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.

Pick a Feeling, Any Feeling

 We psychologists are infamous for asking, “How did that make you feel?”  But we ask for an important reason: Because people often don’t know what they feel.  Often bright and successful people come in to see me and when I ask how they feel about something they reply not with a feeling but with a thought.  Here’s an example of one of those exchanges:

Patient:  My boss just had to tell me that I forgot to include an important document in the middle of the meeting in front of everyone!

CF:  How did you feel when she did that?

Pt:  That she could have told me in private before the meeting and given me a chance to fix it instead of reaming me out in front of everyone.

CF:  Well that’s what you think she should have done instead, but how did you feel about what she actually did?

PT:  That she’s an idiot.

CF:  Ok, that’s what you think about her, but how did you feel?

(This can go on longer, so before it gets painful for either of us I might supply a few feeling words to choose from if someone clearly has a hard time expressing feelings.)

CF:  Did you feel angry or happy or sad or embarrassed or humiliated or something else?

PT:  Oh.  I felt angry and embarrassed.

(Great start!)

CF:  And what did you do?

PT:  I nodded and pretended it didn’t bother me. 

You see there was a lot going on in the situation that the person described.  There were feelings (anger and embarrassment,) thoughts (She’s an idiot,) and behavior (I nodded and pretended it didn’t bother me.)  They are important to tease apart and see how your thoughts affect your feelings, your feelings affect your thoughts, and how they, in turn, affect your behavior.  They are all linked. 

Everyone has had the experience of doing something that they regretted, whether it’s an unexpected reaction or a repeated behavior.  The best way to stop it from reoccurring is to look at what you did and what led to it and break it up into smaller, easier to see pieces of thoughts and feelings – sort of like instant replay – that help you to make sense of your behavior.  Most people aren’t so good at knowing what they are feeling and then expressing it coherently.  Versions of the above conversation have happened with incredibly bright people, and not being able to label their feelings certainly didn’t make them any less bright.  The fact is our society really values being intellectual and minimizes the value of expressing feelings, and often for good reason.  You don’t want the ER surgeon to be overwhelmed with sadness and grief; she has to put those feelings aside for a while and get to work saving a life.  Lawyers also are not paid to put their feelings into a legal motion.  Just the facts please, no one wants to hear if a lawyer felt frustrated because he thought his client was uncooperative. 

But it is especially important in a romantic relationship to be able to share your feelings with your partner.  Be as intellectual as you like at work, but your partner wants to know more, he/she wants to know some of your internal world, which includes your feelings about things and how things affect you emotionally – and your feelings about them and how they affect you emotionally.  These are the juicy bits that don’t get shared with everyone else, which they feel privileged to hear. 

Now don’t worry that therapy with turn you into a teary mess and you’ll lose your intellectual prowess and start spouting off feelings and poems uncontrollably.  Therapy will help you to acknowledge, understand, and express your feelings more easily – if and when you choose to.  Your first language may be more intellectual and you’ll always be more proficient and comfortable in it, but you’ll learn a second language that you can slip into whenever you need to and whenever you want to communicate more effectively in your relationship. 

How do you feel about expressing your feelings?  Just kidding.  Do you have trouble teasing apart your thoughts and feelings?  Do you have a harder time expressing “negative” feelings, like anger, than “positive” feelings, like happiness?

How Long Does It Take before Therapy Helps?

 

I don’t want to sound like a non-committal politician, but it’s different for everyone.  That said, some people begin to feel relief at their first visit due to one or a combination of these reasons: finally sharing things they may never have shared with others, venting, having someone empathetic listen to them, and receiving some reassurance that they aren’t as crazy as they thought they were.

While the Woody Allens of this world would like for therapy to go on forever, it’s totally unnecessary.  However, the benefits of long-term therapy, i.e. more than a few months, are unmistakable.  The people who have worked with me for well over a year have made a good deal of progress in their self-esteem, ability to speak their truth, and willingness to make changes in their lives.  However, I would say that all of these people began to feel better about certain issues in their lives within the first few months.  They just chose to move on to deeper issues once the initial concern that brought them in was no longer an urgent problem.

People tend to come in for therapy because of one particular issue, for example, divorce, depression, work stress, or relationship trouble.  What we tend to discover is that the behavioral or mental patterns contributing to that particular problem are present in other areas of their lives causing some problems there too.  One example would be fear of speaking your truth because you think someone will get angry.  Then the worst possible consequence you can imagine is that someone will get angry and leave you.  Can you see how this fear would inhibit you from telling your partner something that he or she doesn’t want to hear?  But can you also see how it could keep you from speaking your mind to your best friend, your boss, even your landlord?  It all boils down to the same issue; it just presents itself in different scenarios – some more intense than others.  Why?  Well because it’s your issue and you bring yourself to every situation.  Believe me, you’ll even bring it into the therapy room because it’s not like you’ll come in and leave your personality outside the door.  And that’s fine, you will act out your issues with me too and the difference will be that I will be able to point them out to you without getting as confused, defensive, or frustrated as other people in your life would.  In other words, I won’t take it personally and will just talk to you openly about what you are doing in a way that most people in your life can’t.

So, of course, some people come to therapy and resolve the specific issue that was causing them trouble and then they leave happy with their results.  Then other people discover that the initial issue, although it has improved, is just the first layer of that onion, and have the desire and courage to stay longer and dig deeper in order to effect deeper change in different areas of their lives.

Maybe after my long response that’s what it really boils down to: Do you want a little change in your life or do you want A LOT OF CHANGE in your life?  It’s not a judgment – neither one is inherently better than the other.  It’s all about what you want and need.  If you look at your life and realize that there are several areas that you’re unhappy about…well then stick around for a bit, do the work, and watch your life change.

Have you been in therapy before?  How long did it take before your felt some relief?   Does the possibility of how long therapy can take prevent you from ever beginning?

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