Post by Admin on Jun 3, 2019 3:46:58 GMT
Failure is an option
Miranda Wolpert
Published:May 19, 2016DOI:https://doi.org/10.1016/S2215-0366(16)30075-X
www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30075-X/fulltext
"When I raise the topic of treatment failure in therapy with colleagues, the most frequent response is: “There is always something that can be done… We can't give up on people… Failure is not an appropriate term in our field. You can't even talk of ‘failure’.” This is backed up by metaphors of therapy as a journey of discovery, and the demand that everyone has a right to receive help. The aim is to help, and compassion demands ongoing attempts with no checks other than resource. The conversation often turns to the inadequacy of current measurement of impact—perhaps what feels like a failure has long-term positive effects later in life that have not yet been measured accurately; perhaps someone not being worse, or just being alive, could be counted as successes. This might relate to the deep need to help that so many drawn to the caring professions feel.
Yet by every metric currently available, it is clear that not everyone is “better” at the end of even the most rigorously controlled and best provided treatment, or indeed in long-term follow-up studies. Even for the most robust interventions in the most selected populations, such as cognitive behavioural therapy for panic, 30% of those completing the treatment are not better at the end. And for more challenging difficulties, such as eating disorders, fewer than 50% achieve full recovery, with overall deterioration rates of 5–10% for adults, as Lambert pointed out in his thought-provoking piece on treatment failure in 2011 (appendix). For children and young people it would appear the failure rates might be even higher; in their 2010 study, Warren and colleagues documented findings from routine care in community services in the USA of 19% deterioration, 33% no reliable change, 32% improvement, 30% recovery, and 1% subclinical deterioration."
Rest in Link.
Miranda Wolpert
Published:May 19, 2016DOI:https://doi.org/10.1016/S2215-0366(16)30075-X
www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30075-X/fulltext
"When I raise the topic of treatment failure in therapy with colleagues, the most frequent response is: “There is always something that can be done… We can't give up on people… Failure is not an appropriate term in our field. You can't even talk of ‘failure’.” This is backed up by metaphors of therapy as a journey of discovery, and the demand that everyone has a right to receive help. The aim is to help, and compassion demands ongoing attempts with no checks other than resource. The conversation often turns to the inadequacy of current measurement of impact—perhaps what feels like a failure has long-term positive effects later in life that have not yet been measured accurately; perhaps someone not being worse, or just being alive, could be counted as successes. This might relate to the deep need to help that so many drawn to the caring professions feel.
Yet by every metric currently available, it is clear that not everyone is “better” at the end of even the most rigorously controlled and best provided treatment, or indeed in long-term follow-up studies. Even for the most robust interventions in the most selected populations, such as cognitive behavioural therapy for panic, 30% of those completing the treatment are not better at the end. And for more challenging difficulties, such as eating disorders, fewer than 50% achieve full recovery, with overall deterioration rates of 5–10% for adults, as Lambert pointed out in his thought-provoking piece on treatment failure in 2011 (appendix). For children and young people it would appear the failure rates might be even higher; in their 2010 study, Warren and colleagues documented findings from routine care in community services in the USA of 19% deterioration, 33% no reliable change, 32% improvement, 30% recovery, and 1% subclinical deterioration."
Rest in Link.