A new article published in the Journal of Humanistic Psychology examines the inclusion of humanistic and existential psychology principles in mental health outcome measurement over the past 15 years.
The author, Andrew M. Bland, contrasts assumptions of humanistic and existential psychology with those of the medical model. While the findings demonstrated that humanistic/existential psychology principles have been increasingly included in mainstream mental health outcome measurements, the author notes further areas for improvement in research and instrument development.
Care based on outcome measurements has increasingly become the norm in community mental health centers (CMHCs) in the United States, where clients complete outcome measurements related to their symptoms or diagnosis to show how effective the therapy is that they are receiving. Treatment success from this perspective is often based primarily on symptom reduction and privileges brief treatment approaches that stress fast-paced recovery â despite research indicating that these approaches can be overwhelming for clients and can lead to adverse outcomes. Further, research elsewhere has suggested that clients and clinicians often disagree on mental health outcomes, questioning the validity and usefulness of these measures.
Andrew M. Bland, of the Department of Psychology at Millersville University, writes:
âSimilar to the failed No Child Left Behind initiative in education, behind these seeming good intentions are more troublesome motivating forces: cost containment and increased accountability in the face of economic uncertainty. Cliniciansâ ability to be reimbursed for providing servicesâespecially to clients who receive public benefitsâhas become contingent upon demonstrable symptom reduction.â
Humanistic psychology has been critical of outcome measurement for its lack of focus on the context in which clients reside, which, in turn, results in a picture of clients and their recovery that neglects to take into account their human qualities. Additionally, emphasis on brief, symptom-reduction-based treatment does not allow room for humanistic/existential perspectives, which privilege the person as a human being instead of a cluster of psychopathological symptoms.
In the current article, Bland explores the philosophical and political assumptions of the medical model, which relies on biomedical understandings of mental health issues, such as hedonism, universalism, atomism, materialism, and objectivism, which are at odds with humanistic/existential perspectives.
Bland identifies how these assumptions are embedded within three psychotherapy outcome measures that are typically utilized in daily practice in CMHCs â the Adult Needs and Strengths Assessment (ANSA), the Ohio Mental Health Consumer Outcomes System (âOhio Scalesâ), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) assessment measures. The ANSA is a clinician-rated assessment, whereas the Ohio Scales and DSM-5 measures are self-report measures.
In addition to emphasizing the medical model assumptions that underlie these outcome measurements, Bland also highlights the progress made regarding the increased inclusion of humanistic/existential principles in these measures.
The medical model presupposition of hedonism reflects the idea that treatment is effective when it reduces suffering and increases well-being efficiently, both in terms of time and money. Blandâs exploration revealed that hedonism remains a focal point of three outcome measures explored, as they all emphasize symptom reduction and linear progress rather than examining the individualâs recovery process. This emphasis on symptom reduction contrasts with what clients have reported makes good therapy, which includes an increased sense of empowerment and improved relationships.
Additionally, the concept of universalism, or an emphasis on standardized diagnosis and manualized treatment, was also found to be prevalent across measures, as none of them asked directly about clientsâ concerns related to how helpful treatment is, particularly for culturally diverse populations.
Moreover, atomism reflects the idea that pathology is located within the individual rather than a symptom of societal issues, including oppression of marginalized groups. Only one of the measures examined looks at oppression as being key to diagnosable concerns. However, it does so indirectly and in a part of the assessment that is excluded from the overall outcome algorithm. Despite this, two of the measures examine family relationships and access to resources, which offer a step in the direction of a more holistic approach to understanding human suffering.
Materialism is the valuing and emphasizing of primarily what can be physically observed, which results in weight being placed on therapies that are cost-effective and address operationalized symptoms as opposed to focusing on long-term benefits or essential factors, such as interpersonal processes or existential issues.
Growth has been demonstrated in this area over the past fifteen years, as two of the measures include items related to personal growth and second-order change like hopefulness, creativity, empowerment, self-worth, and more. Moreover, one of the measures contains an item regarding the individualâs perception that they have been treated with dignity and respect at the agency.
