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Improvement Isn’t the Only Measure of Success in Therapy

Middle.SchoolersImagine you give a pill to a child with allergies. The allergies remain the same. Did the pill work? Of course not! But now imagine treating cancer: you give the patient a pill and five years later the patient’s health is unchanged. Depending on the cancer this very well may be an astounding result. Let’s look at similar success in play therapy. An article in the Journal for Specialist in Group Work used group sandplay therapy to target problem behaviors in preadolescents. The results are fascinating.

First, here’s how the experiment worked:

56 fourth- and fifth-graders were referred by teachers to the study due to behavior problems including getting along with others, withdrawal, and displaying signs of anxiety or sadness. Half of these students were divided into small groups and they were treated with group sandtray therapy once a week for 10 weeks. The other half went on a waiting list for the same therapy and became the control group (and were then also treated in the 10 weeks following the experimental period).

Here is the ground-shaking conclusion: preteens with behavior issues who were treated with group sandplay saw no improvement in their target behaviors. After 10 weeks, they were exactly where they had been before.

However, during this same time period, behaviors in the control group deteriorated.

It seems as if group sandplay in this setting didn’t stop the problem behaviors of these referred kids. But at least it kept them from getting any worse.

Here’s how the authors say it: “Based on the results… it seems that without the intervention, preadolescents suffered from more behavioral difficulties. It appeared that group sandtray therapy may have prevented the preadolescents from experiencing more behavioral difficulties.”

After the study, students and parents saw no difference in behavior – they saw their problem behaviors as neither worse nor better. But teachers recognized a difference between kids who had received the intervention and those who did not. Across every measure including total behavioral problems, internalizing behavioral problems, and externalizing behavioral problems teachers saw what the study saw: a widening gap in which untreated kids continued to fall away whereas treated kids held their baseline.

In this study, as in studies of degenerative diseases, there is much more than meets the eye of “no improvement.” If the options are to further fall into problem behaviors or to remain steady, the intervention that allows kids to hold steady is pretty obviously the best choice.

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Improvement Isn’t the Only Measure of Success in Therapy

Kristi Pikiewicz, Ph.D.

After a first career in teaching, Kristi Pikiewicz earned a PhD in clinical psychology from Pacifica Graduate Institute. She now works half time as a psychologist at the Mackintosh School and half time in private practice in Boulder, CO. She lives with her husband, a pack of labradors, and young kids just outside Boulder.

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APA Reference
Pikiewicz, K. (2014). Improvement Isn’t the Only Measure of Success in Therapy. Psych Central. Retrieved on April 22, 2019, from


Last updated: 18 Aug 2014
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