goals

Evaluating and Auditing Counselling and Psychotherapy Services: Some Pointers

How do you go about setting up an evaluation or audit of your therapy service—whether it’s a large volunteer organisation or your own private practice?

Clarifying your Aims

There’s lots of reasons for setting up a service evaluation or audit, and being clear about what your’s are is a vital first step forward. Some possible aims might be:

  • Showing the external world (e.g., commissioners, policy makers, potential clients) that your therapy is effective.

  • Knowing for yourself, at the practitioner or service level, what’s working well and what isn’t.

  • Enhancing outcomes by providing therapists, and clients, with ‘systematic feedback’.

  • Developing evidence for particular forms of therapy (e.g., person-centred therapy) or therapeutic processes (e.g., the alliance).

And, of course, there’s also:

  • Because you have to!

Choosing an Evaluation Design

There’s lots of different designs you can adopt for your evaluation and audit study, and these can be combined in a range of ways.

Audit only

This is the most basic type of design, where you’re just focusing on who’s coming in to use your service and the type of service you are providing.

Pre-/Post-

This is probably the most common type of evaluation design, particularly if your main concern is to show outcomes. Here, clients’ levels of psychological problems are assessed at the beginning and end of therapy, so that you can assess the amount of change associated with what you’re doing.

Qualitative

You could also choose to do interviews with clients at the end of therapy about how they experienced the service. A simpler form of this would be to use a questionnaire at the end of treatment. John McLeod has produced a very useful review of qualitative tools for evaluation and routine outcome monitoring (see here).

Experimental

If you’ve got a lot of time and resources to hand—and/or if you need to provide the very highest level of evidence for your therapy—you could also choose to adopt an experimental design. Here, you’re comparing changes in people who have your therapy with those who don’t (a ‘control group’). These kinds of studies are much, much more complex and expensive than the other types, but they are the only one that can really show that the therapy, itself, is causing the changes you’ve identified (pre-/post- evaluations can only ever show that your therapy is associated with change).

Choosing Instruments

There’s thousands of tools and measures out there that can be used for evaluation purposes, so where do you start?

Tools for use in counselling and psychotherapy evaluation and audit studies can be divided into three types. These are described below and, for each type, I have suggested some tools for a ‘typical’ service evaluation in the UK. Unless otherwise stated, all these measures are free to use, well-validated (which means that they show what they’re meant to show), and fairly well-respected by people in the field. All the measures described below are also ‘self-rated’. This means that clients, themselves, fill them in. There are also many therapist- and observer-rated measures out there, but the trend is towards using self-rated measures and trusting that clients, themselves, know their own states of mind best.

Just to add: however tempting it might be, I’d almost always you not to develop your own instruments and measures. You’d be amazed how long it takes to create a validated measure (we once took about six years to develop one with six items!) and, if you create your own, you can never compare your findings with those of other services. Also, for the same reason, it is almost always unhelpful to modify measures that are out in the public domain—even minimally. Just changing the wording on an item from ‘often’ to ‘frequently’, for instance, may make a large difference in how people respond to it.

Outcome Tools

Outcome tools are instruments that can be used to assess how well clients are getting on in their lives, in terms of symptoms, problems, and/or wellbeing. These are the kinds of tools that can then be used in pre-/post-, or experimental, designs to see how clients change over the course of therapy. These tools primarily consist of forms with around 10 ‘items’ or so, like, ‘I’ve been worrying’ or ‘'I’ve been finding it hard to sleep’. The client indicates how frequently or how much they have been experiencing this, and then their responses can be totalled up to give an overall indication of their mental and emotional state.

Its generally good practice to integrate clients’ responses to the outcome tools into the session, rather than divorcing them from the therapeutic process. For instance, a therapist might say, ‘I can see on the form that this has been a difficult week for you,’ or, ‘Your levels of anxiety seem to be going down again.’ This is particularly important if the aim of the evaluation is to enhance outcomes through systematic feedback.

