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Valuing Therapy

Will Joel Friedman, Ph.D. is a seasoned clinician with experience working with adults, couples, families, adolescents and older children since 1976. His aim ...Read More

Valuing True Change Is Best Shown In Direct Experience Within & Without, Not Premature Evaluation Using Return On Investment In A Business Model

What exactly is going on in this so-called modern, technologically sophisticated world, ever more run by MBA’s? How did clients entering into therapy begin drawing premature evaluations of therapy using price and return on investment (ROI)? What is a better way to determine the valuing of true change in therapy? These inquiries are key, especially for anyone desiring lightning-fast cures.

Isn’t it amazing how often people overlook a crisp new $100 bill to pick up a dirty dime? This metaphor is one way to describe not valuing the priceless essential and habitually settling for the familiar mundane? How often do people nowadays know the price of everything and the value of nothing, an observation first coined by British wit Oscar Wilde and one my father loved. Of course, we all know it’s true. What is intriguing is to recognize this perceptual and behavioral “valuing” as a high level form of both deductive and inductive synthetic reasoning coupled with discerning good judgment.

In the context of therapeutic life transformation, relatively new clients sometimes form hasty, premature judgments on the merits of therapy using price—so-called return on investment (ROI) from a business management model—to evaluate whether the rewards justify the investment. Predictably, this process initiated fairly early on in therapy results in the therapeutic services being perceived as wanting for the dollars invested with the users usually quickly exiting. Has the client(s) truly sampled what is available in regard to life transformation? Have these clients even honestly engaged in the therapeutic enterprise by building a therapeutic relationship, fully disclosing their history and issues, and most essentially signing up in a committed way and doing the requisite repeated actions to see progress? If you have not really engaged in therapy, how would you be able to determine its value? You couldn’t.

A second version of price-dominated decision-making in tossing therapy to the curb is a fairly recent phenomenon that can be described as hit-and-run, drive-by therapy, although it seems equally applicable to how some people approach a broad range of professions and services. The point, aim or purpose is to just appropriate and acquire all you can in the shortest possible time and cost, something akin to exploitatively using / misusing a profession to grab what tools, strategies and insights you can to most expediently get the problem handled. Using a business model, money dominated decision-making asks, “What’s in it for me?”, “How does this work assuage my fears and offer me safety?”, and “Bottom line, is this worth the money?”, instead of asking “What service is available for true growth?”, “How does this engagement serve my family, humanity and God?”, and “What is true and real here-and-now?”

Both versions of this business management model are win-loss, zero-sum games, that is, the event, object or activity is perceived as having a limited supply such that if one party succeeds in gaining more, the other party fails by receiving less. Such win-loss, zero-sum games are usually associated with pressure, stress and no-holds-bar competitiveness given that for you to get ahead another must fall behind, since there is only so much stuff we’re all vying for. Zero-sum games are at the root of all arguments, battles, conflicts, power struggles, controlling tugs-of-war, ruthless politics and ugly wars. Actually win-loss, zero-sum games are thinly disguised lose-lose games since even the winners lose, as can be amply seen in what results from all wars—two or more participants, two or more losers. Within a context of scarcity, how would life’s abundance ever show up? Does humanity and dignity even arise in a dog-eat-dog mentality / attachment to getting-yours and avoiding losing-what-I-got?

These money-dominated approaches in harshly and prematurely evaluating therapy as not worth the investment ruthlessly gut, demean and abandon the true valuing of therapy. Of course, the only person being so duped, mislead and taken for a ride is the bottom-line driven client. Time for a reality check: real change and authentic transformation are usually slow with instantaneous moments of revelation, insights and epiphanies along the way, that is, the stutter-step process of one step forward and one-half step back. This unfolding, emerging and evolving process is precisely what tends to be thrown under the bus without a client ever really engaging in a process to know first-hand its true value.

This author submits that therapy is not best evaluated using money and expediency in a business model and proposes more realistic alternative ways to reveal and experience the value therapy brings. To begin with, in valuing of any service or product, some determination is usually made whether it is worth it or not, whether it is important or not. The only question is how this process of valuing unfolds. Contrary to popular notions, money concerns are only rarely at the heart of the issue—valuing therapy is. To begin, it is essential to consider what time frame is appropriate for achieving wanted outcomes.

Given the human propensity to resist all forms of change, no matter how loquacious, elegant and convincing someone is about wanting to change, it is anything but easy. Notice in your own experience and observe other people’s lives to see how little change occurs most of the time. Notice how we avoid, deny and waffle in our doing some new activity, especially lifestyle changes in our diets, exercise, nervous habits, or self-defeating behaviors, drug abuse / dependence, and all addictions. Isn’t change challenging for all of us, even when motivated and face difficult circumstances and uncomfortable feelings and thoughts? It is realistic to see that change requires time, perhaps a few months of weekly appointments, and the results are cumulative and usually enduring. Only then does valuing makes sense, as you are building a solid therapeutic relationship and progressively taking positive behavioral steps. Remarkably, the one client who spontaneously referred to receiving tremendous return on investment (ROI) and was steeped in using business models, made an extensive commitment to therapy! Actually here’s the exception: take actions to grow in therapy over time, and ROI works very well for valuing!

