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Find out whether the work is helping

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Agree on signs of useful change that fit this person and this approach. Include the person’s own account and observable changes in life, relationships, symptoms, or participation. Measures can contribute without becoming the sole definition of progress.

When progress is limited, distinguish an inaccurate formulation, a poorly delivered intervention, insufficient opportunity to practice, an inaccessible service, a weak alliance, a mismatch in preference, and a condition requiring different care. Do not automatically blame the person, the approach, or the relationship.

A review can lead to continuing, changing the focus, adding support, consulting, referring, or ending. Discuss the emotional meaning and practical consequences of that decision. A good ending need not mean every problem is solved.