A Thought I Never Share with a Patient: Does She Even Want to Get Better?

              Feel free to be offended reading this initially. But stay with me, folks!

The vast majority of patients are desperate to get better. But regularly we get others that are less committed to making changes and more interested in venting, processing (with little intention to make changes out of session), or just seeking validation. This is not a bad thing! Most individuals hold the answers to their problems already. I need to break up with my partner, I have to leave my job, I should stop smoking, I need to exercise, it’s time to go back to church, I need to be kinder to myself. Humans often don’t need guidance but need help getting unstuck.

              Therapists are locked in on what needs to be addressed to feel better and in so doing we are constantly assessing the barriers to action. Rarely do I meet someone and tell them they should eat better, start a cardio exercise regimen, spend more time outdoors, and put more effort into their relationships and the patient has an “ah-ha” moment, thanks me for my advice, and leaves session ready to implement those changes. Often therapy is sitting with patients in their ambivalence to change attempting to increase motivation.

              One question I often ask my clients when they are battling with a difficult decision (e.g., going back to school, leaving an abusive relationship, having an abortion), is what would the You ten years from now tell you to do? This allows patients to jump over the barriers to change and connect with what they know they likely “should” do. This exercise furthers our discussion from deciding what to do (you can weigh pro’s and con’s with yourself if you have an hour and a pen and paper), to why it’s hard to do it.

              When working with a patient with whom I’m managing their medication and encouraging them to add psychotherapy, I often get the same response: “I know what I need to do, I just need to do it”. Mulling over inaction and coming up with a plan to do something different is one of the most helpful elements of counseling. Psychologists have a name for this approach: motivational interviewing.

              Other patients come to therapy for another motive other than seeking healing or help with a particular problem. Some seek companionship. I’ve had many lovely clients come without any particular agenda but because they have no one else who will sit with them and really talk. This ranges from the socially anxious young adult who only has acquaintances online to the elderly man whose friends and family are long gone. Yet others are well connected socially but looking for a confidential space to discuss their lives, their relationships, and their goals. We also serve as the containers to many patients who do not wish to change but wish to vent about their stress and dump their problems somewhere. With these clients we look for a direction of therapy that could be helpful. An “in” to at least put a spotlight on a blind spot or challenge their thinking. Some of these patients can be challenging for a therapist because we can’t want their lives to change outside of session more than they do. We can’t work harder than them. Again, we sit in the ambivalence and point out that the client is not ready or wanting to change.

              So when I say that your therapist is wondering if you want to get better, I mean: are you stuck, need guidance and support, or looking for a sympathetic ear?

Feel better, y'all!