Within this timeframe and context of life transformation, one form of valuing to do periodically is a weighing of costs, specifically the costs for coming and honestly engaging in the therapeutic process relative to the costs for not coming or engaging in any therapeutic process. It has been my experience that this vision is not even considered by most incoming clients, not to mention the great numbers that could well use therapeutic services and simply do not come into any form of therapy / counseling. When anyone I’ve presented this format to has honestly looked and seen the costs in coming or not coming into therapy, the costs for not coming into therapy far outweigh the costs for entering therapy almost without exception. In terms of strength of argument, or preferably discussion, I have repeatedly had the experience of clients cancelling after making their first appointment or abruptly ending therapy prematurely usually citing financial considerations, only to make contact once again sometime later facing a far worse situation in their life. Sadness and compassion often arise when I hear this, and there is nothing I can do about it since only each one of us can find commitment in action to effectively grow.

A second form of valuing is to regularly look at what your values actually right now and relatively weigh how much value therapeutic change brings. How do you gauge exactly what is important in your life, that is, what are your true values in the present? Would the honest answer starring each of us directly in our faces be: how we’ve designed our lives in this present moment? How you and I allocate our most precious resources of time, money, energy, enthusiasm, activities, relationships, work / home balancing and so on is precisely our values in this moment, isn’t it? Thus, what we truly value as important is seen directly as expressed by how we live our lives every moment.

Within this perspective, my wise father once remarked that anyone could own a Cadillac. Cadillac’s are considered a premium car and their costs are commiserate with this evaluation. So how could anyone own one? Of course, it would mean giving up something else to be able to own a Cadillac. You may be living in a half-Cadillac up against a wall of mud in an impoverished environment or third- world country, have a paid-in-full brand-new Cadillac fresh off the showroom floor, or anything in-between. Yes, it would take making a trade-off, that is, giving up something else, such as eating out three times a week, buying fewer clothes, and cutting back the entertainment budget, to buy a Cadillac. At the same time, it may well be worth it to you, or not. My father’s point holds: essentially you can have whatever you want in reality, so long as you are willing to give up something else. This form of relative valuing / importance of various resources in your life provides another useful measuring stick. “Is it worth it?” is one of the most essential questions to ask and answer in charting your life course. An equally valuable, complementary question is, “What are you willing to give up to seriously invest in this new direction?” It points to the action-based, nuts-and-bolts necessary to choose making a dream reality.

A third alternative way to consider how to value therapy after a fair time interval is to come into presence and pause, look and see what is occurring both within you and all around you, including your direct sensory feeling experience, your attitudes, perspective and how you hold your life, relationships, life conditions and challenges, and most crucially your outward behavior, along with the feedback you receive from the most trustworthy people and environments. In being present, looking and seeing, you may well be pleasantly surprised to find much more affirmative movement than you had expected, or you may find quite the reverse. Whatever you find, it’s all useful information in seeing progress forward, no movement or even regression backward. There is really no hiding from reality if you look.

A caveat to two seem appropriate at this juncture. Engaged therapy can sometimes take the form of things falling apart and seemingly getting worse in the short-term, especially if one’s world was packed with unexpressed feelings, blatant lies and widespread manipulation, only to progressively resolve and release over some time. While the change process typically includes a fair amount of ambivalence over change, so long as the therapist is engaged, proactive and resourceful, it is critical to notice whether the client is equally signed up in action in being engaged, proactive and resourceful too. No one can expect to get much out of anything that he or she puts very little into. Thinking you are entitled to fine results without putting in the requisite work just doesn’t work well in effective living.

It is also true that you can only help another who is fully on-board to help her- or him-self. How can anyone change another? It’s simply not possible in this world. Actually it’s plenty tough enough to grow oneself! I do not help people; rather I help people help themselves! This is an honorable stance since there is no desire, intention or vision for clients to become dependent upon me. Rather, count and depend on yourself. This is the essence of empowerment, meaning the ability to count on yourself as your own authority, without overtones of self-righteousness, vanity, self-preoccupation or narcissism. Granted that you may well investigate your options, do your homework, consult with trusted advisors in specific areas, and so on before making your own choice, and this is completely understandable. It is clearly worthwhile factoring in the impact of your choices upon others, the environment and unintended consequences. At the same time, given that you will principally be impacted by the decisions you make over your life, it need remain fundamentally yours to choose your life moment-by-moment and not be up to anyone else, at least once you’ve come to an age of maturity and without mitigating circumstances.

Valuing true change in therapy is best shown in direct experience within you and in behavior as we’ve seen in three alternative models of valuing, none of which draw upon making inappropriate premature evaluations misusing return on investment (ROI) or money in a business model. Human transformation takes putting something in, like well-directed skillful means, building a solid therapeutic relationship, an emotionally safe supportive environment, and a solid commitment in action to grow. Psychological therapy is not a panacea or cure-all for anything, and it can provide a powerful springboard for getting unstuck, developing authentic presence, buying out of the mind’s unworkable conditioning and feeling marvelously alive. Therapy’s value is up to you — what quality of life do you desire, what is the cost if you don’t engage, what are you willing to give up, and is it worth it to you?

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