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Many people who see me in order to explore the possibility of doing ongoing psychotherapeutic work together are seeing a psychotherapist for the first time and have little or no understanding about how therapy works, what exactly it is they might expect from the experience, and how to actually get involved in the process.
Others have been in therapy before—perhaps many times before—and are, therefore, “therapy veterans” (as one patient described it). They may be seeking help again because of some new development in their lives that warrants additional treatment, or because previous therapeutic ventures—while helpful—did not feel sufficiently complete.
However, many patients with previous therapy experience are seeking help again because they remain unhappy with the results of their previous efforts. Patients who feel this way are heard to say things like the following: “I have an excellent understanding of how my various difficulties developed, but nothing much is really any different then when I started my first therapy fifteen or so years ago,” or, “I’m fifty-five now and have become an expert about what’s wrong with me, but I’m still the same screwed up guy I was when I was twenty!” or, “I know a lot about myself; I just don’t know what to do with it.”
The term I use for this problem is: insight rich and change poor. In fact, when in the initial sessions I have told a new client that this is what I think they are, the look of recognition—and appreciation—for understanding this is striking!
Psychotherapy or counseling, at best, is a dynamic process that is designed to bring about meaningful change. While the knowledge and insight gained from that process is valuable and a blueprint for change, for most people it is usually not enough to justify the many months and the many dollars often devoted to the therapeutic adventure.
Good counseling or therapy has both therapist and client keeping a careful eye on the extent to which identifiable and measurable change is taking place. Both need to ensure that the therapy avoids becoming a "research only" enterprise with loads of data, but with little or no evidence of recognizable change.
Change occurs in different ways depending upon the nature of the change being sought, as well as individual styles and efforts made to achieve it. Sometimes change is the result of deliberate and focused effort to bring it about, like breaking a bad habit, trying to rid one’s self of a phobia, or overcoming the effects of a trauma. At other times, change may occur unexpectedly—even though it has been worked on—as when one realizes the absence or disappearance of an undesirable behavior, tendency, or a troubled way of thinking.
However change occurs, what is important is that a person looking for substantive change via counseling or psychotherapy emerges from the process feeling as though the hard work and sacrifices made to achieve the changes were well worth the effort and an important gift given to the self for a better, more fulfilling life.
