Assess and Assist: Outcomes based therapy

By Jonathon Sumpter — What does it mean to be a good therapist? Attempting to bridge the emotionally pregnant space so often saturating the counseling room, I find myself facing the temptation to fully commit to either: a) “understand” the black-and-white aspects of the diagnoses and symptoms of a person, or b) or to fully embrace the individual shades of gray in human experience. To approach it from the top down, or from the bottom up: from concepts, and goals, and diagnoses, rather than from fear, loneliness, defeat, rejection and the like: encountering humanity in thought or in feeling.

This often causes conflict in my own thoughts of and my practice of therapy.

The black-and-white approach of therapy seems to imply a specific nature of the clinician’s clinical effectiveness. To me, to be right or wrong has such a “brainy” sound to it. Clinically, option ‘A’ may be more logically “right” than option ‘B’. But often times, I find clients hold more tightly to an emotional connection rather than logical consequences.

Right and wrong also seems to imply something pre-determined: option ‘A’ is right because it has always been so: at least within my perspective, within my experience, and my cultural upbringing. Sometimes it becomes difficult to connect the client’s logical correctness and their emotional connection with my own conceptualization of the case.

What is the right way to do therapy, to do diagnosis, to assess and assist? How does a counselor most effectively positively affect another’s existence? Or is this even the concern? How active is my engagement to therapy? Do I focus on the traditionally based insight-oriented talk therapy, or become an active advocator, a la social worker, for my client? There seem to be conflicting messages in this regard.

Do I give a person a fish, teach them how to fish, help figure out the reason they are unable to get on the boat, or all of the above? If the answer is all of the above, practically how much time is needed to be an “effective” therapist?

In the health-care field, in outpatient mental health and on the floor of the hospital, I am constantly reminded of outcomes-based effectiveness. While I can only work as hard as my clients, are outcomes of health care scored on patient motivation- and if so, no amount of teaching to fish will yield a bounty of plenty during the time being evaluated.

Perhaps I also face the temptation to be the solo architect of the bridge being built in that emotionally pregnant space. Not approaching therapy in a global way that bases outcomes in my own preconceived paper-based, right-and-wrong. Not grouping every therapy seeker as solely a logically or emotionally focused, or as only case-management oriented or insight oriented client.

To borrow from Narrative therapy- allowing the client to “write” the story of what therapy “means” to them may allow me to feel a little more comfortable ensuring clinical structure to achieve that goal. However, we will see in five years when I’ve actually had some experience- and when I’m viewed by someone looking at my outcomes.

1 Response to “Assess and Assist: Outcomes based therapy”

  1. 1 Assess and Assist « johnathansumpter Trackback on September 30, 2011 at 12:30 pm

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