24 Jan

Resisting Change in Psychotherpay

“A world that can be explained even with bad
reasons is a familiar world”. (Camus)

People seek the guidance of a therapist when there is disruption and distress in their lives and their usual self-limiting, risk-avoiding way of operating are not paying off. Such patients arrive full of fear, pain, and turmoil expressing strong and genuine wishes to deal with their situation. As surprising at it may seem however, most of these people are not truly serious about actually doing something to change. Rather, their primary motivation is to get the pain to stop.

Like everyone else, the psychotherapy patient is all too often inclined to act out of fear rather than a longing for growth. Otherwise, the patients I see would be eager and excited to come to my office rather than suspicious and doubtful. In spite of their obvious distress and expressed desire to find peace, very few patients are prepared to replace their painful but familiar ways for better ones. Rather than wishing to learn enough about their condition so as to alter their life to live more productively, their compelling desire is to no longer feel what they are feeling.

It should not be surprising then that though the patient enters therapy insisting that he wants to change, what he really wants is to remain the same and get the therapist to make him feel better.  Rather than replacing their existing system for something new, the hidden wish of both the personality disordered and the neurotic is to become more effective in terms of how they already live their lives, a sentiment captured by one writer who describes therapy patients as “preferring the security of known misery to the misery of unfamiliar insecurity” (Sheldon Kopp).

Each therapy patient resists change in his or her own unique way. Each brings with them an armada of protective attitudes and strategies which began developing early in life to satisfy one primary motivation: the avoidance of any danger or risk that could cause pain. In their typically risk avoidant ways, they continue to operate from a personality structure designed from infancy to keep them safe when in reality, most of what they needed to protect themselves from as children no longer exists. This form of protection not only prevents the realization that the danger has passed, it also restricts the opportunity for new experiences and learning.

The unfortunate result of shielding themselves for so many years is the development of a limited, fearful, and distorted view of reality. The ongoing life struggles which inherently accompany such a perspective guarantees the continuation of their pain and frustration and ironically, perpetuates the very need for such strong defenses.  Moreover, these habitual defensive postures are invisible to the patient leaving them blind to the very attitudes and behaviours which generate such disruption in the first place.  No longer able to trust in their own experiences as a useful guide in their life, they come to my office unsure of whether even that decision is a bad one. (see my article The Remarkable Thing About Anxiety)

Yet if it wasn’t for their suffering there would be no motivation for these patients to seek help. And in spite of their profound resistance to surrendering their dysfunctional and characteristic defenses, their pain offers hope. It is the central source of their desire to do something about their life however confused that may be, and which, under the right conditions, offers a starting point with sufficient energy to propel the patient into making a real difference.

One of the ongoing therapeutic tasks is to manage this pain with compassion; to work with it in a balanced way so as to keep just within the painful limits. Too much anxiety, doubt, and fear and the patient will run for shelter elsewhere. Too little and they will leave having learned nothing about themselves, their world, or about others.

If these patients can be introduced gently and gradually to their fears they can come to know themselves sufficiently well so as to make healthier choices. Unfortunately for many, the fear and distrust is simply too great. Out of frustration at being unable to find a solution to their difficulties they may be willing to receive a magical cure, but they are not free to learn about themselves. Their inability to trust their own experiences and judgments precludes trusting anyone else and in spite of the predicament this generates, it remains safer to suffer in known misery. For such people, the therapist and the therapy is destined to become just one more disappointment in an already disappointing life.

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