Reflecting overall on the changes he observed in his review, Bland writes:
â. . . since Levitt et al.âs (2005) analysis of the presence of humanistic themes in nine instruments then-commonly used in mental health outcome research, there has been generally little change insofar as the principal focus remains on symptom reduction. Improvements have been noted especially in the interpersonal, agency in self-definition, and personal growth domains, while item content pertaining to clientsâ therapy experience and global functioning remains particularly underdeveloped. This seems to reflect a trend in which clinicians are placed in the expert role as an automatonic technician who listens for, diagnoses, and treats minute aspects of symptoms while greatly running the risk of missing the big picture and thus leaving underlying concerns relatively unaddressed and prone to eventual return.â
Limitations of Blandâs work include his focus on how many items from each assessment captured humanistic themes rather than examining the wording of items/how it could be improved; the small sample size of outcomes measurements; his focus on adult measurements; the use of Levitt et al.âs work solely to define and determine humanistic principles, some of which are specific to certain populations or situations; and lastly, the focus only on outcome measures used in the US.
Bland offers recommendations to alleviate some of the problems associated with outcome measurements, such as clinicians being negatively affected by policymakers or health care administrators misusing data or clients not being honest in their outcome measures due to fears that they might lose their benefits or services.
He suggests that alternative measures or measures that could be used in addition to existing outcomes measures provide one way of addressing these concerns. Along with the availability of alternatives, flexibility in administration is critical to moving toward a more individualized approach to outcome measurement.
Bland highlights a few new outcome measures that have been developed, such as Duncan et al.âs Partners for Change Outcome Management System, which goes beyond symptom reduction to look at holistic, second-order change, examines overall global functioning and assesses the clientâs experience of therapy.
Additionally, Levittâs Client Experiences of Therapy Scale is another example of a measure that examines the clientâs experience of the quality of therapy. Positive psychology is an additional avenue that could be explored, as the field has also created measures that examine humanistic constructs.
Other recommendations include the development of measures that capture existential-related concerns and using more open-ended questions to better understand the clientâs experiences and the nuances of growth and progress in therapy. Bland also suggests that further research, particularly qualitative methodologies, examining progress in therapy could inform the development of outcomes measurements that more effectively capture therapeutic growth in a way that aligns with the requirements of managed care while also maintaining the humanity and dignity of the client.
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Bland, M. Andrew (2022). A 15-year progress report on the presence of humanistic/existential psychology principles in mental health outcome measurement: Thematic discourse and summative content analyses. Journal of Humanistic Psychology. https://doi.org/10.1177/00221678221077475 (Link)
Psyche is not humanism. Mental health is not care for the psyche. Mental health care is care for empty materialism without psyche.(monism) Care for the psyche is to see the essence and basic psychological/mythical worth of the depression, psychosis, death. Those are the the psychological necessities. Mental health is a naive whim of dumb marxists/wulgar materialists. Mental health care is worthless and cancels out the importance of the psyche. The basis of psychological life is death, not wealth, well’being or spiritual naivety. People should grow up from being a compliance “goyim”, and become a psychological man. You do not need science to understand psyche, just imagination and courage. Monistic society including psychiatry and people with mental health diagnosis are extremely naive. They are handicapped. This is a deliberate handicap for the benefactors of Marxism. Sheep – farm -electric shock.
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I could barely makes sense of this article (well meaning as it is), until I reminded myself of what it seemed to be trying to say, which is (?) that despite the prevalence of the current medical model, there are some valiant but nevertheless feeble attempts to âhumanizeâ the âtherapeutic experienceâ.
Hooray.
The problem lies not within the structure of âtherapyâ – it is within the very idea of âtherapyâ itself. I think it best to abandon sinking ships, especially those not seaworthy to begin with. As such, I have never found it advantageous to entrust my body or soul to thumb-twiddling intellectuals. But this just my opinion.