General

A popular measure of general psychological distress (both with therapists and clients), particularly in the UK, is:

This can be used in a wide range of services to look at how overall levels of distress, wellbeing, and functioning change over time. A shortened, and more easily usable version of this (particularly for weekly outcome monitoring, see below), is:

Another very popular, and particularly brief, general measure of how clients are doing is:

Two other very widely used measures of distress in the UK are:

The PHQ-9 is a depression-specific measure, and the GAD-7 is a generalised-anxiety specific measure, but because these problems are so common they are often used as general measures for assessing how clients are doing, irrespective of their specific diagnosis. They do also have the dual function of being able to show whether or not clients are in the ‘clinical range’ for these problems, and at what level of severity.

Problem-specific

There are also many measures that are specific to particular problems. For instance, for clients who have experienced trauma there is:

And for eating problems there is:

If you are working in a clinic with a particular population, it may well be appropriate to use both a general measure, and one that is more specific to that client group.

Wellbeing

For those of us from a more humanistic, or positive psychology, background, there may be a desire to assess ‘wellness’ and positive functioning instead of (or as well as) distress. Aside from the ORS, probably the most commonly used wellbeing measure is:

There’s both a 14-item version, and shortened 7-item version for more regular measurement.

Personalised measures

All the measures above are nomothetic, meaning that they have the same items for each individual. This is very helpful if you want to compare outcomes across individuals, or across services, and to use standardised benchmarks. However, some people feel that it is more appropriate to use measures that are tailored to the specific individual, with items that reflect their unique goals or problems. In the UK, probably the best known measure here is:

This can be used with children and young people as well as adults, and invites them to state their specific problem(s) and how intense they are. Another personalised, problem-based tool is:

If you are more interested in focusing on clients’ goals, rather than their problems, then you can use:

Service Satisfaction

At the end of therapy, clients can be asked about how satisfied they were with the service. There isn’t any one generic standard measure here, but the one that seems to be used throughout IAPT is:

Children and young people

The range of measures for young people is almost as good as it is for adults, although once you get below 11 years old or so the tools are primarily parent/carer- or teacher-report. Some of the most commonly used ones are:

  • YP-CORE: Generic, brief distress outcome measure

  • SDQ: Generic distress outcome measure, very well validated and in lots of languages

  • CORS: Generic, ultra-brief measure of wellbeing (available via license)

  • RCADS: Diagnosis-based outcome measure

  • GBO Tool: Personalised goal-based outcome measure

  • ESQ: Service satisfaction measure.

A brilliant resource for all things related to evaluating therapy with children and young people is corc.uk.net/

Process Tools

Process measures are tools that can help assess how clients are experiencing the therapeutic work, itself: so whether they like/don’t like it, how they feel about their therapist, and what they might want differently in the therapeutic work. These are less widely used than outcome measures, and are more suited to evaluations where the focus is on improving outcomes through systematic feedback, rather than on demonstrating what the outcomes are.

Probably the most widely used process measure in everyday counselling and psychotherapy is:

  • SRS (available via license)

This form, the Session Rating Scale, is part of the PCOMS family of measures (along with the ORS), and is an ultrabrief tool that clients can complete at the end of each session to rate such in-session experiences as whether they feel heard and understood.

For a more in-depth assessment of particular sessions, there is:

This has been widely used in a research context, and includes qualitative (word-based) as well as quantitative (number-based) items.

Several well-validated research measures also exist to assess various elements of the therapeutic relationship. These aren’t so widely used in everyday service evaluations, but may be helpful if there is a research component to the evaluation, or if there is an interest in a particular therapeutic process. The most common of these is:

This comes in various version, and assesses the clients’ (or therapists’) view of the level of collaboration between members of the therapeutic dyad. Another relational measure, specific to the amount of relational depth, is:

A process tool that we have been developing to help elicit, and stimulate dialogue on, clients’ preferences for therapy is:

This invites clients to indicate how they would like therapy to be on a range of dimensions, such that the practitioner can identify any strong preferences that the client has. This can either be used at assessment, or in the ongoing therapeutic work. An online tool for this measure can be accessed here.

Interviews

If you really want to find out how clients have experienced your service, there’s nothing better you can do than actually talk to them. Of course, you shouldn’t interview your own clients (there would be far too much pressure on them to present a positive appraisal) but an independent colleague or researcher can ask some key questions (for instance, ‘What did you find helpful? What did you find unhelpful? What would you have liked more/less of?) which can be shared with the therapist or the service more widely (with the client’s permission). There’s also an excellent, standardised protocol that can be used for this purposes:

Note, as an interviewing approach has the potential to feel quite invasive to clients (though also, potentially, very rewarding), it’s important to have appropriate ethical scrutiny here of procedures before carrying these out.

