One of the differences between behavioral therapy and other types of psychotherapy is the concrete measurement of progress. Psychological research has shown repeatedly that people's episodic memories, or memories of past events, are often not very reliable. Such memories are easily influenced, in the case of memories of progress the influence usually is current state of mind or mood.
Frequently, clients would come into my office discouraged: “I just don't feel I'm getting any better. Is all this work worth it?” Now, fortunately for me, as a behavioral therapist I had all kinds of data. For instance, when my clients arrived for their appointment, they completed a short assessment rating symptoms. I could pull out their prior assessments to show how their ratings had improved.
Another way we could assess progress was that assignments were created with ways to measure improvement. For example, a person with depression is often told to try and engage in activities that brought pleasure in the past. Instead of telling someone this and relying on their memory of the past week, I had them write it down with a rating of how enjoyable it was.
What often occurs especially for those with depression is the memory is distorted by the depressed mood. So, if asked about enjoyable events, they say, “Nothing is enjoyable. I always feel the same.” Yet, when they rate an event immediately after it occurs, the rating often shows something different. I could look at the ratings and respond, “No, there is variability in your ratings. You don't always feel the same.”
So why does this matter? When people are discouraged they are more likely to quit trying. The thinking for many of those with mental illness can be distorted by the illness. And without any opposing evidence they become more and more convinced that their thinking is accurate. But with evidence they can be persuaded to challenge the inaccurate thinking. As a result they can feel encouraged to keep making the effort. Another thing that has been shown repeatedly in psychological research is that the more a person tries the more he or she is likely to be successful.
I often found that my job primarily involved motivating my clients. Developing a plan was the easy part but keeping them focused and motivated was the important part. And the best way to do that was by using concrete evidence. Just an aside, but ratings and other evidence also circumvented the common statement made by clients, “You're paid to say nice things to me. Why should I believe you?”
1) Simple. Almost anything can be measured. Many things can be measured on a 10 point scale. What is your level of anxiety when you engage in a certain behavior? How enjoyable was an event? Other things can be measured on a frequency basis. How many times did you smile or say “hi” to someone today? How many pleasurable activities did you attempt? How many times did you resist a compulsion? A daily log with hash marks or a number next to activities is fairly simple for most people to keep.
2) Positive. If possible, try to make the measurement positive. For instance, when people are trying to lose weight they often keep track of pounds which may not always be encouraging. Instead, keeping track of the number of healthy choices made throughout the day can be more positive and lead to the same goal.
3) Write it down. This may seem obvious but many people try to keep track in their heads. This is not effective because as stated previously, episodic memory is notoriously inaccurate. In addition, seeing something on a piece of paper (or a screen) is more convincing.
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Dr. Monica Frank