Emotional Health · Health

Dr. Ford on Emotional Health: The Art of Change—When Self-Help Is Not Enough

It’s not hard to see how failing to address the underlying problem that causes a behavior can lead to failure. For example, consider the story of Virginia.

Virginia, 67, lost her job and her husband within two years. Living alone on a reduced income, she felt she had few prospects for a new job and she couldn’t imagine herself finding a new partner. Her initial grief and expectable mourning evolved into a chronic depression in which she was plagued by tearfulness, insomnia, and anxiety. Her children lived far away, and she felt isolated as well. She began to find that the only thing she could look forward to in her day was her nightly cocktail, and she started drinking earlier and earlier as the months wore on. While the alcohol numbed her anxiety, made her loneliness easier to bear, and helped her fall asleep (though she often would awake anxious in the middle of the night as its effects wore off), it also intensified her depression and left her feeling ill, tired, and unmotivated each morning.

While some of Virginia’s problem was behavioral (she had developed a bad habit) and also social (she was isolated, lonely, and lacked social support), she was not motivated to give up her drinking because of the important role it played in alleviating (at least marginally) her psychological symptoms. Also, because she was depressed, she felt hopeless about her life and pessimistic about her ability to solve her problems. Only by getting into therapy was she able to untangle the web of difficulties she was faced with. She came to understand that the loss of her husband was not just a straightforward case of grieving—she was also angry at her husband, who had been aloof and withdrawn. She felt she had wasted her life living with him and working at a career she didn’t like in order to help support the family. She hadn’t been able to acknowledge her rage while he was alive because she felt trapped. After he was gone, she was hampered by feelings of guilt—feeling that she should not be so angry at someone who was gone.

Early on in his pioneering quest to understand the human mind, Freud discovered that neurotics tended to hang on tightly to even the most self-destructive of behaviors, and he coined the term repetition compulsion as a name for this finding (‘Remembering, Repeating and Working-Through,” 1914). His view was that people have the urge to try to master childhood traumas that they experienced as passive victims by repeating the circumstances of the trauma, but with themselves in the active role. The most clear-cut example of this phenomenon is that of the victim of early abuse who later in life reenacts it by abusing someone else in turn. The less conscious you are of your feelings, the more likely you are to engage in these “reenactments.”

We are prone to repetition in many aspects of our lives, above and beyond childhood trauma. Later psychoanalysts expanded on Freud’s theme and recognized that we seek to master our past in many ways and in many arenas. In his classic work Childhood and Society, Erik Erikson wrote, “Some people make the same mistakes over and over . . . the individual unconsciously arranges for variations of an original theme which he has not learned either to overcome or to live with.” The way we behave in our interpersonal relationships and our emotional responses to others, for example, are always to some extent governed by the themes of our early life. Some Object Relations psychologists (the term for a psychoanalytic theory of how the human psyche is influenced by our experiences with other people) use the analogy that each of us is compelled to replay an internal drama that is shaped by our early lives (Joyce Madougall, Theaters of the Mind, 1992).

For example, one person might have a “leading role” for an authoritarian man or woman. He or she may either seek out people who can play this role well, and/or compel others because their own behavior provokes it (e.g. if you act like a wayward child, your partner may become angry and authoritarian in response). Psychotherapy, by helping you understand your inner life and motivations, gives you more control over your actions. What was once compulsion can become a choice.

How can you know when you may be unable to change without the help of psychotherapy? Broadly speaking, there are some key signs that you may have a problem that needs more than just resolutions, habit-change, or willpower to overcome. Those signs include—

  • You have been struggling with the same issue for a long time without improvement. While usually people have to make multiple attempts to solve a problem (people who successfully stop smoking have typically tried and failed several times before), if you make no progress from year to year, or you problem worsens.
  • You are involved in repeated situations that have the same pattern or outcome over and over: for example, if you have a habit of always choosing a certain kind of partner or you keep getting into conflicts with a certain type of person at work.
  • Your behavior is causing you and/or your family physical harm or danger: examples are protracted drinking, drug abuse, illegal activities, abusive relationships. The latter can be particularly hard to break free of without understanding the psychological “glue” that makes you stay.
  • You are experiencing “symptoms” that are either severe or not amenable to change on their own: This can be anything that is unhealthy or disturbing to you or those who care about you, including anxiety, sleeplessness, hypersomnia (sleeping too much), tearfulness, eating problems, compulsive gambling, sexual acting out, thrill seeking, irritability, inability to concentrate or meet obligations, etc.

This list is far from exhaustive, but the basic idea is that some problems are too big, too complex, or too intractable to solve on your own. I remember one woman who, looking at her diary from five years before, found that she’d had exactly the same complaints about her marriage back then that she had in the present. She knew it was time to try some different way to approach the problem, since nothing she had done on her own had helped. She began individual therapy, and subsequently couples counseling, when she realized she wanted to stay married despite her many years of unhappiness (they are much happier together today, 20 years later). It was difficult, but with time, patience, and courage, people can change in amazing and surprising ways.

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