The Psychotherapist's Continuous Evaluation of his Work

The problem of evaluating the effectiveness of psychotherapy is really that of evaluating the changes the patient makes which indicate he has gained better mental health. Because its manifestations are often hidden or subtle, change is often difficult to determine. Minute changes may take place that may not yet show up as alteration in behavior or symptomatology. No objective, generally applicable scale of measurement of change has yet been devised. The point of view of the observer, his own values and his relationship to the patient will influence how he evaluates change. Sometimes it is difficult to determine what part of the patient's progress is the result of therapy and what part is due to natural reparative processes. In this paper we will have to discuss some general considerations before going into the specific factors that enter into the therapist's continuous evaluation of progress.

First, we need some idea of what good mental health is. In what direction do we want to help the patient move? Let us review the rather all-inclusive description of good mental health (which I believe most will agree is acceptable) given by Wolberg in his recent book (1):

“Ideal objectives of mental health are many. They require that the person be capable of deriving pleasure from creature comforts in life—from food, rest, relaxation, sex, work and play. He is capable of satisfying these impulses in conformity with the mores of the group. Mobilizing whatever intellectual and experiential resources are required, he is able to plan creatively and realistically, and to execute his plans in accordance with existent opportunities. This involves an appraisal of his aptitudes and limitations, and a scaling down of his ambitions to the level of his true potentialities. It includes the laying down of realistic life goals, an acceptance of his abilities and a tolerance of his shortcomings. Presupposed is a harmonious balance between personal vand group standards, and thos