“Insight does not equal change”

Part of an occasional series about phrases that this therapist finds himself repeating, often.

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As a clinician in private practice, one of the phrases that I frequently hear myself saying is this: “Insight does not equal change.” In therapy, this most often emerges at the beginning of treatment or sometimes when we have reached a plateau. This phrase itself is a sort of “light bulb moment” where we realize that just because we understand something does not mean it will change.

Since much of my time is spent working with children and adolescents this necessarily means working with the parents of children and adolescents. And when working with parents, there is often a pull toward explaining a simple behavior in a complicated way.

And yes, the beginning of the behavior may have its roots in some deep object-relations, Freudian soil, but this insight does not equal change. And change is what is usually desired by the patient and their family.

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Let’s try an example: “anger issues”. This is sort of a catch-all label for when a child reacts with anger to some event. Now, a good assessment is important so that we can see whether there is some depression or anxiety present. We should look for dietary changes, assess whether there is the possibility of mood changes related to undiagnosed diabetes, thyroid difficulties, or some other medical issue.

Another common root cause for an “angry” child may be the anger or depression displayed by a parent. And one should certainly assess for some sort of abuse or neglect. Any of these (in addition to some root in the Freudian soil) could be part of what we are seeing when we see “anger”.

But then what do we do? This is where getting stuck on the cause may keep us away from the intervention.

So taking our example again, let’s imagine that once we think through this display of “anger” we see that the child is actually anxious and fearful. Remember that at the bottom of anxiety is the “fight or flight” mechanism. So some of us run from trouble; some of us get angry when we get scared. Just think of all those videos you might have watched of people punching their “friends” who jump out and scare them.

So some of the best interventions for anxiety have to do with either expending or soothing that anxious energy. This may mean getting regular exercise or it may mean reacting calmly and with understanding to your child instead of yelling at them to “STOP BEING ANGRY!!!”

Often intervention means stopping, removing yourself from the situation and taking a good, deep breath.

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Remember that our bodies and brains are tied together. You are not just teaching your brain some neat, new trick. We have to communicate with our bodies, sometimes as the first step.

But the reason that I point out that “insight does not equal change” in this situation is that these interventions will take small efforts over time. The interventions themselves will build and build; just because you recognize that your child is feeling anxiety underneath that anger does not mean that everything will suddenly be different.

The clouds are not going to part. The light is not shining down. The “Hallelujah Chorus” is not playing. Insight does not equal change. Change happens slowly, over time.

And while yes, a good assessment for the source of a behavior is helpful, there are also times that we simply won’t know where some behavior started. Children (and adults for that matter) do strange things sometimes. It may be worth spending more time on what reinforces a behavior than where the behavior started.

For those of us that call ourselves “adult” now, we think about how some behaviors are reinforced simply because they make us feel better, even for a short period of time. Some of our habits around eating or drinking can fall into this category; even when we may deal with our underlying frustration, sadness, or worry, there is still a habit left to change and steps to take.

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Even as the adults, we may have some wonderful insight into the “why” or “source” of a behavior, but changing that behavior is where the work is.

Changing behavior is often slow and a sometimes tedious effort.

Behavior change is step-by-step. And while there may be some big steps along the way, the path is made by many of those short, repetitive efforts.

So yes, spend some time looking at the situation, the context, the behavior itself. Assessment guides intervention. But place your effort on finding ways to facilitate change. Insight is good, but “insight does not equal change”.

Originally published on Medium.com on February 21, 2019

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