THOUGHTS ABOUT QUALITY
by Hans TenDam
According to our Articles of Incorporation, EARTh wants “to improve and enlarge the professional application of regression therapy in Europe.” By “the development of professional standards.” Whatever these standards may be, many of them we share many with the helping professions in general and psychotherapists in particular. They are in our Code of Conduct.
But what about the quality of our work? What is good regression therapy? I guess we would all agree that good regression therapy gets good results and that it doesn’t take ages and loads of money and growing dependence on the therapist to get there. Good results means that we are effective. Getting there without undue delays, costs and complications means that we are efficient or, if you prefer that word, productive.
Good results. How do we know that we have got them? First that the question of the client has been answered, that the problem is resolved, and that the results endure. During the Round Table in November we agreed on the term ‘life-changing results.’ We didn’t mean that those results are necessarily spectacular (though they sometimes are), but that they are not ephemeral, disappearing after a short euphoria.
Are we responsible for the results? Not completely. We don’t do treatments, we guide people through something they do. We could say that half of the responsibility is ours and half of the responsibility is the client’s. When sessions don’t work, clients blame us for incompetence and we blame clients for resistance. Imagine an incompetent therapist treating a resisting client! The mind reels from such a nightmare.
A good therapist has good results. On the whole. And if results are not good, at least the client should not worsen and we should not unduly extend the therapy. Now how do we know that the results are good on the whole? If we don’t know that, how can we improve?
The first criterium is client satisfaction. But when? Direct after the session? After a fortnight? After three months? One year? We could apply usual standards in the field of psychotherapy. Three months seems reasonable. And how? Again, we could follow standardized survey questions. Some people are more enthusiastic, others more reserved in their judgment.
Satisfaction is also not the same as results. Some people are very statisfied with the therapy, though their original problems have not disappeared. Others are dissatisfied with the therapy, even think it nonsense, though all their problems have gone. But again, on the average, client satisfaction is the best indicator for therapy success.
Not all clients take the trouble to give feedback, even when they are asked. In my experience about one third responds after three months. We may increase that percentage but we we always have a number of non-respondents. WE may assume that people not responding are, on the average, somewhat less satisfied. But how much? There remains always a dark number.
During training, the criterium is teacher satisfaction. We may assume that most teachers are so experienced as therapists, that they know the difference between a good and bad session. But a teacher is not an objective observer. Some teachers consider themselves primadonnas and derive ego-satisfaction from harshly criticizing their student’s efforts. More often, teachers derive ego-satisfaction from having many graduated students. Also, teachers tend to judge students in how they copy their teacher’s example.
What can EARTh do to upgrade the quality of the work of its members? First, of course, by selection: not admitting those that seem unqualified for the work. Second, by stimulating exchange between professionals, in general: by promoting learning. This means peer-supervision, workshops and publications. Third, by ongoing research into what regression therapists do and what are the results of their work
On the long run, research seems the most fundamental contribution. Because research into results, with different problems, different clients, different methods helps us to find out what works best under what kind of circumstances with what kind of methods, with what kind of clients.
As people differ and circumstances differ, we cannot hope (and should not hope) to find straight answers to what works best in a given case. Even in evidence-based medicine we have first choices and second choices. What works in general well, may not work well with this client in this situation. Partly we may be able to analyze the situation and decide what to do, but there seems always an important part for intuition. Now intuition may be developed too: by stimulating experience, perceptiveness and peace of mind.
Some of us may work more methodically, others may work much more intuitive, but we should always look with an open mind at what is happening and what are the results of our work.
Good therapists get on the whole good results with minimal side-effects. It is no good when the client has a restored self-confidence and now finally kills her husband. Good therapists have good skills. Trying to describe those skills in terms of observable behavior, in my training program we came up with more than 30 skills. I am neither suggesting that we should rate members on all of them, nor should we rate each other on those skills.
If we want to have some quality assurance in EARTh, we need a good admission policy, a good procedure to recognize schools in our field, some ongoing audit over time (difficult!) and lots of professional exchange and research.
At the Summer School 2009 we may organize discussions about aspects of quality. Maybe we’ll have less workshops and more well-focused discussions between ourselves. We need less teachers then, but more secretaries.
So, my provisional conclusion is: quality means more secretaries