It ain’t over ‘til the fat lady sings’ is an operatic reference to the rather large Valkyrie, Brunhilde, who, wearing her horned cap and holding her sword and shield, sings an aria signaling the end of a Wagnerian opera. In the English language, we have a number of cautionary colloquialisms, such as this one, warning against jumping the gun, because nothing is a foregone conclusion while a process or activity is still ongoing.
The flipside of counting your chickens before they hatch is not recognizing the end when it’s staring you in the face. It’s a fine balancing act between knowing that the future isn’t written in stone and knowing that the future has arrived.
In the health field, it used to be easier to determine the end of treatment. Or, at least, health practitioners believed so. Those were the days when the treatment model was to cure the patient. The end of treatment was when the illness was eliminated and the person was returned to a pre-morbid state.
The conditions for this treatment approach are quite simple. First, you need to know the etiology of the illness. More specifically, in order to eliminate the illness, you need to eliminate the cause of the illness. Second, you need to have a treatment approach that has the effectiveness in cutting away the cause with the precision of a surgical knife. Third, you have to assume that any changes wrought by the illness are only temporary and can be reversed.
The problem is that in both medicine and psychotherapy, we often don’t know the etiology or have a highly precise treatment protocol. In medicine, this is the reason why physicians will provide the patient and their family with outcome probabilities. Even those who wield surgical knives, the surgeons, give probabilities for successful endings. As for the changes caused by the illness, they are typically permanent. The most we can hope for is that those changes will fade with time.
For these reasons, compounded with the rising costs of healthcare, the health field has been moving away from the old model and moving towards a recovery model of treatment. With the recovery model, the therapeutic goal is two-fold. First, get the patient to a pre-morbid state of functioning and, second, address the antecedents of the problem so that they can no longer disrupt the person’s life.
Although recovery as a goal is more readily achieved than a cure is, the therapeutic goal can be much more elusive with the recovery model. For example, what exactly was the pre-morbid level of functioning for a particular client? In order to help a patient recover, some knowledge of this is necessary. Goals based upon normative data can play a vital role in getting into the ballpark, but is the ballpark sufficient? Each patient has their own idiosyncrasies which can influence where the actual goal of recovery may lie. The source for this individualistic information is the patient. Therefore, recovery is ultimately determined by the patient’s own perception of their functioning.
In medicine, it is much easier for physicians to determine whether change is occurring and whether recovery has occurred because physical changes are readily observed and measured. Psychotherapists, on the other hand, are faced with a greater challenge, because they work with the mind; something that can’t be directly observed or measured.
Because psychotherapists aren’t able to directly measure their client’s mind, they need tools that can indirectly provide them insight into the mental health of their client. Such tools measure established indices of functioning, such as personal well-being, interpersonal relationships, and social interactions, which enable the therapist to make inferences regarding the mental health of their client. Because of the individualistic nature of recovery of something that can’t be directly observed, it is critical that these tools are capable of enabling the therapist to determine whether change is occurring or not. These tools need to be able to provide the therapist with the power to ‘see’ that recovery has been achieved. In short, the tool needs to be a Brunhilde, whose aria announces the end of treatment.
MyOutcomes, the web-based application of feedback-informed treatment, is the Brunhilde of psychotherapy. However, instead of delivering an aria, MyOutcomes provides the ORS, or Outcome Rating Scale. The ORS easily brings the client’s voice into the therapeutic session, allowing the client to share their perception of their own functioning on a personal level, interpersonal level and social level. With regular use of the ORS, the psychotherapist and the client have the power to observe whether recovery is occurring and whether recovery has been achieved.
Yogi Berra used to say, ‘It ain’t over ‘til it’s over.’ By incorporating MyOutcomes into their practice, therapists can be confident that recovery has been achieved.