Continual improvement in therapy is the exception, not the rule. Stalls and deterioration may indicate a problem with the client, therapist or both, but may also be a sign of progress onto dealing with greater difficulties masked by the initial problem.
The impression given by many textbooks is that improvement is gradual and continous. Clients progress smoothly from one treatment goal to the next until all issues have been resolved and they can be discharged from your caseload.
Many therapists experience a sinking feeling when a client who had been making progress reports no change (or worse, a deterioration) in mood or function (or both).
A seventy year old sales manual is not an obvious first choice for a therapistâ€™s bookshelf, but this is no ordinary sales manual. How to Win Friends & Influence People offers ways to make people like you, win people to your way of thinking & change people without giving offence or arousing resentment, achievements as useful to therapists and our clients as to salespeople.
Written in 1936 by Dale Carnegie, a public speaking coach, the book summarises twenty years of training courses and advice for salespeople and their managers. The language of the book is very much of its time, as are the examples Carnegie uses to illustrate his points (you will learn more about US presidents and 1930â€™s gangsters than you ever wanted to know!), but the core messages are timeless.
Carnegie argues that successful outcomes arise from positive relationships, much as Carl Rogers (father of counselling) believed that unconditional positive regard for the client was an essential part of effective therapy.
Therapeutic change is due more to factors outwith therapy than any one aspect of therapy. Factors outwith the session are at least as important as our rapport with our clientsâ€¦and much more important than our years of experience or the technique weâ€™re using.
The myth of therapy is that it is done by therapists to patients and that the outcome is a measure of the therapist or of the technique employed, not of the client (unless, of course, the client is â€œresistantâ€ or â€œnon-compliantâ€, in which case the outcome is very definitely attributed to them!).
The myth of therapy is perpetuated by research focusing upon the outcome of a given intervention on a given condition, where the therapist is merely a vessel for delivery of the treatment and the client is an interchangeable recipent of said treatment.