How will we know this is working? This is a question I ask my clients during the first session. It is important to me that we move forward, and if we're not, we need to find out why and work out what to do about it.
I pride myself on providing high quality and effective evidence based mental health support. At the start of treatment, I use a self-report outcome measurement tool called the Depression Anxiety Stress Scale (DASS21). The DASS21 is a valid and reliable way to rate clients depression, anxiety, and stress to determine a starting point. I then use the DASS21 throughout the course of treatment particularly at the sixth session when the client is due to be reviewed by their referring GP.
I have recently undertaken a review of 30 clients that I have seen over recent months that have completed six sessions. Start of treatment and review scores were analysed using statistical software (SPSS, paired samples t-test for those interested) to determine statistically significant change between the beginning of treatment and at review.
As illustrated in the graphs, at the beginning of treatment, on average clients rated depression as severe. At review, on average they rated depression as mild. For anxiety and stress, at the beginning of treatment, on average clients rated themselves as moderate. At review, on average clients rated anxiety and stress as normal.
For the technical interpretation: there was a significant difference in depression scores between the beginning of treatment (M = 21.33, SD = 8.9) compared to scores at review (M = 11.33, SD = 8.7), t(29) = 5.41, p < .001. For anxiety, there was also a significant difference between scores the beginning of treatment (M = 12.20, SD = 8.3) compared with scores at review (M = 5.67, SD = 7.1), t(29) = 5.22, p < .001. Finally, for stress, there was a significant difference in scores between the beginning of treatment (M = 21.53, SD = 8.5), compared to scores at review (M = 10.73, SD = 7.8) t(29) = 5.78, p < .001.
A number of caveats apply. The main one being that although the outcomes are statistically and clinically significant, there are a number of other factors that can contribute to my clients improvement. For example medication, social support and lifestyle changes such as increasing exercise and reducing substance use can contribute to improving mental health.
What can be concluded is that while this client sample was engaged in treatment with me, there was clinically significant improvements. Evidence based contributing factors would have most likely been recommended and supported by me as part of my clients overall treatment plan.