A new article published in the Journal of Humanistic Psychology examines the inclusion of humanistic and existential psychology principles in the measurement of mental health outcomes over the past 15 years.
The author, Andrew M. Bland, contrasts the assumptions of humanistic and existential psychology with those of the medical model. Although the results demonstrated that principles of humanistic/existential psychology have increasingly been included in mainstream measures of mental health outcomes, the author notes other areas for improvement in research and development. implements.
Outcome-based care has increasingly become the norm in community mental health centers (CMHCs) in the United States, where clients complete outcome measures related to their symptoms or diagnosis to show the effectiveness of the therapy they receive. From this perspective, treatment success often relies primarily on symptom reduction and favors brief treatment approaches that emphasize rapid recovery – despite research indicating that these approaches can be overwhelming for clients and can lead to undesirable results. Additionally, research elsewhere has suggested that clients and clinicians often disagree about mental health outcomes, questioning the validity and usefulness of these measures.
Andrew M. Bland of the Department of Psychology at Millersville University writes:
“SLike the failure of the No Child Left Behind initiative in education, behind these apparent good intentions lie more troublesome motivating forces: cost containment and increased accountability in the face of economic uncertainty. The ability of clinicians to be reimbursed for providing services, particularly to clients who receive public benefits, has become contingent on a demonstrable reduction in symptoms.
Humanistic psychology has criticized outcome measurement for its lack of focus on the context in which clients reside, which, in turn, paints a picture of clients and their recovery that neglects to consider their human qualities. Moreover, the emphasis on brief treatment based on symptom reduction leaves no room for humanistic/existential perspectives, which privilege the person as a human being instead of a set of psychopathological symptoms.
In this article, Bland explores the philosophical and political assumptions of the medical model, which draws 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 in three psychotherapy outcome measures that are typically used in daily practice at CMHC – the Adult Needs and Strengths Assessment (ANSA)the Ohio Mental Health Consumer Outcomes System (“Ohio Scales”)and the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) evaluation measures. The ANSA is a clinician-rated assessment, while the Ohio Scales and DSM-5 measures are self-report measures.
In addition to emphasizing the assumptions of the medical model that underlie these outcome measures, Bland also highlights the progress made in the increased inclusion of humanistic/existential principles in these measures.
The presupposition of the medical model of hedonism reflects the idea that treatment is effective when it reduces suffering and increases well-being in an efficient way, both in terms of time and money. Bland’s exploration revealed that hedonism remains a focal point of the three outcome measures explored, as they all focus on symptom reduction and linear progress rather than examining the recovery process. ‘individual. This focus on symptom reduction contrasts with what clients have reported as good therapy, which includes an increased sense of empowerment and improved relationships.
Additionally, the concept of universalism, or the emphasis on standardized diagnosis and manual treatment, also turned out to be prevalent across the board, as none of them directly asked about the client concerns regarding the usefulness of treatment, particularly for culturally diverse populations.
Additionally, atomism reflects the idea that pathology lies within the individual rather than a symptom of societal problems, including the oppression of marginalized groups. Only one of the measures examined considers oppression to be the key to diagnosable problems. However, it does so indirectly and in a part of the assessment that is excluded from the overall score algorithm. Despite this, two of the measures examine family relationships and access to resources, which is a step towards a more holistic approach to understanding human suffering.
Materialism is the valuing and emphasis placed primarily on what can be physically observed, resulting in an emphasis on therapies that are cost-effective and address operationalized symptoms, as opposed to focusing on long-term benefits or essential factors, such as interpersonal or existential processes. 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 such as hope, creativity, empowerment, self-esteem , etc. In addition, one of the measures contains an item concerning the person’s perception that they were treated with dignity and respect at the agency.
Reflecting broadly on the changes he observed in his review, Bland writes:
“. . . since the analysis by Levitt et al. (2005) of the presence of humanistic themes in nine instruments then commonly used in mental health outcomes research, there was generally little change as the primary focus remains on symptom reduction. Improvements were noted particularly in the domains of interpersonal, agency in self-definition, and personal growth, while the content of items relating to therapeutic experience and overall client functioning remains particularly underdeveloped. This seems to reflect a trend in which clinicians are placed in the expert role as automatic technicians who listen, diagnose and treat minute aspects of symptoms while running the risk of missing the big picture and thus leaving relatively unaddressed and prone underlying concerns. to a possible return.
Limitations of Bland’s work include his focus on the number of items in each assessment that captured humanistic themes rather than examining the wording of the items/how it could be improved; small sample size of outcome measures; its emphasis on adult measurements; using the work of Levitt et al. only to define and determine humanistic principles, some of which are specific to certain populations or situations; and finally, the focus solely on outcome measures used in the United States.
Bland offers recommendations to alleviate some of the problems associated with outcome measures, such as clinicians being negatively affected by policy makers or healthcare administrators misusing data or clients not being honest in their outcome measures. for fear of losing their benefits or services.
He suggests that alternative measures or measures that could be used in addition to existing outcome measures offer a way to address these concerns. Along with the availability of alternatives, administrative flexibility is key to moving towards a more individualized approach to outcome measurement.
Bland highlights some new outcome measures that have been developed, such as those of Duncan et al. Partners for Change Results Management Systemwhich goes beyond symptom reduction to look at second-order holistic change, examines overall global functioning, and assesses the client’s therapeutic experience.
Additionally, Levitt’s Therapy Ladder Client Experiences is another example of a measure that examines the client’s 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 developing measures that capture existential concerns and using more open-ended questions to better understand client experiences and the nuances of growth and progress in therapy. Bland also suggests that further research, especially qualitative methodologies, examining progress in therapy could inform the development of outcome measures that more effectively capture therapeutic growth in a way that aligns with managed care requirements. while preserving the humanity and dignity of the client.
Bland, M. Andrew (2022). A 15-year progress report on the presence of humanistic/existential psychology principles in the measurement of mental health outcomes: thematic discourse and summative content analyses. Journal of Humanistic Psychology. https://doi.org/10.1177/00221678221077475 (link)