When I’m working with a client, one of the first things I have to assess is how ready they are to change. There are formal questionnaires that can be used to measure how ready an alcoholic is to give up drinking or how ready an addict is to give up their drug of choice. For clients with depression and anxiety, though, the assessment is more a feeling that I get when talking to them.
It’s hard to boil it down to a single metric. But there are signs that someone isn’t there yet. They want support and affirmation from therapy, but they’re not ready to try something new. Yet. Which is fine. It’s part of the therapist’s job to meet a client where they are and to help them to find the motivation to change – the desire to actually do something different.
There’s a group of clients I think of as the yes men: they’re quick to say “uh huh” when I offer a suggestion. They nod eagerly at any interpretation or idea raised in session. When I first started as a therapist, my ego told me this meant that I was just so wonderful at my job that I was hitting the nail on the head each and every time. I’ve realized since that this group of clients are not really listening, considering, or internalizing anything I’m saying. It might be that they want to believe that I can tell them the answer, so they grasp what I say like a drowning person would a life preserver. Sometimes they’re so accustomed to pleasing and satisfying those around them, that they no longer listen to their own inner voice and have learned to hide completely behind the words, ideas, and wants of the people around them. The reality is that no therapist is right 100 per cent of the time. I want clients to be willing to look inside to decide whether what I’m saying resonates or not and to challenge me when it doesn’t fit correctly so that we might find something that does feel true to that specific client.
Another group of clients I short-hand as the excusers: always a reason and an objection to any suggestion. A reason why what’s suggested won’t work for them specifically. An obstacle to any action they might need to take. An argument for every interpretation. This is the opposite situation to the yes men – while I know I’m not always right, I hope I’m also not always wrong. I do know that research has shown certain aspects of self care are fundamental to beginning to feel better. Willingness to engage in self care is an important aspect of being really ready to change in other ways.
For change to happen, we have to be willing to try something we haven’t yet – to try the things we’ve thought of but didn’t believe could work or the things that we haven’t even considered yet.
Most people on my couch don’t fall neatly into either of the two above categories, but they can exhibit aspects of both depending on what we’re talking about in a specific session. The reality is that change is really hard and really scary. It’s not something that people come to easily. It’s also something that people fight against because they don’t want to accept the idea that even though their problems and emotional state are not their fault (more on this in a bit) they are theirs to cope with and adapt to.
It’s my job as therapist to first help clients to see that there is nothing wrong with their emotions. Emotions are an important and vital part of our lives, they’re a product of both our genetics and our environment. We learn about our place in the world and how we can and should react to it from our earliest childhood experiences, but childhood alone doesn’t determine emotion. Our genetics determine our predisposition to emotional states as much as our environment. This all reduces to the very simple idea that our emotions are not our fault and they are not wrong.
That said, our reactions to those emotions – the behaviors we engage in in response to our emotions – might not be so effective. They can get in the way of our long term goals and our values. They can leave us feeling embarrassed and ashamed. So the second thing I want my clients to understand, is that these actions and behaviors are a choice. They can feel urgent and necessary, but to engage in them is always a choice that we get to make. The power of choice is that we can choose to do something different. Change is within our own power and grasp. If we’re ready to break the chain between urge and behavior.
So my goal in therapy is to slow down my clients, to empower them and to affirm their ability to make choices. To choose to care for themselves. To choose to listen to themselves and to prioritize their own needs and wants. To recognize and enumerate their own values and goals and to work to achieve them. When they realize that they can change and they find something that helps them to want to change, that is when the meaningful work of therapy can begin. I want to slow down the link between emotion and behavior, to give clients a moment to make a different choice – when they’re ready.