Do you have to want to change?

Remember this joke?

Q. How many psychiatrists does it take to change a light bulb?

A. None—the light bulb will change when it’s ready.

Well it is actually appropriate in talking about therapy.

How much does a person have to want to change in order to change at all? Basically nothing is going to happen as a result of therapy if the person doesn’t want to change. And it is a lot more complicated than it seems. Change is inherently destabilizing and uncomfortable, even when it seems highly desired. So there is a big difference between feeling you want to change and actually doing the changing.

I read somewhere that a famous guru when asked how to stop smoking said, “That’s easy. Don’t smoke the next cigarette.” All the work of therapy lies in that space between the question and the action. 

The pattern of beliefs and feelings we have about ourselves, built up over a lifetime often with roots in our earliest relationships and never really challenged by us create the prison we live in. We don’t realize is that this prison has only three walls and no bars keeping us in. We don’t realize this because we stand in the corner looking at the walls in front of us and believe that there is no way out. Therapy is, at least in part, the process of turning around and discovering that we can walk out of our prison. That process is not easy and it can take a very long time, but stripped to bare essentials, that is what we do in therapy.

So you decide one day to go to a therapist to see what she can do to help you. In therapy, no matter how much you may believe you are controlling your responses and behavior, over time your habitual ways of thinking and acting about yourself and your world show up. These are the stories you tell yourself about yourself; they make up your prison. As the therapist questions your habitual responses and views and challenges your ideas about yourself and the world, ever so gradually, you start to change — daring to be more open, to question what you have believed, to try new ways of behaving. It is slow and subtle. The therapist has to be both patient, caring and willing to challenge you, the patient, even make you uncomfortable or upset. And be able to not take personally the feelings you have toward her or him.   Gradually the story you tell yourself about yourself changes, not in kind but in degrees. The things that used to be self-defining recede a bit to allow other self-perceptions and beliefs to come to the fore. The more deeply ingrained the patterns, the longer it takes to change them.  

The therapist doesn’t DO anything. We listen, we offer observations in the form of interpretations, we may confront but we have no magic to make change happen. It is entirely possible to spend months or even years in therapy without changing at all. The hard work of making the change — or, to return to our famous guru’s recommendation, not smoking the next cigarette — is up to the patient. So why see a therapist? Because it is very difficult to see yourself clearly. Just as a camera cannot photograph itself except in reflection, the kinds of changes that are the heart of therapy need someone to serve as a mirror, as someone who can see and hear you without having an agenda about or for you, someone who can be caring and brutal. I can’t think of anyone I know who has done that without help, including myself.

Got questions about therapy? Leave a comment or email me using the form on the right, and I will do my best to answer. Please keep questions general rather than about your therapy or therapist.

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