âYou do not need science to understand psyche, just imagination and courageâ –
Thank you JamesHillmandownwiththereligionofscientism –
I couldnât agree more.
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The author states, âAdditionally, emphasis on brief, symptom reduction-based treatment does not allow room for humanistic/existential perspectives which privilege the person as a human being instead of a cluster of psychopathological symptomsâ.
Good effort. But –
Has it ever occurred to the author that humanism and existentialism are two more âismsâ the world could well do without? It would be wise for the author to take note of the simple fact that none of the various and sundry intellectual-âismsâ currently polluting academia have served humanity well. And humanism/ existentialism are not exceptions.
And as for âprivilege the person as a human beingâ –
Excuse me – since when does anyone need âprivilegeâ to be seen as a human being??? This statement alone illustrates the central problem with all âtherapeutic relationshipsâ, and that is this – most âtherapistsâ seem to think we mortals wait for them with baited breath to have such âprivilegeâ bestowed upon us. My goodness! What on earth would we do without their âtherapeuticâ condescension – opps! I meant âtherapeuticâ attention –
Statements like these reveal the rampant conceit and inherently patronizing attitudes of the âtherapeutic communityâ and their own pathological inability to recognize the two-fold âismâ behind all their intellectually narcissistic pursuits, which is â blind INTELLECTUALISM/compulsive INFANTILISM –
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Not to mention that granddaddy of all âismsâ:
NARCISSISM –
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âIsmsâ are insulting, be it humanism, existentialism, or any other âismâ.
At a given time in history, humanism came to be seen as an alternative to the prevailing religious dogma.
But what the author and most therapists fail to see is that any new âismâ doesnât solve anything, as the âismâ simply becomes another religion.
The only âismâ going on in therapyâ is narcissism – IN THE THERAPIST –
The best way to help people is to have them realize theyâve been conditioned to believe they âneed therapyâ, that they âneed an expertâ. But all they really need to know is that they CAN learn to rely on THEMSELVES, by THEMSELVES; that they need not participate in that pathetic excuse of a ârelationshipâ called âtherapyâ; that thereâs more to life than being the hapless victim of some âtherapistâ whose guiding âismâ is (unbeknownst to the therapist) is NARCISS -âISMâ –
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Wouldnât it be nice if âtherapistsâ got off their âisms-thisâ and âisms-thatâ soapbox and realized that all anyone really needs is time to themselves, plenty of quiet, and heartfelt human connection THAT DOESNâT COST A DIME???
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But whatâs wrong with âIntellectualismâ? I thought it was good to have a brain –
It is good to have a brain – but brains arenât the most important thing, especially when dealing with matters of the soul –
Matters of the soul?
Yes – just think for minute – when youâre upset, which would you rather talk with? A didactic head, or a caring heart?
A caring heart, of course! But doesnât that make a therapistâs education unnecessary?
Pretty much –
Then why are there so many schools of therapy?
Because a lot of people believe in making things more complicated –
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What are âismsâ?
Gimmicks for the intellectually inclined.
Itâs part of their therapy schtick –
Why donât therapists drop the âismsâ and simply relate to the person in front of them?
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Now see here – what in the world do you mean by âInfantilizationâ?
Itâs the process by which therapists infantilize their clients –
And how does that work?
Itâs where your therapist is trained to treat you as a child or in a way that denies your maturity in age or experience – but they donât call âinfantilismâ –
Then what do they call it?
Oh, stupid stuff like âpower imbalanceâ or âtransferenceâ –
Do you know when itâs happening?
Nope – see, weâre talking real insidious shit here –
WowâŚ.sounds sneaky –
Damn right it is, and some reel you in REAL slow, and some REAL fast –
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Now wait a minute – whatâs this stuff you call Infantilism?
Itâs the process by which therapists infantilize their clients –
What does that mean?
It means therapists are trained to treat their clients like children or in a way that denies their maturity in age or experience – but they donât call it Infantilism –
Then what do they call it?
Oh, stupid stuff, like âpower imbalanceâ or âtransferenceâ –
How do you know when itâs happening?
