Aaron Beck was 19 years old, depressed, and almost out of hope when he decided to try therapy for the first time.
"I was skeptical," he said. "It was kind of my last chance. If it didn't work, I didn't think anything would, and I was ready to just let things in."
He turned to Community Youth Services in Olympia, an organization that provides mental health care, among other services, to teenagers and young adults.
Before long, his therapist tried something unusual. She brought a laptop to a session and asked him which aspects of his life he wanted to lay out on a digital graph.
“I remember measuring how active I was, how often I was practicing meditation," he said. "One interesting thing I wanted to measure was how often I would have a communication with a stranger."
What results after a few sessions is a picture of a person’s life in spiky lines of blue, purple, and yellow. Some patients measure their sleep habits, their moods, or how their relationships are going.
The graphing tool, called a dashboard, is part of a program that Community Youth Services started using a couple of years ago called Managing and Adapting Practice, or MAP.
It also shows the techniques the therapist uses session to session, so they get a sense of which strategies are working. Yet another part of the program connects therapists with an online database where they can punch in information about a patient and find the most recent and credible research on treatments.
Therapists are increasingly turning to digital tools, like graphs that track their patients’ progress, to inform treatment. But shift to data isn’t entirely smooth, and has raised questions about the extent to which therapy is art or science.
'People Aren't Linear'
Carrie Mayeux was Aaron Beck’s therapist. She said she resisted aspects of the system at first. Therapists are highly trained, and don’t always like to think of their work -- or their patients -- as quantifiable.
“I had a hard time at first and sometimes still have one because people aren’t linear," she said. "And just by me doing a certain practice doesn’t mean someone’s going to react in a predetermined way.”
But she said she came to view the dashboard as merely a tool; Her judgment was still driving the treatment.
One day at Community Youth Services this winter, Mayeux opened her laptop and brought up a graph from another former patient, a young woman. One line represented how close she felt to her boyfriend. Another tracked her drug use.
“One of the most significant pieces for her, when we were looking at this, is she saw how often she used mirrored how close she felt to her boyfriend, who’s also using," she said.
Mayeux said the patient was able to gain insight into her life after seeing her habits laid bare on a computer screen.
"This portion right here, where the blue line of her substance use fell, and the closeness to her boyfriend actually stays the same, is kind of when her insight shifted and she was able to see that they could do different things together than use," she said.
The woman eventually got on the addiction treatment medication Suboxone, and the blue line representing her drug use plummets to zero.
'Something That Is All Too Rare'
Programs like this are rolling out across the country. It’s part of a decades-long evolution in psychology toward the use of “evidence-based practices" -- strategies rooted in data and research.
Eric Bruns, a professor in the University of Washington’s psychiatry department, said the shift has been "extraordinarily slow" and therapists who embrace evidence-based practices are still relatively rare.
That’s in part because mental health care providers are too overburdened and underfunded to train in something new. And it’s in part because of resistance to change.
"It’s unfortunate but true that we still have a lot of practitioners out there who think that the art of therapy doesn’t require them necessarily to ask these questions that are quantifiable," he said. "And simply knowing whether or not a client is expressing that they’re doing better is something that is all too rare.”
'This Roller Coaster Is Real'
Carrie Mayeux said some patients bristle at the idea of having their progress graphed. But Aaron Beck said he's the sort of person who responds to cold, hard information. He remembers the first time he looked at a graph of his feelings and habits and felt hopeful.
“It was satisfying I suppose to kind of see that, while I’m living in the moment, here’s the graph that shows that this is life and this happens, this roller coaster is real and true, and yes it gets bad and then it gets better again."
Beck is 22 now and a writing tutor at his college. He hopes to be a teacher someday. And he still draws on the experience of seeing his life -- the ups and downs -- as a picture.
“For me, as someone struggling with depression, it’s really empowering to see that there are good times.," he said. "And also to forgive myself a little bit for being depressed in the bad times, because it’s natural."