September 3, 2019

Why quick change is good in therapy – and what you can do to make it happen

Decades of clinical research have culminated in a simple truth: People who tend to get better from therapy do so sooner rather than later.

Decades of clinical research have culminated in a simple truth: People who tend to get better from therapy do so sooner rather than later. In fact, research suggests that an early positive response in the first four to six weeks of therapy is one of the strongest predictors of whether or not someone will get better over the course of their mental health treatment.

In this way, the ability of your therapist to notice positive response (or lack thereof) early in the treatment process, and adjust their approach accordingly, is of crucial importance to getting the most out of your time with your therapist.

Why might this be?

An astonishing number of evidence-based practices (EBPs) have been developed for a wide range of mental health conditions over the past few decades. Division 12 of the American Psychological Association (APA) curated a list of APA-supported EBPs for a variety of mental health diagnoses, and a quick trip to their website can make your head spin. Each EBP has its own unique theories, practices, and approaches related to whatever it is you might be struggling with.

Moreover, research suggests that the vast majority of EBPs tend to have similar success rates at the population level. In other words, each specific EBP is, on average, about as effective as the others within its diagnostic category.

However, this story looks much different at the individual level. Just as there is no single musical genre that resonates with all of us, there is simply no one-size-fits-all approach to mental health treatment.

Each of us may respond slightly differently to different EBPs based on a complex interaction of individual, therapist, and sociocultural factors. Although you shouldn’t expect to solve all your life problems in the first month of therapy, it is reasonable to expect that the right EBP for you should produce at least mild change during this early time.

Finding the right type of therapy for you can, and often is, a process of trial and error. You and your therapist need to work together to notice when your treatment is working for you and change it up when it is not.

Make no mistake—even the most effective therapists work with individuals who may not respond to treatment right off the bat. Excellence in therapy comes from noticing this effect early on and being flexible in the therapeutic approach to meet the unique needs of each individual.

It's clear that early change is a good change in therapy—but how do you really know if therapy is working in the first place?

My own experience as a therapist has taught me that when I ask my patients how things have been going over the week, the most common response is the dreaded and oh-so-vague “Things are good”—and for good reason. Small but important changes in your symptoms and behavior throughout the week are often quite difficult to articulate to your therapist.

Although therapist skill and expertise can certainly play an important role in understanding how things are progressing in therapy, research indicates that therapists sometimes fall short of identifying those who are benefitting from services versus those who are not.

For example, one study asked 40 therapists to predict the prognosis of their 550 combined patients early on in treatment and followed these patients over the course of treatment. Of the 40 patients who not only didn’t benefit from treatment but actually deteriorated throughout the course of psychotherapy, only three of these patients were accurately identified by their therapist at this early stage. In fact, this same research found that a computer algorithm far surpassed therapist ability in predicting treatment response and patient deterioration early on.

Although follow-up studies suggest that things aren’t quite as grim as these initial results, the vast majority of randomized controlled trials (RCTs) nonetheless tend to indicate that adding routine outcome monitoring into clinical practice improves outcomes, largely by improving the ability to detect whether or not an individual is benefitting from treatment early on in their care, and adjusting care accordingly.

This practice, often referred to as measurement-based care (MBC), emphasizes a synthesis of clinical judgment and objective measurement to track progress in therapy. Despite the proven benefits of MBC, only a small fraction of therapist actually practice MBC their own practice.

However, new developments in mental health technology are increasingly making MBC accessible to patients and therapists alike. Recent trends have pushed for increased visibility of health information among the general public. For the first time, patients have the opportunity to view objective information about how their treatment is going—and speak up when they want something to change.

For example, behavioral health care companies such as Blueprint are making the process of using measurement in clinical practice easier than ever. Through an app on your phone, you can track your own symptoms and risk factors by answering a series of questions assigned to you by your therapist. This information is analyzed and reported back to yourself and your therapist, and it provides you with access to objective, precise information about how your treatment is going on a week-by-week basis.

Cutting-edge tools offer an effective way to maximize your time in therapy and ensure that things are on track. And when things are not going so well, make sure to change it up!