Children and young people

Process tools for children and young people are even more infrequent, but there is the child version of the Session Rating Scale:

Demographic/Service Audit Tools

As well as knowing how well clients are doing, in and out of therapy, it can also be important to know who they are—particularly for auditing purposes. Demographic forms gather data about basic characteristics, such as age and gender, and also the kinds of problems or complexity factors that clients are presenting with. These tools do tend to be less standardised than outcome or process measures, and it’s not so problematic here to develop your own forms.

For adults, a good basic assessment form is:

For children and young people, one of the most common, and thorough, forms is:

Choosing Measurement Points

So when are you actually going to ask clients, and/or therapist, to complete these measures? The demographic/audit measures can generally be done just once at the beginning of therapy, although you may want to update them as you go along. Service satisfaction measures and interviews tend to be done just at the end of the treatment.

For the other outcome and process measures, the current trend is to do them every session. Yup, every session. Therapists often worry about that—indeed, they often worry about using measures altogether—but generally the research shows that clients are OK with it, provided that they don’t take up too much of the session (say not more than 5-10 minutes in total). So, for session-by-session outcome monitoring, make sure you use just one or two of the briefer forms, like the CORE-10 or SRS, rather than longer and more complex measures.

Why every session? The reason is that clients, unfortunately, do sometimes drop out, and if you try and do measures just at the beginning and end you miss out on those clients who have terminated therapy prior to a planned ending. In fact, that can give you better results (because you’re only looking at the outcomes of those who finished properly, who tend to do better) but it’s biased and inaccurate. Session by session monitoring means that you’ve always got a last score for every client, and now most funders or commissioners would expect to see data gathered in that way. If you’ve only got results from 30% of your sample, it really can’t tell you much about the overall picture.

Generally, outcome measures are completed at the start of a session—or before the start of a session—so that clients’ responses are not too affected by the session content. Process measures are generally completed towards the end of a session as they are a reflection on the session itself (but with a bit of time to discuss any issues that might come up).

Analysing the Data

Before you start a service evaluation, you have to know what you are going to do with the data. After all, what you don’t want is to a big pile of CORE-OM forms in one corner of your storage room!

That means making sure you price in to any evaluation the costs, or resources, of inputting the data, analysing it, and writing it up. It simply not fair to ask clients, and therapists, to use hundreds of evaluation forms if nothing is ever going to happen to them.

The good news is that most of the forms, or the sites that the forms come from, tell you how to analyse the data from that form.

The simplest form of analysis, for pre-/post- evaluations, is to look at the average score of clients at the beginning of therapy on the measure, and then their average score at the end. Remember to only use clients who have completed both pre- and post- forms. That will show you whether clients are improving (hopefully) or getting worse.

With a bit more sophisticated statistics you can calculate what the ‘effect size’ is. This is a standardised measure of the magnitude of change (after all, different measures will change by different amounts). The effect size can be understood as the difference between pre- and post- scores divided by the ‘standard deviation’ of the pre- scores (this is the amount of variation in scores, which you can work out via Excel using the function ‘stdev’). Typically in counselling and psychotherapy services, the effect size is around 1, and you can compare your statistics with other services in your field, or with IAPT, to see how your service is doing (although, of course, any such comparisons are ultimately very approximate).

What you can also do is to find out the percentage of your clients that have shown ‘reliable change’ (which is change more than a particular amount, to compensate for the fact that measures will always be imprecise), and ‘clinical change’ (the amount of clients who have gone from clinical to non-clinical bands and vice versa). If you look around on the internet, you can normally find the clinical and reliable change ‘indexes’ for the measures that you are using (though some don’t have them). For the PHQ-9 and GAD-7, you can look here to see both calculations for reliable and clinical change, and the percentages for each of these statistics that were found in IAPT.

