Great expectations

I've had several opportunities to think about expectations recently.

There are the clients who, at the start of therapy, are insistent on a strategy that will magically and, more importantly, immediately transform their lives. There are the clients who have started medication and are disappointed to find that, although they may feel a little better, their troubles have not completely resolved or that the medications come with their own costs. Then there's me. I'm not immune from having my own set of high expectations either. As someone with chronic illness that sometimes throws up odd and unpleasant symptoms, I'm guilty too of wanting my doctors to fix it right now.

It would be nice if we could all get our wishes met....if I had that magic wand that I could wave at my clients and their life would magically be transformed.....if I could wave it at myself and suddenly become a bastion of great health.

It's not realistic though and one of the hardest things, particularly in starting therapy, can be to work through acceptance of the fact that change requires time and often considerable effort. Managing expectations in this respect early on is critical to successful therapy.

Expectations come into play later too. Often people expect a straight line trajectory to recovery. Once people start to see an improvement, and this can be valid both in relation to physical disorders and in the management of health conditions, the general expectation is that recovery will simply continue. Yet it is quite common, in both situations, for progress sometimes to go backwards.

This can be quite devastating and often underestimated by physical and mental health practitioners and even by those who love and support us. The thing is, when this happens, it can be be hard to remember the progress made since the onset of our difficulties. In some ways, a step backwards can be more difficult to cope with that the original onset of our problems.

In terms of psychological disorders, relapse can be quite common and part of building people's resilience must involve the management of expectations in this respect and the provision of strategies to recognise when this is occurring so that remedial action can be taken early on.

I always draw a distinction between lapse, a return to some of the behaviours seen in at the onset of a condition suchas hypersomnia, and relapse, a return to most or all of pre-treatment behaviours. A lapse is what will more typically be seen and, if picked up, can allow the implementation of a pre-planned strategy to prevent things from getting worse.

An important thing to do is to kearn to recognise and act on early warning symptoms which will vary by disorder and by individual. When things appear to be going a little pear-shaped, it can be easy to dismiss their importance and to start to avoid certain situations that draw our attention to the fact that problems are beginning to reoccur. For these reasons, and because sometimes the road to lapse/relapse can be subtle, others can sometimes help us to pick up on a lapse earlier. It can be helpful to have someone who can be trusted aware of early warning signs with permission to draw it to our attention if they notice two or more symptoms. Trusted, however, is a word that cannot be stressed enough.

For ourselves, it is important to avoid any tendency towards 'all or nothing' or 'overgeneralisation' thinking....that the return of one symptom means our condition is fully returned or that because we're not functioning so well in one area, all the gains we may have made in other areas are lost. Recognising these thought patterns and challenging them with the evidence, making an effort to recall gains made, can be helpful.

What have your experiences been with managing expectations either as an individual with a physical or mental illness or, from the flipside, as a health practitioner? What do you find helpful?

Please take time to share your views.