What to do in therapy part 1

The news today that there are many more cases of autism disorders than currently diagnosed raises many questions (see here for the BBC story).

Not least is the one about how these children and young people should be given emotional support, and whether mental health interventions can essentially eradicate the problem. What works in theory may not work on the ground with an individual child.

I spend a good deal of driving time cogitating on my work.

The thing is, it won’t matter how many hours I claim for CPD: if none of them cover this “thinking” activity, I won’t improve/develop.

So, perhaps it’s age and a sense of responsibility kicking in, but I find myself continually questioning whether I have done the right thing, used the right kind of intervention, worked early enough, held back enough, taken too long, not taken enough time – well, that sort of thing, though I’m not as bad a therapist as it sounds!

What I came to thinking about is the difference between efficacy and effectiveness studies.

Since this is a blog not a treatise, I’ll omit the detail and simply point out that effectiveness studies assess whether my clients benefit from my interventions under the conditions that I work in. That is, in uncontrolled field settings.

This is important. We’re bombarded with advice and guidelines about what to do with what. And none of that necessarily relates to me and my settings.

Efficacy studies, on the other hand, omit a great deal of the reality in situ:

• We can’t run a parallel child because all are unique. Omit the trimmings of a particular child and you don’t have a “control”, merely another child.
• We can’t eliminate other factors that may be influencing a child’s progress at the same time as we work with them. Indeed, specifically with children and young people, we would expect them to improve over time as they continue to develop cognitively and emotionally.
• And we can’t be scientific in the tick-box sense because therapy is a flexible art, tweaked daily according to need.

Surely this means we should be seeking to provide a variety of therapies for all young people so that they have choice in what they can make use of to heal themselves. No one can dictate that. And I foresee a directive on recommended therapies for autistic disorders, and that won’t be perfectly suited to a particular child, either, any more than the depression and anxiety ones are!

But f you’re interested in the prevalence of autism and how diagnosis is now made, then do read Unstrange Minds by Roy Richard Grinker. It’s very good and most informative and demystifying.