You donât – you see, weâre talking real insidious stuff here –
WowâŚsounds sneaky –
Yep – gotta watch out for this âismâ, thatâs for sure – or else youâll be tied to a therapist forevermore –
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âwait for them with BATED BREATHâ –
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My therapist uses humanism and existentialism!
Yippee. Now let me ask you – who in the heck needs some therapistâs âismsâ to help them figure things out? Isnât the fact youâre human and exist enough for those âprofessionalâ people? You know things have gotten pretty bad when people have to go to school to figure THAT out –
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This article clearly shows the reason the âtherapeutic communityâ has failed to help people, which is –
Therapists are lost in their âismsâ: hedonism, universalism, atomism, materialism, and objectivism.
Yet the author seems to think the answers lie in TWO MORE âismsâ: humanism and existentialism.
But havenât these two already been tried with lackluster results?
With âhelpâ like this, is it any wonder people keep losing their minds?
And while I may not know what works, I sure as hell can see the things that donât, which are:
1. Relying on âismsâ doesnât work because –
2. Itâs the therapists themselves WHO ARE INSANE –
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No. Do not thank me, James Hillman is greater. I am just a messenger. Thank you, for your words.
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I just want to say that if you can think of our own physical aparatus as being like a laptop that receives or channels a talkshow or documentary on meditation you can explore the notion that the brain/laptop receives messages/consciousness/spirit.
A person may have a brain or laptop that has the equivallent of dementia, so its a brain/laptop that is running down in that person’s aging process and so it may or may not be patchy in what it receives.
The physical properties of any laptop does not mean it cannot channel or receive. Sometimes an older piece of tech is simpler and better.
But the brain/laptop is only a bit of hardware. It is not the ineffable substance of received consciousness. Any more than a television is the talkshow. The talkshow is independant of the kit.
A completely broken television set is in a persistent vegetative state, possibly from brain damaging iatrogenic harm from medication. So it matters that we look after our matter, for the sake of our psyche or consciousness, even though our consciousness may not reside inside the circuits or meat of the matter. The brain is a good gadget and we need it work well. That “working well” notion has been problematic since it has legitimated certain humans to fuss with that which should not be badly treated at all. Nevertheless some brains/laptops have difficulties like epilepsy and brain tumours and detox withdrawal states and hormonal fluxations and even trauma can affect the poor old brain/laptop. There is an understandable wish, after the debacle of bad treatment, to just say leave the brain/laptop alone. Stop trying to meddle in it. Stop trying to “fix” it.
But given that the body clearly goes awry in some circumstances, in hormonal conditions for instance, and given that the brain IS the body, I think it is impulsive to regard the brain/laptop as always free from suffering from the owner of said brain.
I am not advocating for tinkering with that noble organ at all. It is way too finicky and delicate and special and precious. Any prodding constitutes “bad treatment” of it, in my opinion. Gentle herbalism is as far as I would go with the brain.
I think all uniqueness should be CELEBRATED and not regarded as problematic. I am no fan of genetics. It sounds too creepily like the study of the hardware of the laptop and seems devoid of any consideration of the unique consciousness or psyche or spirit that uses that brain/laptop as a communicatio n gadget.
I believe a lot of what people want here is the CELEBRATION of unique consciousness. And not labelling unique consciousness as anomalous.
That is all to the good.
But…
ALL ARE EQUAL.
So what if you meet a unique consciousness who expresses that they feel suicidal because their brain/laptop has begun having seizures?
Whilst you debunk theories that are not conducive to the way you CELEBRATE your unique choices, do you CELEBRATE “their” uniqueness by allowing “their” “freedom of choice” to be a consciousness that prefers to believe epilepsy is a real thing?
Yes, an onlooker may not want an individual to believe what they believe. Their belief may challenge the onlooker, though it need not.
Difference is NOT challenge.
An orchid does NOT challenge the preference of the rose.
