Insight Alone Isn’t Enough – How the Best Therapy Works

There’s a longstanding debate in psychology between analytic (insight-oriented) therapy and behavioral-based therapy.  Back in the early days of psychoanalysis, it was believed that insight was enough to “cure” a person of their ills.  It was thought that if a person realized what was the fear or traumatic incident that first initiated the problem, then this new knowledge alone would enable the person to feel and behave differently.  Not to knock the brilliance of Freud, but insight alone isn’t enough to effect real change in your life.  Insight, or what Oprah would nowadays call an “aha” moment has to be coupled with behavioral change.  Then the behavioral psychologists, who would focus mainly on changing behavior without gaining understanding about the underlying issues being addressed, left out the important insight component.  Why is insight important?  Because the things that we do make sense to us.  Even if they seem crazy or self destructive or prevent us from reaching our goals, on some level – consciously or unconsciously – they make sense.  And, until you figure out why, you’ll be hard-pressed to give the behavior up.

Here’s a case example to illustrate this point:  Natalie* grew up with an angry, volatile father.  He was not physically abusive toward her, but he was verbally abusive.  She never knew what would set him off and tried very hard to be both perfect and invisible, the former so that she wouldn’t give him any reason to be angry and the latter in the hopes of his just not seeing her at all (if he didn’t see her he couldn’t yell at her).  Smart as her little girl strategy was, Natalie couldn’t totally avoid her father and the fact was that he didn’t need any reason to get angry.  Her father was an angry man and it was never really anything imperfect about Natalie that made him angry; he just came that way and anything and anyone could set him off.  Well when he did catch her and began his tirade Natalie quickly learned that any back talk or expression of anger on her part enraged him all the more.  He wanted her to take it and not say a word back.  In fact, if she cried, he also became angrier.  She learned that it was safest to show no reaction at all and that his tirade would end quicker if she was stoic and had no visible reaction.  On the inside she was scared, hurt, and angry, but she learned not to show it.  Afterwards she would run to her room and cry alone.  This was the pattern the entire time she lived with her father.

Well in her romantic relationships as a adult, Natalie had a hard time ever saying anything that a partner might not like for fear of getting him angry.  She continued to try to be Miss Perfect in her own way.  She avoided obviously angry and volatile men, but certainly more even-tempered men are allowed to get angry from time to time and to voice it.  Even when Natalie was with a calm man, she could never respond to anything that she perceived as anger, criticism, or displeasure with her coming her way.  She had no idea how to respond or even defend herself; suddenly she would be a child again and she would freeze and show no reaction at all.  Clearly it was standing in the way of her having a healthy relationship because disagreements can’t be resolved when one person is too scared and frozen to participate.

So Natalie came to therapy and discovered where her present day reactions originated.  She realized that despite consciously believing that she wanted to make her relationship work, her silence was hurting it.  But on an unconscious level her silence made sense – it was her way of protecting herself by shortening and preventing the escalation of what she expected to be an angry tirade.  So Natalie had this great insight, but she still continued to behave in the same way because knowing what initially caused her reactions wasn’t enough to change them overnight.

So on to the behavioral change efforts.  An important start to help Natalie change her behavior was to share her insights with her partner.  He was happy to be supportive because he didn’t want to hurt or scare her and, being a fairly calm person, he didn’t want to be cast in the role of “angry, volatile man,” which is how Natalie would perceive him when he voiced any displeasure with something she did (and what displeased him most was her way of becoming silent when something important came up.)  His knowing this about her made it easier for him to gently ask what was going on inside her when she became mute.  He knew she was probably feeling scared and would do his best to help her feel safe.

However, his understanding and reassurance also wasn’t enough to effect change.  Natalie had to practice a different behavior, i.e. say something at those moments when she was used to staying silent.  It was very hard for her and very uncomfortable.  She felt all of the same fear, even though this was no longer her father, but a calm person.  What she had to do was actually speak and prove to herself that 1) she could tolerate the discomfort of this new way of behaving, 2) she could survive what would come if she “talked back”, and 3) that this loving man in front of her wasn’t her father and he was not going to react in the same way.

Her initial attempts were incredibly scary and awkward for her, but she practiced and did her best.  She began with just saying things like, “I feel bad,” or at other times, just plain old, “Ouch.”  But she eventually learned how to discuss things with her partner from the position of a grown woman rather than a frightened child.  She discovered, to her surprise, that a man really did want to know what was going on inside of her during these moments, which, sadly, had never occurred to her before.  Not only was Natalie helped by all of her hard work, but her partner was too.  He felt grateful and relieved to be appreciated for the loving partner he was trying his best to be, rather than having some angry father image put onto him.  He also felt heard because all of those times that Natalie would keep silent he would get upset thinking that she wasn’t listening to him.

I hope Natalie’s hard work was helpful in illustrating how the best therapy combines these two very important components of insight and behavioral change.  If you want to really help yourself or a loved one, seek out therapy that fosters both.

* Name and exact circumstances have been changed.