How Change Happens in Therapy
By Margarita Tartakovsky, M.S. for Psych Central quoting UB’s Joyce Marter.
Change is pivotal in therapy. In fact, it’s the reason people seek professional help in the first place, according to Deborah Serani, Psy.D, a clinicial psychologist and author of the book Living with Depression. Sometimes, they want to change themselves. Other times they yearn to change others.
“I’m still surprised at the number of people who come to therapy to learn how to get someone else to change,” said Ryan Howes, Ph.D, a clinical psychologist and author of the popular blog “In Therapy.” “They want to know how to get their boss to talk to them differently, or want their wife to appreciate them more, or want their friends to be more considerate.”
Of course the only person you can change is yourself. That includes changing your beliefs, behaviors, reactions and patterns. As therapist Joyce Marter, LCPC, said, “In therapy, change may mean letting go of dysfunctional relationship patterns, irrational beliefs and self-sabotaging behaviors and then replacing them with a more positive, conscious and proactive mode of operation that leads to greater happiness, wellness and success.”
Why is Change so Hard?
According to clinical psychologist Christina G. Hibbert, PsyD, change is difficult because most people don’t know how to change, or we’re just not ready. She believes there are six stages of change, which are part of the “transtheoretical model of change.” This model demonstrates that change isn’t linear but a spiral. She said:
Most people spiral up and down the six stages of change several times before they actually make change that lasts. That’s just part of the nature of change.
As I always say, “As long as you’re in the spiral, you’re making progress. It doesn’t matter whether you’re spiraling up or down, what counts is that you keep on working.” Teaching this to my clients helps them see they’re actually doing better than they think.
(Hibbert explains the model in this post.)
Sometimes change isn’t really what you want. Howes gave an example of a husband who thought he wanted his wife to change.
I’ve worked with couples who claimed to want changes from their partner, but when change happens they want the old familiar dynamic back. A husband wants his wife to be more social, for example, but when she branches out he feels jealous and wants the homebody back. I encourage couples to be clear about the change they ask for, and prepared for that change to occur.
We also gravitate toward the familiar, and fear the unfamiliar, said Marter, owner of the counseling practice Urban Balance. “Change can be scary because people fear the unknown, perceived loss of relationships or the risk of failure.”
Howes quoted the common saying: “The devil we know is better than the devil we don’t.”
Some people hyperfocus on external changes. “I’d say that so many of us struggle with external change because we secretly hope we can bypass the true work which is changing how we feel inside,” said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. Put another way, “when we place too much concern in things looking different then we tend to overlook the deeper need to shift our internal climate.”
Change is tough because it also takes time. According to Serani, “It takes time to discover patterns that create undesirable thoughts and behaviors. It also takes time to understand what issues get in the way of achieving your goals once you know what you need to change.”
Naturally, resisting change is normal, Marter said. “Breaking through defense mechanisms and developing the tools to think and operate differently is a process with ups and downs.”
While change is difficult, it’s to be expected. “I think we need to recognize the inevitability of change. We are all changing in some way or another, every day,” said clinical psychologist John Duffy, Ph.D, author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.
How Therapists Facilitate Change
“I try to teach clients to be like a super-sleuthing detective. I want them not to just crave change, but to be immensely curious about it,” Serani said. In fact, she believes that “enthusiastic curiosity” helps us develop insight and replace old behaviors with new ones much faster.
Healthy change, she said, happens when we ask key questions, such as “Why isn’t this new technique working? What’s getting in the way? How can we make it work better?”
Hibbert, an expert in postpartum mental health, helps her clients learn how to change. “My job as a psychologist is to provide the ‘how’ so the client can get to work. I’ve seen many people make amazing changes, so I know it’s possible. You just have to believe it’s possible for you.”
Howes helps clients gain a clearer understanding of the trade-offs of change.
As pessimistic as it might sound, I try to help people know that change means trading in one set of problems for another. Sure, there may be some clear benefits to change, but there is always a different set of hardships to endure.
Just ask the people who win the lottery. Financial problems are solved, but a host of new problems emerge. If they’re informed and prepared for their new set of problems, change may be welcomed instead of dreaded.
Change is an inside job. Marter quoted Eckhart Tolle, author of The Power of Now, who said: “If we get the inside right, the outside will fall into place.” She explained:
Many people think if they have the perfect job, house, relationship, or body, they will finally be happy. Through therapy, I help clients make internal changes – such as detachment from ego, focus on essence, silencing the inner critic, practicing positive thinking and gratitude – that lead to positive change in life.
Marter teaches her clients to recognize that it’s “inner forces” that determine their lives, not external ones. This way “they feel empowerment to enact positive change in their lives, both personally and professionally.”
Plus, she teaches them to practice assertive communication, which includes “asking for what they need, setting healthy limits and boundaries and saying no to old patterns that are no longer serving them.”
Sumber also helps his clients transfer the focus from external change to internal transformation.
I work with clients to release their expectation of external manifestations and allow for a shift in their conscious awareness of who they are and why they are doing what they are doing. Most clients are surprised in the end to find that things have indeed shifted externally as a result.
Duffy helps clients foster self-awareness, which he views as a requisite “for satisfactory, proactive change. Otherwise, we are simply reacting to life, and often feel we are victim to it.”
Real change requires work and effort. As Serani said, “toxic tendencies or undesirable thoughts don’t happen overnight. They are created and cultivated over time. And the same goes for change. It doesn’t happen overnight either.”
Positive change is a process that ebbs and flows. But it’s worth it. Change is “an essential part of healing and development,” Marter said.