4. Three Outcomes
When a person comes to therapy there are only 3 potential outcomes. They can get better, they can stay the same, or they can get worse.
I suspect that almost all therapists enter the profession in order to have the opportunity to impact others. We believed that becoming therapists would allow us to make a difference in the lives of others. As a result, it is not uncommon for therapists to attribute some, if not much, of the therapeutic outcome to our own efforts. If a client’s condition improves it must be, at least partially, because we provided quality care. Likewise, if a client’s condition worsens we convince ourselves that there was probably something we could have done different that would have led to a better outcome.
In reality, there are many variables that can influence if a client gets better, stays the same, or gets worse. Some of these variables, such as the strength of the therapeutic relationship, can be affected by the therapist. However, other factors, such as the client’s level of commitment, are more difficult, if not impossible, for the therapist to impact.
When a client improves it’s hard to tell which factors induced the change, but sometimes I have my suspicions. For example, occasionally I will have a highly motivated client, with strong support from friends and family, who rapidly improves. As much as I’d like to credit their improvement to my amazing therapeutic skills, sometimes I think they could have achieved similar results with any semi-competent therapist. Sometimes I think the client would have improved just by sitting in a room and talking to the wall. In fact, sometimes people appear so ready to change that it seems even an incompetent therapist, offering the world’s worst counsel, couldn’t keep them from improving.
(Regardless of the reason why, I always love to be a part of someone’s growth and development, Even in these cases when I feel I had very little influence on the ultimate positive result, its always fulfilling to be a witness to growth.)
Similarly, sometimes after a series of what seem like amazing sessions, a client’s condition will decline. Every new therapist has had the disheartening experience of feeling responsible for not doing more after a poor outcome.
If you’re a therapist long enough, you will have a client who seriously hurts their self or someone else. In fact, it’s somewhat likely that a client you work with will take their own life. Imagine that scenario for a moment. Imagine choosing a profession specifically so that you can help people improve their lives. Imagine that after spending years honing your skills, a client comes to you for help. Imagine that you respond by providing the best care you are capable of, and yet somehow the end result is an utterly devastating tragedy whose repercussions will reverberate for generations. Re-read the last 3 sentences and let that sink in for 15 seconds.
Unfortunately, in therapy, like in life, tragedies happen that are outside of our control. Sometimes, no matter how hard we try, it still seems like we don’t make a difference. And its not just in our heads, we can look around and see the devastation we were unable to limit.
But of course, sometimes you do make a difference. In fact, it goes farther than that. If you’re lucky, every once in a while you will work with clients who need you. They wont need just any semi-component therapist, and talking to a wall will be of no help. They will need you. The lifetime of decisions you have made, both small and large, will have led you to become what seems like the perfect person to provide help in this moment. While you are never solely responsible for the improvements of your clients, in this moment you’ll feel that what you did mattered. What you were doing for years, or even decades mattered. You truly made a difference, perhaps your efforts even tipped the balance. Perhaps you did something no one else would have, or could have done. Every once in while what you do will be absolutely irreplaceable, and just maybe, you will feel it.
Of course its not just therapists who can be irreplaceable. There will be times in all of our lives when we are uniquely prepared to be a force for good.
Whats worth fighting for? Making yourself into a person whose efforts can be, from time to time, irreplaceable.