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Since a judgment of worse is always made in relation to a standard, which presupposes a definition of better, it is clear that the problem of what constitutes a negative effect is inextricably interwoven with a definition of mental health. Any form of psychotherapy or behavior modification is designed to move the patient toward a particular ideal or norm; the techniques used in a given form of therapy are instruments for accomplishing that purpose. Only by considering multiple perspectives will it be possible to derive a comprehensive definition of mental health and meaningful evaluations of psychotherapy outcomes. Consider the following: If, following psychotherapy, a patient manifests increased self-assertion coupled with abrasiveness, is this a good or a poor therapy outcome? If, as a result of therapy, a patient obtains a divorce, is this to be regarded as a desirable or an undesirable change? A patient may turn from homosexuality to heterosexuality or he may become more accepting of either; an ambitious, striving person may abandon pre-
Strupp et al. (Sat,) studied this question.