Online Services

One way around having to input and analyse masses of data yourselves is to use an online evaluation service. This can simplify the process massively, and is particularly appropriate if you want to combine service evaluation with regular systematic feedback for clinicians and clients. Most of these (though not all) can host a wide range of measures, so they can support the particular evaluation that you choose to develop. However, these services come at a price: a license, even for an individual practitioner, can be in the hundreds or thousands of pounds. Normally, you’d also need to cost in the price of digital tablets for clients to enter the data on.

My personal recommendation for one of these services is:

At the CREST Research Clinic we’ve been using this system for a few years now, and we’ve been consistently impressed with the support and help we’ve received from the site developers. Bill and Tony are themselves psychotherapists with an interest in—and understanding of—how to deliver the best therapy.

Other sites that I would recommend for consideration, but that I haven’t personally used, are:

Challenges

In terms of setting up and running a service evaluation, one of the biggest challenges is getting counsellors and psychotherapists ‘on board’. Therapists are often sceptical about evaluation, and feel that using measures goes against their basic values and ways of doing therapy. Here, it can be helpful for them to hear that clients, in fact, often find evaluation tools quite useful, and are often (though not always) much more positive about it than therapists may assume. It’s perhaps also important for therapists to see the value that these evaluations can have in securing future funding and support for services.

Another challenge, as suggested above, is simply finding the time and person-power to analyse the forms. So, just to repeat, do plan and cost that in at the beginning. And if it doesn’t feel like that is going to be possible, do consider using an online service that can process the data for you.

For the evaluation to be meaningful, it needs to be consistent and it needs to be comprehensive. That means it’s not enough to have a few forms from a few clients across a few sessions, or just forms from assessment but none at endpoint. Rather, whatever you choose to do, all therapists need to do it, all of the time. In that respect, it’s better just to do a few things well, rather than trying to overstretch yourself and ending up with a range of methods done patchily.

Some ‘Template’ Evaluations

Finally, I wanted to suggest some examples of what an evaluation design might look like for particular aims, populations, and budgets:

Aim: Showing evidence of effectiveness to the external world. Population: adults with range of difficulties. Budget: minimal

  • CORE-10: Assessment, and every session

  • CORE Assessment Form

  • Analysis: Service usage statistics; pre- to post- change, effect size, % reliable and clinical change

Aim: Showing evidence of effectiveness to the external world, enhancing outcomes. Population: young people with range of difficulties. Budget: minimal

  • YP-CORE: Assessment, and every session

  • Current View: Assessment

  • ESQ: End of therapy

  • Analysis: Service usage statistics; pre- to post- change, effect size, % reliable and clinical change; satisfaction (quantitative and qualitative analysis)

Aims: Showing evidence of effectiveness to the external world, enhancing outcomes. Population: adults with depression. Budget: medium

  • PHQ-9: Assessment and every session

  • CORE Assessment Form

  • Helpful Aspects of Therapy Questionnaire

  • Patient Experience Questionnaire: End of Therapy

  • Analysis: Service usage statistics; pre- to post- change, effect size, % reliable and clinical change; helpful and unhelpful aspects of therapy (qualitative analysis); satisfaction (quantitative and qualitative analysis)

And finally…

Please note, the information, materials, opinions or other content (collectively Content) contained in this blog have been prepared for general information purposes. Whilst I’ve endeavoured to ensure the Content is current and accurate, the Content in this blog is not intended to constitute professional advice and should not be relied on or treated as a substitute for specific advice relevant to particular circumstances. That means that I am not responsible for, nor will be liable for any losses incurred as a result of anyone relying on the Content contained in this blog, on this website or any external internet sites referenced in or linked in this blog. I also can’t offer advice on individual evaluations. Sorry… but hope the information here is useful.

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Synergies are Good: Why ‘Win-Win’ Configurations Matter More than you Might Think

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How can you help people make positive changes in their lives?  

If you’re starting from the position that people are getting things wrong—maladjusted, dysfunctional, misinformed, etc.—then it’s pretty straightforward: teach them the ‘right’ way to do things.  But if your starting point is that people are already doing their best—for instance, that they have an ‘actualising’ tendency, as the humanistic and person-centred therapies hold—then it gets more complicated.  Because how do you help someone who is already actualising to actualise more?

