Change Isn't Always Good for You

The fundamental belief about psychology is that patients are resistant to change because it implies the possibility of failure and, to quote psychotherapist Moya Sarner, we at times "choose a safer life over a better life." I love that line but note that there's more to it. It isn't just failure that patients fear; they fear losing themselves.

While this may feel strange, since most of us obviously prefer "better" to "safe," consider how important our identities are to us, and how our defenses, habits, and beliefs form the essence of who we are. Then, think about how scary it might feel to lose that, not only because of the unknown in our gamble but also because we would struggle with what to identify with. As the body may reject implanted organs, the mind may tear at the stitching of an acquired trait.

As with much else in life, there are competing interests in the process of psychological change— between risk and safety, yes, and between character development and authenticity. To lose one's protective shell raises the question: Is this really who I am? Take, for example, a struggling couple where one spouse implores the other for more physical affection. On the one hand, the partner may acquiesce. But, on the other, that partner may feel as though they aren't being true to themselves because they tend to express their love in a different way. The uncomfortable partner may present with a fear of rejection but may also note that "excessive" physical touch makes them feel disingenuous, as though someone else were moving their body for them.

This is why the talk about change in psychotherapy often misses the mark, and why I prefer to consider the work of therapy to entail shifts in perspectives and cultivating better adaptations to one's personal and interpersonal problems. Patients, especially our perfectionist clients, tend to dislike the notion of personality change. Many wish to keep their personalities, for the most part, intact, while at the same time feeling an internal pull to be better; they fluctuate between rebelling and pleasing, not ever fully knowing which is right. One of the main complaints I receive from patients is that prior therapists told them what they needed and how they should change. This isn't to say that most therapists impose their wills on their patients but rather that personality change as the driving force of treatment creates a significant amount of pressure for both parties, which is probably why some therapists become frustrated, and thus domineering, when change doesn't occur. (An aside: perfectionist patients who are people-pleasers may try to use treatment for the purpose of wholesale personality change to please the therapist and others in their lives, seeking to become perfect clients rather than individuals.)

Psychoanalyst Nancy McWilliams poignantly wrote, "Psychotherapy does not make dependent people independent; on the contrary, it makes them able to more effectively use their natural dependence in their personal interests." Her comment can be generalized: Psychotherapy does not cultivate deep personality change; on the contrary, it makes patients better able to use their strengths effectively and adapt to their limits. This perspective has been reductively misconstrued as "symptom management, which avoids root causes." But, fundamentally, many want to live lives that are more or less in line with their needs and usual tendencies, even if they resolve to take more risks.

So, we may fail to ask the patient who isn't affectionate whether he's ever tried to be more affectionate. Usually, patients have already tried to be different people, playing a role in some sense, which usually fails. The question of why people sometimes prefer to hold on to each and every part of themselves is a philosophical one. Maybe it's the terror of death or loss aversion (and most of us want to be loved more for who we are rather than what we can provide), but we know that the goal of maintaining authenticity, the ability to express who you are without shame, should be taken as seriously as any involving a character shift. In my experience, patients can tolerate tweaks to their personalities—better thought of as adaptations—but remain on guard against becoming "better" people.

When we say we challenge our patients, we mean that we present alternative perspectives and why they may be equally or more plausible than current ones. Ultimately, however, patients are the ones who decide how true to remain to themselves.