We all hear about the importance of measurable outcomes, and in mental health these are often measured with psychometric scales like the Depression Anxiety Stress Scale (DASS), or the K10.

We take a baseline measure, and then test as we go along – it offers a sense of reassurance that we are on-top of things, have some understanding of what people are experiencing, and that treatment is moving in the right direction – it is working!

However, sometimes people will report feeling better within themselves, but their test scores are worse than when they started.  This can be confusing for the patient and the practitioner, unless you understand that this could be the result of improved self-awareness and psychological integration.

Common defences against emotional pain include:

• disconnection
• suppression
• intellectualising
• + other mechanisms

All of these cut a person off from their emotional experience.

The patient may initially present as 

• emotionally blunt
• feeling frustrated
• feeling angry
• feeling exhausted

This is very likely because they have not had the experience of being able to connect with, appreciate and express their emotional life…

Which also means they don’t properly connect with or understand how they feel and will often report lower test scores as a result. 

Therapy can help someone to become more in touch with their emotional life, which may bring them in contact with more painful experiences but will also help them to feel more emotionally alive and healthy.

This will also result in increased reports of distress on Psychometric scales, because now they can feel more – however subjective feelings of wellness will be on the improve too.

This is similar to developing increased sensitivity in a part of the body that may have previously been numbed, or somehow calloused-over due to repeated friction/irritation (as you would see with the skin).