One way of tackling this might be to say that, ‘Ok, the person does have a potential to actualise, but the problem is that the environment they’re in gets in their way.’  So it’s not that the person isn’t capable of actualising, it’s that their world isn’t letting them.  Problem is, that then makes the person little more than a pawn to their world.  Are we really so powerless?  And, if so, what does that say about the human being’s natural capacity to actualise?

For people who believe in an innate human ability to ‘grow’ and act in prosocial ways, there’s a similar paradox at the socio-political level.  It’s easy enough to explain social ills if we start from the premise that people can be intrinsically selfish and competitive; but if people are inherently prosocial, how do you explain gun crime, or homophobia, or Nazism?  How can something so bad come out of something so potentially good?

This is where the concept of ‘synergies’—and its opposite, dysergies—comes in.  Synergies are win–win relationships: where two things go together to make something more than either alone.  Let’s take a really simple example.  Narek wants to be in a relationship and so does Paul.  Narek and Paul get into a relationship together.  Now they’ve both got more together than either had alone.  So we can say here that there’s a synergetic relationship between Narek’s desire for a partner and Paul’s desire for a partner: because the more that one of these things happens the more the other thing does too.

Synergies have been described by Peter Corning as ‘nature’s magic’ and, in a way, they are magical, because they make something out of nothing.  They’re where 1 + 1 = 3.  Here’s Narek, and here’s Paul, and without either bringing in more than what they’ve had, they’ve managed to create something more than what they were.  That’s amazing, isn’t it—something out of nothing?

Synergies don’t just operate between people, they operate within people as well.  Say Narek, like most of us, wants to feel good about himself, and he also wants to have a relationship with another man.  So if he can feel good about himself as a gay man, he’s got a win–win relationship on the inside too. 

Contrast that with a dysergetic internal relationship, where Narek doesn’t feel good about being gay.  Now his choice is to either (a) express his gay side and feel bad about himself, or (b) try and feel good about himself by suppressing his gay side. But either way he loses out: 1 + 1 = 1.

What this example should also begin to show is how the concept of synergies and dysergies can answer the opening question in our blog. Because it’s totally fair enough that Narek wants to feel good about himself, and it’s totally fair enough that he wants to express his gay side.  Both of those are parts of his actualising being.  But because they are pulling against each other, he ends up getting less out of life than he could otherwise.  He’s an actualising being that’s not actualising to his full potential.  And it’s not because he’s maladjusted, dysfunctional, or misinformed; it’s because the things he’s trying to do, with the best will in the world, are dysergetically-related rather than synergetically-related.

Ok, so here’s where I want to make a really bold claim.  I think that nearly everything we do in therapy, whatever orientation, and whether we consciously call it as such or not, is about helping clients reconfigure their ways of doing things so that they are more synergetic.  What we do is we help them think about their lives and how they’re acting, reflect on what’s working and what isn’t, and then think about ‘better’ ways of moving forward (better, of course, for the client, not for us).  So that might mean, for instance, reflecting on ‘defensive’ strategies that have emerged in their childhood, and thinking about whether they want to continue with that; or looking at black-and-white patterns of thinking and seeing if it’s better to see shades of grey.  And it may also be about helping clients to process things at more embodied levels: for instance, to really feel their anger and hurt towards their parents, and to recognise that those feelings are really legitimate.  But, in all of this work, what we don’t do is to pathologise their ‘unhelpful’ ways of doing things.  We don’t intimate to clients, for instance, that their defense mechanisms are really dumb, or that black-and-white ways of thinking are just pointless.  And the reason we don’t is because we can see the intelligibility of these ways of doing things: of course, it makes absolute sense that we want to protect ourselves, or that we want to see the world in more simple ways.  It’s just that those ways of doing things act against us in other ways and are ultimately unproductive. So the question is not about right or wrong, but about how we can get all our needs met in ways that support each other: i.e., how we can be more synergetic.

So I’m suggesting that positive change at the individual level works through the development of synergies; and I think positive change at the social and political level can be conceptualised in a similar way too.  Two communities talk across their differences and start to value each other, nations move from the ultimate dysergetic state—war—to peaceful co-existence, people learn to live in synergetic harmony with their environment.  Groups, striving to do their best, strive to do their best in ways that other groups can also do their best. 

