in therapy, an overwhelmed mother looking for medication and a therapist to erase years of bad parenting and unstable family circumstances.

So, maybe effectiveness isn't something about me, my skills, or personality; maybe it's an interaction of all the things I bring to the table and what the client brings. Maybe all I can do is try my best, try to encourage my clients to try their best, and hope for little miracles.


  1. And you are gaining wisdom too!

    The last week or so I've been so annoyed with teaching. Yesterday I thought that if I had to spend any more time teaching the chromatic scale I would go nuts. But at least when I'm not an effective teacher (or, actually, music lessons aren't effective, if I've learned from your blog) the biggest problem is the kid doesn't know his scale. Big deal. Comparatively. I am sure you are a wonderful therapist.

    You were always effective when you were my roomie! :)

  2. thanks...:) chocolate, ice cream, good friends all are good therapy!

    I like to think that "effective" is overall a relative term. After re-reading my blog, I realized I never did find a true definition of it. I guess it all depends...