More Than a Number

In my professional life I’ve used many different types of assessment and evaluation forms over the years, but I’ve always thought of them as impersonal, intrusive and inaccurate in their findings. People who are feeling anxious find them particularly challenging to fill in for obvious reasons (who wants to be ticking boxes about their private emotions while feeling distressed) but despite this they are widely used to assess the psychological states of those seeking support. I’m a researcher and I know that data collection can be important. It’s used to prove concepts and create evidence bases, but more often than not evaluations used in psychiatric settings are literally about ticking boxes for stakeholders rather than for the benefit of the individual. Forms and evaluations are often part of the diagnostic process but diagnosing and pathologizing emotional and psychological states is something I’ve questioned throughout my professional life for lots of reasons. Individuals filling in forms are unlikely to know how the information that they are sharing will be evaluated, for example, in the CORE test, boxes are ticked, scores are added up, but very few people understand what the meaning of the resulting data is, and how it will inform their access to support. These questionnaires can make us feel uncertain, and off balance. We know that people will look at them and make decisions about us based on our answers, that may affect us in ways that we don’t have control over, creating the possibility of power imbalances at the outset of any therapeutic relationship.

People make inferences about each other when they look at the answers to people’s questions, but the types of questions used in questionnaires and even the order that the questions are posed in are known to influence the responses given. How people feel one day, is not necessarily how they feel on another day, and yet the information disclosed is stuck in a database somewhere, (or held in someone’s unchallenged perception of us) saying something about who we are that may or may not be truly representative of us. Even if it is an accurate representation of our experience, who is it for? Why is it considered more valuable than a continuing exchange of evolving information over time and space in a trusted relationship? Most questionnaires also have the issue of not being culturally aware or sensitive in their orientation which renders the responses and inferences less than relevant to those outside of the ‘culture’ in which the form was developed. Imagine how bewildering an experience this might feel for those attempting to fill them in with no hope of being understood.

The only question you will find on Out of the Loop is basically – ‘Where are you on a scale of 1 to 10 if 10 is panic and 1 is calm?’ This question isn’t about collecting data in the evaluation sense. It was borne from an instinctive way to help me and the anxious person I’m working with to gauge how they are doing in the moment. It’s really just a way for you to get a sense of where you are at different stages of learning about anxiety. There was an idea to make the scale on this website interactive, so that people would be able to see the anonymised collated scores of those who have used the process, but I realised that I don’t want to collect data about human beings. It really doesn’t feel right. If people want to share their experiences with me, qualitatively, in their own words, or talk to me as a counsellor, or anxiety specialist, I am honoured to listen, and converse on equal terms. I don’t write anything down unless I’m asked to by the person I’m working with, and that is usually just for them to use as reference post session. Thankfully, there are people out there working in the field of psychology who recognise the intrusion and potential hazards of evaluating and diagnosing rather than seeing distress as natural human responses to life’s adversities. Dr Mary Boyle and Dr Lucy Johnstone have, along with experts by experience among their colleagues, developed a respectful, collaborative approach to making meaning of experience through open dialogue, formation, and enquiry. This way of working with people generates an environment of equality and co-creation. By asking the question ‘What happened to you?’ rather than a set of enquiries geared at finding out ‘What’s wrong with you?’ a genuine and personal exploration of a person’s life and the impact that it’s had on them can be explored in a setting of unconditional positive regard. Being labelled with a ‘disorder’ has historically led to a reduction of autonomy for individuals who are struggling emotionally. To be able to explore experiences without the fear of being labelled collapses the power imbalance that can be present in the systems that have been established to help us with our ‘mental health’. This hierarchical system is being challenged as people realise that they are the experts of their experience and this experience is valued and recognised by those who went into the field of Psychology to try to understand and help one another when times are emotionally tough. The name of this approach is the Power Threat Meaning Framework, and if you are interested in learning more, you can check out the book they have written here and a link to their work here.

My original training as a Counsellor was in the Person-Centred Model based on the work of Carl Rogers, which grounds me in a place of seeing people, not illnesses. Thankfully, person-centred values are being re-visited as the top-down systems built without them struggle to connect at a meaningful and human-centred level. One day we will hopefully see that being a person, distressed or not, doesn’t mean we need to be measured and categorised to be understood or supported.