“Am I going to get better?”

I sat at the end of an initial session recently. The person seated across from me had a complex and chronic history of mental health diagnoses, not the least BPD and substance abuse. Following a lengthy intake, I asked if they had any questions of me before we finish for the day. They looked at me straight in the eye, paused, and asked, "Am I going to get better?".

I took a breath.

A bunch of thoughts began to run through my head. Surprisingly, noone has ever asked me this question. The thought must rack the mind of every client I see… surely. 

What do I say? 

Integrity is one of my closest held values and so fluffing around an answer doesn't cut it for me. The reality is, though many mental health professionals may like to fool themselves into thinking otherwise, we have limited idea whether what we are going to do is actually going to help…. We have statistics and research articles and meta analyses to back the choices we make and the practice models we adopt- but these were tested on specific, clearly defined boxes of people that perfectly fitted inside a set of DSM criteria. 'Evidence based practice' is a cliched term used to reassure professionals that this isn't the case. This is not the practice of psychology that we live and breathe. Psychology is as much an art as it is a science.

These are not the clients we see. Not the clients that I meet anyway. This was not the person sitting in front of me with wide eyes. The people I meet are unique, beautiful humans that certainly don't fit into boxes that a medical institution has dreamed up. Their lives are extraordinary and varied and their experiences are scattered across symptomatic check-lists.  

I let my client know this perspective. I used deidentified examples from my own professional experience but let them know that nothing came with a guarantee. No timeline would ever be definitively accurate. For me, and for everyone, human mental health evolution is lifelong. 

I explained the above in less than elegant prose to my client.

They appreciated my honesty. People know when they're being lied to. With this client and the next, I look forward to what the journey will look like. To embrace the uncertainty as the only certainty that we have.