“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

“Our hurts return at different ages and stages.”

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

Photo by Brent De Ranter on Unsplash

As a clinician in private practice, a phrase that I hear myself repeating often is “Our hurts return at different ages and stages”. This phrase generally arises in working with the parents of a child or maybe even a young adult when some early difficult event in their life seems to have returned.

We feel like we have circled all the way around to the exact same spot again.

You may feel defeated or may say, “But I thought we had beat this” or “I thought I was done with talking about this.”

But here we are … sometimes dealing with the same problematic behavior. Sometimes we are treading through the trauma again, although there is something different this time around.

We feel like we are in the same place, yet it is different, all at the same time.

Our hurts do change us. Much in the same way that a physical injury means that we have to adjust; we find a new way of moving through the world and often a change in how we view the world. The world won’t be the same again. And there is a way that this change unfolds again and again, over the lifespan.

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Children go through developmental stages, with discrete tasks to work through.

Depending on when the trauma happened, there may be a great deal of self-blame associated with it. Children often see themselves as the center of the universe, therefore they often see themselves as having a major role in an event, even if the trauma was certainly not caused by them.

For instance, if the trauma is the loss of a parent, a child may have worked through the difficulty at the earlier age. But when moving into adolescence, the absence of that parent means something different to them. Even in their physical self, that child may look for their missing parent in their facial features or in the way that their body is maturing. “You look just like your mother when you …” is common for children to hear.

In addition, there is the realization that this missing parent will never watch them play soccer. The missing parent will not have a chance to criticize who they are dating. The child will not hear, “I’m proud of you” from the parent who is no longer present.

The original absence of the parent was a trauma, but the absence continues as the child moves into a new stage of their lives.

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Young adults hit milestones in their lives that remind them of the original trauma.

As the child turns into an adult, there are new questions about identity and finding one’s place in the world.

For the young adult who has experienced difficult events in their life, identity questions lead them to look to how their identity has changed with respect to what has happened to them, and specifically the trauma.

Who am I now? How do I tell my story?

Another aspect of identity is about relationships. Relationship questions arise because learning to be intimate with someone (whether emotionally or sexually) may bring up some of the violations that occurred with the original trauma.

So even though they may have worked through an aspect of the trauma at the age it occurred, we should be aware that it may come around again … in a different way perhaps … in a different guise.

But … we didn’t circle around to the exact same place; it is more like a spiral.

Yes, we may finish with the trauma at that stage, but it does not mean that we don’t find it waiting for us at the next stage.

This is not necessarily a pessimistic stance. Because the spiral shape of change represents growth and development, not stasis.

Circling around and around again would be frustrating for you as a person, but also for parents who are raising children affected by trauma.

Being realistic about the nature of trauma means moving into a recurrence of symptoms with curiosity, seeing this as an opportunity for growth.

In a way, it should not be a surprise that you (or your child) encounter a different aspect of the trauma as you move into different developmental stages. But if it does feel like a shock or surprise, then simply step back, take a deep breath, and think about what you might need in that moment.

  • What worked before to help you through may work again.
  • The lessons you learned then may need to be adapted to a new age and stage.
  • And this new older you has the opportunity to see the hurt in a different and potentially healing way.

So when you find that you are working through the hurt again, recognize that this may be another “age or stage”. There may be new meaning and potential for healing here too … if we are willing to walk through it.

Originally published on Medium.com.