In nearly four decades of practicing psychotherapy, I have met thousands of people who have come seeing help for a variety of reasons. The need to either get some help dealing with some obstacle that has come up in their lives or the desire to achieve some change in themselves are the most usual motives I have encountered.
In either case, there seems to be a prevalent expectation that the work of therapy involves developing deeper understanding, insight if you will, and that this insight will cause the desired change or help to happen.
This is simply not true. Insight is not the same thing as change. More accurately, perhaps, a better or deeper understanding does not change anyone or anything. It is, rather, a necessary step in the process of achieving change.
A song by Hal David and Burt Bacharach called “Wishin’ and Hopin'” that was recorded and popularized by Dusty Springfield in 1964 says this musically. It isn’t wishing, hoping, thinking or praying that brings change – It is action.
Clients are often both surprised and disappointed when they have that very special “Ah hah!” experience – That sometimes overwhelming experience of realizing something they did not realize before. It can feel like an epiphany. The disappointment that tends to follow quickly afterward is that this new insight did not change anything about their lives.
This is the point at which the real work of psychotherapy begins. That new understanding needs be transformed into behavioral change by the client. Helping the client do this successfully is at the heart of what a therapist does.
In the early days of psychoanalysis, it was believed by many practitioners that insight, in and of itself, was cathartic and change making. Over more than a century of trial and error and of specific clinical investigation, this has been found to not be completely the case. Catharsis (the process of resolving and settling feelings) has been shown to help people feel better, but rarely brings automatic change to their behavior or to their lives.
Insight that is not used to guide behavioral experimentation or change is tantamount to pure intellectualism and has little to do with the quest for healing or change that has driven a person to make a first appointment.
The requisite understandings and insights may well occur in the office of the therapist but the change must happen in the larger part of the client’s life outside the therapy session. Once this is understood, the working (or ‘middle’) phase of therapy can get under way.
In no instance I have encountered is enhanced insight tantamount to necessary changes. Changes require changed actions to be fully actualized and integrated.
Understanding things better is a largely academic and inquisitive activity that may well help a person lay out a plan for themselves. But, in and of itself, it won’t and can’t change much. What is talked about, realized and learned in the therapy must be brought out into the real world by the client with a commitment to an effort to apply it.
The bottom line is, if a person wants something to be different, they must choose to do something differently. With or without profound insights, this is the real work of therapy and is rarely easily accomplished – But is always possible.