Have you ever noticed yourself repeating the same unhelpful behaviours or patterns in your life, even when you know they do not work out well for you? Have you noticed your clients doing the same thing, even when they are aware of the problem? If you are anything like me, there's a good chance you have. Understanding why it happens for all of us is key to helping our clients, and ourselves, make changes to unworkable behaviours that last.
The first thing to understand is that simply 'knowing', on an intellectual level, is rarely enough to change a deeply ingrained and well-practiced behaviour. If it were that simple, all anyone would need is some psychoeducational pamphlets and their lives would be changed for the better. An everyday example is knowing that doughnuts aren't great for me doesn't, by itself, stop me choosing them over healthier alternatives, even if I am trying to improve my health. That intellectual understanding is at best a starting point for the work that needs to happen and, for many people, reaching that stage is a piece of work in itself.
Of course, often people believe their behaviour does work for them, even if we as therapists may be inclined to think that maybe it does not. It is important to note that it is not the job the of the therapist to convince the client one way or the other but to help the client fully explore, by coming in to contact with consequences of their behaviours, whether it really does work for them. For e.g., a client may need help to recognise that some behaviour that may have worked at one time, in one context, may not be so helpful now - such as suppressing their feelings to avoid harsh criticism in childhood may have been protective, but which now hamper close relationships with their partner or their own children. Or to help them discover that behaviours that work short term, such as avoiding anxious feelings, do work in the short term but also cause bigger problems down the line either by maintaining their fear of non-dangerous situations or by disconnecting them from meaningful parts of their lives they might otherwise wish to engage in. Helping clients to connect to these longer-term consequences is important in building willingness to make changes.
As part of coming to understand the unworkability of our some of behaviours that are getting us stuck, we need a way to judge what is and is not workable. Many clients will come to therapy with the understandable goals of getting rid of unwanted personal experiences (painful thoughts and feelings). While this makes sense, it gives us, and the client, no understanding of the kind of life they want to build. Without that, it is impossible to know whether a behaviour truly works for them or not, in any given situation. For e.g., a common hypothetical exercise is often completed with clients in which they are asked, if we could offer you a life without pain or suffering (or without whatever specific personal experience they wish to avoid, such as anxiety) but the consequence would be you had none of the relationships, achievements, goals etc you want would you take it? Or alternatively, if I offered you a life of meaning, purpose, with connections to the relationships, goals and achievements you want but you had to take some of that unwanted experienced (e.g., anxiety) with you, would you take it?
Most clients, and most people generally, take option two which tells us that there are things which are important to them, and which are more important than avoidance of their unwanted thoughts and feelings. This is vital information, not least because it gives us something to aim at and see if behaviours really are workable, but also because it immediately helps frame avoidance of inner experiences (which is often a significant feature of many difficulties our clients are experiencing) as problematic. One of our aims in therapy might then be to help the client stay connected to the consequences of avoidance in relation to the things that really matter to them while helping them develop the ability to work with the difficult personal experiences that show up for them along the way.
Just as importantly as recognising the workability of our behaviour in relation to the things we value, is recognising that all of us have developed a story of who we are. Sometimes called the ‘conceptualised self', it is a story about who we are and what we can and cannot do, etc which places limits the behaviours we engage in. At extremes this may look like "I am a bad person" or "I am unlovable" or even "I am strong" or "I am better than other people", but will also include all kinds of subtle self-stories about who we are, such as 'I'm right/left brained', "I'm a kind person" "I don't suffer fools" etc. Essentially, if you notice yourself describing yourself with an 'I am.." statement you are probably looking at a self-story/conceptualised self.
These stories, even ones that might seem on the surface to be positive, place limits on our behaviours and keep us rigid. For e.g., holding rigidly to a story that we are the 'good guy', or 'smarter' might lead us to ignore evidence of our own wrongdoing or mistakes or to dismiss others legitimate complaints a little too easily which could easily have negative consequences. Equally, if you believe yourself unlovable you are likely to avoid opening yourself up to what will seem like inevitable rejection from others. Exactly how that plays out for an individual - whether it is total avoidance or, more commonly, degrees of maintaining distance and disconnection in relationships, - will depend on the specifics of their history and context, but the importance of the self-story/conceptualised self in creating rigid behavioural is an important part of that context. The point here is not to argue whether a story is right or wrong but to notice that when we hold it very tightly, and treat it as though is objectively true, or as if it literally describes everything there is to us, it can lead us to become rigid in our behaviours when, in order to 'break out' of unhelpful behaviour patterns or cycles, what we need is to be more flexible.
That rigidity is not limited to our sense of ourselves but also to rules, assumptions and beliefs we may hold about ourselves, others, the world and what is and isn't possible. We often have may rules about how we, others or the world 'should' be which can restrict us. If we 'should be strong' for e.g., we may find expressing emotions we see as weak, or which make us vulnerable difficult to allow. We may then 'need' to engage in behaviours to ensure we do not contact those emotions in the short term which may then create bigger problems for us in the long term, either in terms of those emotions repeatedly coming back up or in damaging our relationships or opportunities to engage in meaningful activity. If others 'should' follow your rules, then you may find yourself becoming easily irritated with others or engage in behaviours that try to exert control over other people. It may be that ultimately this does not work well or causes other difficulties because we cannot make other people follow our rules consistently. Loosening our grip on the belief that others 'should' might be the workable solution even if we would prefer that they did as it is beyond our control and may be leading to worse outcomes, once we start to pay attention to them.
So, by this stage we might have a good idea about how our self-stories, rules and avoidance of our inner experiences can maintain unhelpful behaviours, and get in the way of changing them, but that might still not be enough to change. One explanation for this is that all of us will have developed learned responses to our thoughts and feelings. Simply knowing all this, while useful, does not necessarily mean we have access to other, more flexible, responses we need to change our behaviour. Without new responses the intellectual understanding is likely to give way to the existing rigid behavioural patterns that people are struggling to step out. This is because changing those behaviours risks putting us into contact with unwanted (often painful) thoughts and feelings for which we do not yet have new responses for.
The aim then of therapy is not just to help a client gain insight into their behaviours, their personal experiences, and their responses to them, but to help them develop the skills to respond flexibly to them, experientially - or in other words by doing rather than simply talking about doing. What this means is actively (gently and progressively) helping them to contact those experiences they have spent so much time and effort building behavioural repertoires often specifically to avoid. Through that contact, we can help them learn new ways to respond to those experiences that do not involve having to immediately escape them. The specifics of how to do this I will begin to explore in later articles but for now reminding ourselves that there is more to change than knowing something is not working, and then perhaps berating ourselves for not changing as a result, is not a bad place to start.
Christian Hughes is a Psychotherapist, and former uniformed military mental health clinician, specialising in Acceptance and Commitment Therapy, Compassion Focused Therapy & CBT, with expertise in trauma & PTSD and a special interest in Moral Injury.