This post was chosen as the AAMFT “Member Blog of the Week” on March 24, 2011

A recent article in the New York Times has left me a bit steamed. In it, the author (Dr. Richard A. Friedman) states that he does not believe that insight can help someone in therapy feel better. To this point I would agree, insight alone is definitely not enough. But therapy isn’t about just understanding what the problem is, it is about challenging and embarking on answering this question; what are you willing to do to make it different? And this is where my job hits the pavement, sitting with and supporting clients through the hard work of change. Together we identify, interrupt and replace the old pattern/message/story and craft a new one.

There is an adage that comes from the world of addiction recovery but it’s one that I use with every client. It states that “Change will not happen until the pain of remaining the same is greater than the pain of change”.

In session, I hold out my hands and gesture that in one hand we have the pain of remaining the same and in the other hand we have the pain of change. Clients now have to choose a pain. Clients are typically in my office because the pain of remaining the same has reached a point of being greater than the unknown pain of change. So we discuss this and contract together to move into and through the pain of change.

There are few guarantees in therapy. What I can guarantee clients is pain, they just have to choose which one they are willing to embrace. If they choose the pain of remaining the same then they do not need my assistance, they are already familiar with what it is they do or tell themselves to manage their everyday. If they choose the pain of change, well then here we go. The second thing I can guarantee in therapy is work.

My style and approach may be different from the author’s but I would then challenge him to possibly embrace some pain of change and see how he can offer his patients a new experience.

The truly amazing thing about this profession is that the therapist is never done learning either.