Tracking progress in therapy can seem to be a difficult task. Children who are brought to therapy for some sort of behavior problem (like not following directions, hitting people or disrupting class) often continue to exhibit these behaviors even after therapy has started.

Baseline Measurements:

In order to truly track progress, you really need to have an accurate baseline.

Baseline is a way to refer to behaviors BEFORE therapy started.

If your therapist gets a good indication of your child’s baseline behaviors, then you can avoid this frustrating weekly check in conversation.

It will probably sound like this:

Weekly  Check-In on Progress

Therapist: How are things going with Johnny?

Parent: Oh, about the same. 

You might repeat that week after week for months.

So, if that is how it feels in your life, I would encourage you to ask a different question.

Three different questions, actually.

In fact, tracking progress in therapy (or even in gymnastics, or spelling or anything else) becomes much easier when you focus on three key areas.

Therapist Secret Tracking Measures Revealed

The three areas that will help you tell if your child is actually making progress in therapy are:

  • Frequency
  • Intensity
  • Duration

Tracking Progress: Frequency

One key way to determine progress is to look at the FREQUENCY of behaviors.

How many times does the behavior occur in a day or a week or a month?

If this is a negative behavior like hitting, then you would want the behavior to go DOWN.

If it is a positive behavior like saying thank you, then you would want the frequency to go UP.

So, when a parent comes in a says, “Johnny is still hitting” that is a true statement and as a parent, you might be frustrated.

But if the FREQUENCY of hitting went down from 3 times per day to even twice a day, then he is making progress! And over the course of therapy, it should continue to go down in frequency to just maybe once in a month.  And then to zero.

If you want to start exercising five days a week and you usually work out zero days per week, then increasing the frequency to even once per week is progress! Just because you haven’t hit the goal, that doesn’t mean that you are not working!

Tracking Progress:  Intensity

The second measure of progress in therapy is to look at the INTENSITY of behaviors.

How strong is the behavior?

This is usually done with some type of rating scale.  Again, if this is a negative behavior, you want the intensity to go DOWN. If it is a positive behavior, you want the intensity to go UP.

So, you might look at the intensity of a meltdown and rate it on a scale of 1-10.  10 being the most intense ever and 1 being very mild.  If Johnny’s tantrums are typically an 8 or 9 and now they are about a 5 or 6, then he is making progress.

Again, as the parent, you are still probably annoyed (or exhausted) from dealing with the tantrums, but the truth is that your child is slowly acquiring a new skill.  So, that is good.

Tracking Progress: Duration

A third way to measure progress is to look at the DURATION of a behavior.

How long does the behavior last?

Remember the pattern, negative behaviors should go DOWN in duration and positive behaviors should go UP.

If you have a child that is having meltdowns, were they usually 30 minutes and now they are only ten? That is progress.

As a parent, dealing with a five minute tantrum is much easier than dealing with a 45 minute meltdown.

Putting All Three Together

For some behaviors, you might be looking at only one of those three areas.  But for many behaviors, you can track all three and hopefully notice a trend across the board.

Final Thoughts:

So, before you give up on therapy and say “this isn’t working” I would encourage you to really think about the baseline behaviors.

Where did you start from? And what is the frequency, intensity and duration of a behavior that you are working on now?

And don’t try to change everything at once.  Start with ONE or TWO (at most) behaviors.  If you start to see a change in those three areas, then you are seeing progress.  Keep working!

Why a white daisy?

Apparently, when people  are asked to draw a flower, the first one that comes to mind for a majority of people is the daisy shape.   This single flower (just the flower part without the stem or any leaves and on a solid black background) was show to study participants after being shown a high-arousal negative image. Examples of high-arousal negative images include awful things like violence, injuries and car crashes.  Two trials were conducted:  in the first subjects were shown a high arousal image and then either a) the flower image b) a mosaic of fragments of the flower image or c) a visual fixation point.  In the second trial, the high arousal image was followed by either a) the flower image, b) a chair (deemed a neutral image) or c) a blue sky with clouds (deemed a positive non-floral image).   Systolic and diastolic blood pressure readings were taken throughout the experiments.  

As expected, mean blood pressure was lower when participants viewed the flower versus the fixation point or the mosaic flower,  but what was unexpected is that the flower image actually reduced mean blood pressure to a level lower than the baseline.  Both the flower image and the blue sky had a similar positive impact in changing mood from negative to positive (with the blue sky having the most overall impact).  However, only the flower (not the sky) caused a reduction in mean blood pressure.  It was determined that viewing a simple flower image could in fact change a negative mood into a more positive one and also decrease blood pressure. 

The power of the single flower image was then studied in regards to salivary cortisol levels.  During this study, the high-arousal images were once again paired with the flower image, the flower fragment mosaic or the fixation point.  Once again, only the flower image was shown to significantly decrease stress during the recovery phase. One final examination looked at fMRI images of the brain during these conditions.  Through this imagery it was discovered that the flower image was effective in decreasing the amygdala-hippocampus activation that occurred after viewing the high arousal images. Researchers speculated that the flower image was a distraction tool that was helped prevent the recall of the stressful images.  

The brief viewing of this single flower image was shown to be effective at reducing negative emotions and created better functioning of both the cardiovascular and endocrine systems! Having such a simple tool available to help reduce stress and regulate unpleasant emotions and is one possible tool for interrupting ruminating thoughts or unpleasant flashbacks.  

About the Author Jen Taylor

Jennifer Taylor, LCSW, RPT is an experienced child and family therapist and public speaker who specializes in trauma, ADHD, and conduct problems. Discover more about her diverse clinical background and family. Reach out to Jennifer with questions or comments by emailing at info@jentaylorplaytherapy.com

Jennifer Taylor, LCSW, RPT is an experienced child and family therapist and public speaker who specializes in trauma, ADHD, and conduct problems. Discover more about her diverse clinical background and family. Reach out to Jennifer with questions or comments by emailing at info@jentaylorplaytherapy.com

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