This is a humanistic perspective: not a radically socialist or a radically libertarian one. It’s a politics of understanding rather than a politics of blame. It’s saying that people, even when they act in oppressive or highly damaging ways, aren’t generally setting out to do so. Rather, even the most oppressive people are essentially like us: trying to get their needs met. Only they’re doing it in ways that are incredibly dysergetic to the rest of us, and not always willing to recognise that they’re doing so.

What does any of this mean in terms of what we can do—at the personal or socio-political level—if we want to try and make things better?  In my just published book, Integrating counselling and psychotherapy: Directionality, synergy, and social change (Sage, 2019), I try and outline some of the principles by which synergies can be developed, whatever the level.  There’s establishing trust, and communicating more clearly, being assertive, and embracing creativity and difference and diversity. 

I guess my hope is that, by seeing positive change in this light, we can begin to try and understand the common principles that make things synergetic or not.  As things stand, the development of synergies is always implicit: an underlying process that we try and make happen, without much conscious thought.  Perhaps we can move to a place where we more consciously think, ‘How can we create synergies here?’  And we can also look at the limits and challenges of synergetic processes (for instance, over-compromise), and perhaps develop even deeper and more integrative principles of positive change.

Perhaps, most importantly, what the concept of synergies does is allow us to understand people, and societies, as doing best but could also do better. It means that we can engage with people in deeply respectful ways, while also holding on to the potential for improvement and change. That’s something that, albeit implicitly, is right at the heart of our therapeutic work. And if we can also put that ethos at the heart of social and political change activities, I really believe it maximises our abilities to bring good things about.

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How do you go about getting what you want from life? Seven stages that might get missed

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‘The central “business” of human life,’ writes James Bugental, the existential-humanistic therapist, ‘is the translation of intentions into actuality as we try to have the living experience which we believe we need and want.' In other words, human living is about striving towards the things we want--for ourselves, for others, for our world--and, ideally, with passion, excitement and success.

But how do we go about getting what we want? Based on the psychological theory and research, it's possible to identify seven stages in this process: 

  1. Emanation: the bubbling up of wants and desires.

  2. Evaluation: checking these out against reality and working out what's best to do.

  3. Intention: making a commitment to achieving particular things.

  4. Planning: Working out how we are going to do it.

  5. Action: Getting on with it, and maintaining our activity.

  6. Feedback: Monitoring how we're getting on and making any necessary changes.

  7. Termination: Disengaging with our goals and bringing things to an end.

Of course, all these stages are entirely interlinked. And there can be multiple processes going on at once, all at different stages.

Ideally, we go through each of these stages--at least to some extent. So we give our wants and desires free flow to bubble up, and then we think about them in a reflective and mature way, working out what makes sense to take forward. We spend some time thinking about plans for making this a reality, and then get on with it, all the while keeping an eye to what impact this seems to be having. And when we've done enough, we're ready to disengage, enjoy our successes, and turn our attention to something else.

The problems can come, though, if any of these stages get missed out, done badly, or if we get too focused on them to the expense of other stages. So you might find it interesting to think about the stages in this process that you do really well, and those that you could pay some more attention to.

Emanation: Are you someone who pushes down your wants and desires, who finds it hard to be in touch with your intuitive sense of things? Or, conversely, are you someone who has so many different wants and desires bubbling up that they feel overwhelmed and in chaos.

Evaluation: Sometimes it's great to go with our desires. Sometimes, they can take us to some crazy places. So are you someone who tends to skip the evaluation phase, and just pushes on to doing things without putting the effort in to weighing up what's best? Or, conversely, are you someone who spends so much time evaluating and balancing things up that you never actually make a commitment to doing anything?

Intention: And then, do you have the passion, conviction and confidence to try and take forward what you know is best, or falter at this point and go back to evaluating? This is the big existential leap--into the unknown. The point of no return where, yes, you'll either fail or succeed and what you're wanting to do. But maybe, conversely, just run at intention and commit yourself to everything without really filtering down to what your priorities are. We can't do everything we want: try to do it all and you can sometimes end up doing nothing.

Planning: Some people are great planners. Some people are obsessive planners and drive everyone else crazy because they seem so locked in to the planning stage. And other people just think 'What the hell' and skip this stage entirely: leapfrogging from emanation to intention to action. But a bit of planning and forethought can go a long way: research shows, in particular, that working out what you are going to do when things go badly can be essential in reaching your goals.

