How do we evaluate change? The place of the review

Psychodynamic work is essentially attuned to understanding the repetition of unhelpful actions and practices that impede development both for adults and children. Although the ‘working through’ of these experiences takes place over a shorter period of time than in conventional open-ended therapy, the intensity of the time-limited process can in itself be helpful. The sense of urgency that often accompanies the problems of the child and young person, gives time- limited psychodynamic psychotherapy its impetus in working towards solutions, which whilst they may not attend to the full panoply of problems, can go a considerable way to unlocking the impediments to development. Luborksky (1984) refers to this as helping patients gain a greater level of mastery over their relationship difficulties.

The best way to evaluate change is to ask the client or patient. Even time-limited psychotherapy should build in a review halfway through the therapy for everyone concerned. Reviewing the therapeutic progress has an important function in all psychotherapy as it offers a space in which both therapist and patient temporarily step out of ‘role’ for a brief period of time in order to review the therapeutic work. We often ignore the fact that psychotherapy comprises the (often) tacit acceptance of the ‘role’ of patient and the ‘role’ of therapist as a given, which may be rarely or never referred to in traditional open ended therapy after the first session.

It is postulated that a level of transparency and the need to step out of ‘role’ in order to review the therapy, should be an essential element of any therapy of whatever length. The absence of a review goes some way to explaining the at times confused sense some patients have even after many years of therapy, about what has actually been achieved. The lack of review may be justified by the rationalisation that everything the patient produces has a pathological and/or unconscious intent, and therefore cannot be open to everyday life scrutiny, and is only to be considered within the context of the transference. It is here that psychotherapists may end up being hoisted on their own petard. Patients may then have to resort to acting out through coming late, missing sessions, or abruptly terminating the therapy, because they have never been able to have a conversation with their therapist about where they are going, when they may arrive at their destination, and what the outcome might be.

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