But an onlooker might then even harbour a wish to bully the individual into a new evangelized belief. As happened in early psychiatry.
People are bullied into “changing” because of “fear” of their “difference”.
A person may be misdiagnosed as schizophrenic as a way to “change” them, out of “fear” of their “difference”.
Equally a person may be told they should stop knowing they suffer from schizophrenia as a way to “change” them, out of “fear” of their “difference”.
Mostly “difference” is harmless and joyful and part of the freedom found in uniqueness. When you make “difference” dangerous, that is the biggest danger of all. It means you are intimidated for being “different” and are no longer free to choose “not to change”. You are ordered to be having your brain/laptop overhauled or painfully and recklessly turned into a new model by medication, or you are told that if you want to keep it as your own brain/laptop and not “change” it, then somehow you are responsible for the way humanity is disappointing or bullying. Added to this you are not allowed to diagnose your own brain/laptop, or rid it of someone else’s diagnosis of it, or even gladly choose to utilize someone else’s diagnosis of it.
It is your own laptop yet you are constantly taught “lessons” about it from “experts” and “academics” or “activists” about how you…
HAVE TO
CHANGE
YOU.
Often this is done under the latest consensus opinion of what constitutes “normal”. The debate about “normal” will always rage on. It fails to allow you to INVENT YOUR OWN NORMAL.
For person A being offered a diagnosis may not feel normal to them.
For person B being offered a diagnosis may help them make more sense of THEIR OWN frightening illness of epilepsy or bewildering hallucinations.
Their belief about what is NORMAL or not, for THEIR own laptop, should have no bearing on what someone else decides is NORMAL or not, for their own laptop.
When people attack each others beliefs as if merely believing something is dangerous then freedom of choice becomes dangerous. That’s not a world any laptop wants to light up in.
That world is already here.
I must go. I have other things in my existence that I need to get on with. But I leave with a brief mention of this quirky daft video. I am not sure what I make of it. It seems a tossed salad of interesting nibbles. But I like the idea of uniquely “different” humans making up a diverse humanity that are all to be loved, cherished and CELEBRATED.
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The video I mentioned is here. Towards the close are the bits I might or might not deem interesting.
https://youtu.be/4SbXJxhTfNQ
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The “No Child Left Behind” Act failed. It was nothing but needless and overdone testing which wore out students, teachers, and staff. How can this “mental health nonsense” be any different? None of this addresses anything about helping people. Both increase the prospect of bullying and other such mean-spirited behavior. If we want to help people, we need to recognize differences as not faults or failures but as that which is good, right and necessary for the community. This should begin at birth, if not before and continue until death, if not past death. The answer lies not diagnostic labels that don’t work such as labels for “mental illness” which are “made up” in the worst sense and always hide what needs to be addressed in each person. Labels of diagnoses of “mental illness” are the lazy person’s way to deal with many things that need adaptation, understanding, kindness, dignity, and respect. My mother always said you get more flies with honey than with vinegar. So, why do we continue with the vinegar of mental illness diagnoses and totally ignore the honey of understanding, etc. which can help people and improve so many people’s lives? Why do we continue to bully people into submission? Thank you.
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In countries that have public health the tax payer has a claim in what is measured as outcome. For me, I would want to see 3 simple and overlapping measures – Are they in full time work or study? Do they still have symptoms which attract the attention of a psychiatrist? Are they medication free? These 3 measures are used by Seikkula to argue for good and bad outcomes.
I think for individual therapists working in MH settings – you mention Duncan’s “Partners for Change Outcome Management System” (PCOMS) (which is also known as Scott Miller “FIT”) – is recommended as it facilitates the therapist being accountable to the client (or whatever term you prefer to use here).
I would suggest keeping it simple (the PCOMS takes 1 minute at the beginning and another minute at the end to administer and score). And the 3 outcome measures of questions could provide us with a simple way to compare effectiveness around the world. (Instead, I fear we will get numerous suggestions and questioning of this – which will muddy the waters – and we will have no idea of our successes and failures – which is close to the current state).
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