Action: Once you get going, do you persist with it, or do you get distracted and go onto other tasks before you're anywhere near completing your current one? A million jobs left unfinished?

Feedback: Research shows clearly that attending to how you're doing helps you get to where you want to go to. If you're trying to make friends, for instance, is it working, or do you seem to be putting people off more than attracting them? And do you get defensive and obstinant, and push on regardless. But conversely, are you so concerned about feedback that you're bending and twisting like a willow, always trying to get it exactly right?

Termination: Keeping on regardless can be a waste of energy, particularly where goals are unattainable or futile.  But some people do exactly that. And the research shows it can lead to depression, and may also be tied in with things like obsessive behaviours. Some times, you need to let go, and knowing when to 'hold them and fold them' is, perhaps, one of the greatest life skills.

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None of us are perfect at getting from where we are to where we want to be. And if you think about the millions of things that we're all trying to do at any one time, it's not surprising. But thinking about the places where you might tend to go wrong could be helpful: getting a bit more balance in your life, and a bit more of what you want out of it.

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If you're 'prevention focused', don't expect to be happy (and don't expect to be calm if you're focused on promotion)

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I love the chapter in the Oxford handbook of human motivation by Abigail Scholer and E. Tory Higgins (2012): 'Too much of a good thing? Trade-offs in promotion and prevention focus'.  Basically, it says that people vary in terms of how much they are 'promotion-focused' (trying to make good things happen), or 'prevention-focused' (trying to stop bad things from happening). But the really interesting point is that if you are a very prevention focused person--someone who's always trying to stop catastrophes from happening--then you can't expect to experience too much happiness: after all, that's not what you're aiming for. At best, what you're going to experience is calm and relief.  And the same thing holds for people with a natural tendency towards promotion: if you spend your life trying to get new experiences (that's me), then you can't complain if you don't have much calm or respite in your life (that's me too). What's the solution? Scholer and Higgins suggest that it may be best to have a balance of prevention and promotion focus, so that you can make the most of whatever situation and circumstances you encounter. So the first thing to ask yourself is whether you're a promotion or a prevention kind of person. Then think about whether you want to bring a bit more of the other one into your life.

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Feeling good means 'actualising' our directions in life

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A lot of contemporary models of human being suggest that we are basically 'directional'. What that means is that we are always 'going to somewhere', always pointed in particular directions. We're striving, trying to improve things, trying to be something and somewhere more than we are: even if it's more chilled out! If that's the case, then we can understand wellbeing in terms of how much we're able to 'actualise' this direction: how much we're aligned with where it is that we want to go.

This actualisation process can be understood in terms of six As. First there is awareness: knowing what our goals are and where we are trying to get to. Second there is anticipation: having a sense that our goals are possible and things that we can achieve. Third comes approach: progressing towards the things that we want; and then comes acceleration: moving towards our wants at an increasing speed. Importantly (but maybe not the most important thing) is then achieving our goals. Finally, and particularly one that may become more important with age, is appreciating what we have achieved.

So, viewed from this perspective, the 'good life' is one in which we have things in life we're striving towards which are important to us, and we have a sense that we're making some kind of progress towards them. We don't have to get these goals all the time, or move rapidly on to other things, but just a general sense that we're pointed in a direction and that we're able to attain it in some way.  And from this perspective, psychological problems are associated with not being clear about what we want from life, or knowing what we want but feeling that it is impossible to get there--or not making any progress at all. Or even it might be about getting to our goals but then not taking the time to appreciate what we have achieved and just rushing on to the next one.

Last thing: if we think about wellbeing in this way, it also shows how what we feel is both about ourselves AND our social and political environment. I might not progress towards the things I want because I don't have good strategies for getting there.  But I also might not progress towards the things that I want because the world is telling me about all these amazing things I should have (a perfect body, the latest phone, a devoted partner) and then not providing me with any possibility at all of getting there. So helping people change the way they go about things can be important--through therapy or self-development work--but what can also be really important is focusing on social and political change. If we create a fairer world with more resources for everyone, then more people can move towards more of what they want more of the time.