Making Progress

Therapy is a process of change. When it is working as it should, any description of the patient is a description of a person in transition. [Wachtel 1987]

There are no hard and fast rules for measuring progress in therapy, and in lengthy treatments evidence that it is happening at all can sometimes seem elusive. When we are dealing with something as complex as the mind we are not going to observe change taking place in a straightforward easily-measurable fashion.

Some of the most readily-identifiable signs of progress should come in the initial phase when we are making the transition from struggling to cope alone to having someone there to help, and if progress is seen at this stage it is a fair sign that, assuming the continued commitment of both parties, progress will continue into the more difficult times ahead when it may not be so easy to perceive.

When we first enter therapy our most pressing need will be for relief from symptoms and it is not unusual for a partial relief from symptoms to be experienced quite rapidly. But after the 'honeymoon' period deeper and more complicated processes start to take hold.

I was enthusiastic about therapy when I started and thought I was racing along making fantastic progress. Then after a while I seemed to lose momentum. Progress seemed to be slowing down and I began to wonder whether the treatment was working as it should.

I began to complain to my therapist that in spite of all the work I'd done and all the optimism I'd felt nothing much seemed to be happening. He replied, more times than I care to remember: "You have to bring your feelings into the session." Bringing feelings into the sessions makes a direct contribution to the development of transference, and getting us engaged in transference is the real aim of the early stages of therapy.

These are some of the phenomena which can take place as we progress:

Regression. The phenomenon of the mind returning to early stages of development is known as regression. During therapy sessions we can regress to any stage of our emotional development that is necessary, and over the course of time we are likely to move back and forth between various stages.

Dependence.

Often it is argued that the therapy should not serve as a 'crutch'. It should be noted, however, that crutches are not always employed as a permanent supportive device; often crutches are used as a temporary way of enabling a healing process to proceed in such a way that crutches will no longer be necessary. [Wachtel 1987]

When therapy, particularly intensive therapy, progresses as it should dependence will be an inevitable consequence of our interaction with the therapist. Lifelong patterns of feeling and behaviour have to break down and new patterns have to be established, and we cannot undertake such a delicate operation without a measure of dependence on the person who holds us together while we do it.

Internalising the therapist. An important sign of progress, particularly in intensive therapy, is when we can begin to feel that the therapist 'stays with us' when we leave the consulting room. We begin to not only understand and accept what the therapist has to offer us, but actually build it into ourselves at the unconscious level.

Every aspect of therapy takes place in the face of our resistance to it, and making progress can be seen in terms of overcoming resistance, or at least, of steadily pushing back its boundary. In some respects we may have to seem to get worse before we can get better. As our defenses break down the underlying problems are stirred up, and as they come to the surface we may well feel we are getting worse. But this is necessary in order for the problems to be worked through with the therapist, which should eventually bring relief from the problems altogether.