Click here to read Part 1.
In my first post, I talked about what to expect from therapy, which included a focus on change. I am devoting extra time to this in Part 2 because change is so important and yet so misunderstood.
Recently a nine-year-old girl, whom I've been seeing twice a month for a while, came into the room and started by saying she was having a really hard day. This was somewhat unlike her because she had been putting on such a brave face for most of our time together. She then described the compulsions she had engaged in, and how it caused a big problem. She didn't think that her OCD was part of why we were there until that day, when she admitted that the behaviors actually can and do get her into trouble.
I thought, Finally, we're having a breakthrough! My mind momentarily raced to all the new work we could start: we can talk about the compulsions and gain understanding, we can talk about all the positives from change and gain motivation. . . But no sooner did I think of these things than she slumped into her chair and, with all the stubborn sullenness a nine-year-old can muster, said, "And the worst thing is it's never going to be better because it's my brain that makes me do it and my brain can't change!"
Even though I could hear her using words that were a bit beyond her, like she was repeating someone else's explanation, I knew this idea was etched deeply in her mind: if the problem is my brain, then I can't change it. There's a big piece missing from this theory, but I get where it came from. There is a biological reflection of each mental health disorder within the body, especially in the brain. So often, mental health disorders have been stigmatized and treated with the flippant disregard of the (possibly) well-meaning friend or relative who says something like, "Get over it." A logical response is to point out that there is a physical component that anyone, were they looking inside your brain, could physically see. While I understand that the "get over it" point of view is to say that some mental toughness is needed, just pulling yourself up by your bootstraps is not going to cut it when it comes to mental health disorders. They are called disorders because they cause an impairment in function, i.e. in one's ability to "just get over it."
There's no denying that a mental health disorder can be reflected in the brain. But what I want to add to that is: this does not mean there is nothing you can do to about it. In fact, we do something about it all the time.
It's called neuroplasticity: neuro meaning "of the brain" and plasticity meaning "the quality of being easily shaped or molded." In biology and specifically evolution, plasticity refers to the ability of an organism (plant, animal, bacteria, human) to change and adapt to their environment. Have you ever heard the saying, "Use it or lose it," when it comes to people's ability to use their brains as they age? This is because of neuroplasticity. When you learn something, your brain makes new physical connections, connecting pathways to other pathways. When you practice that thing over and over again, you're making those connections stronger and deeper. If you don't practice, they become like a path through a grassy field that no longer gets used: the once clear path starts to grow over with grass and weeds. It may all but disappear. Neuroplasticity is lifelong. That's why they say: use it, or lose it. It goes for a 90-year-old as much as a 9-year-old. In the case of my 9-year-old, she has repeated certain behaviors over and over, strengthening and clearing the pathways, which makes them more obvious, deep and strong. The result she now feels is a compulsion. It isn't going to be obvious that she can change it, because the pathways that exist now are already so obvious that it will seem like she must follow them. But it only seems that way. She wasn't so keen to believe me that day, but I taught her the word neuroplasticity, and she liked knowing that. Knowledge and observation of this is where we can start. Later, we'll move on to the next stages of change.
Stages of Change is a model that was first introduced and applied within the field of addiction by DiClemente and Prochaska. It is also called the transtheoretical model of change. We know now that these stages can be applied to anyone with a problem that can be changed. Sometimes you'll see the stages listed as such:
Learning about how we change, and then accepting and expecting the phases of change, helps people feel empowered. I've seen it happen. It normalizes change. It illustrates the path. And it can do this for you, too.
Change is a vital part of life. We are doing it whether we know it or not, and we can use the available knowledge and research about change in order to empower the process of change for ourselves. Expect it if you're going (or considering going) to therapy.
Change can be good. You can do it!
And you already are.
There is what would now be considered an old phrase, “There’s no two ways about it,” which the American Heritage Idioms dictionary defines as: No room for difference of opinion, no alternative, as in We have to agree on the nomination, and no two ways about it. [early 1800s].
To have no room for difference, no alternative, just clarity as far as the eye can see - what a desired state of being! Life must be so easy in the world in which there are no two ways about it. But wait - what planet is that on? Because certainly, clearly (maybe? probably?) it is not this one.
I’ll say it in a word: ambivalence. Literally broken down, ambi means “two” or “both” and valence comes from the Latin for “go.” Put that together and you have someone who is ambivalent, or going in two different directions. Sometimes it’s easy to see just how this doesn’t work. Imagine for a moment you feel like a road trip and are torn between going to California or Washington either tomorrow or next week. As long as you’re ambivalent about the time and place, you’re not going anywhere.
It’s not so easy to see when the problem is internal, not represented by distinct places in time and space but rather by feelings. What happens if you want to meet new people, but you don’t like leaving the house? You admire your father but hate how he treats you? You love your spouse but you can’t stand him? Ambivalence, that’s what. Ambivalence is a major issue in counseling – I wanted to say problem, but it’s so much more than that. It’s sometimes the most uncomfortable feeling that people identify, even worse than anger or sadness. At least when you’re sad, it’s pretty easy to know.
A lot of people, much more than I would say realize it, come to my office ambivalent about counseling. Many times I’ve heard some variation on, “I wanted to come, but I almost canceled.” Maybe it was anxiety – they didn’t want counseling, but they wanted to get rid of anxiousness. Maybe their partner suggested they come, or a doctor or nurse. Kids, by the way, rarely say a parent made them come, and I believe them. Kids, especially adolescents, really find ambivalence distasteful and won’t tolerate it for long, even if they don’t have a word for it.
I guess ambivalence is the biggest problem when people don’t recognize it. I may recognize it, but that doesn’t mean I can tell someone, “You are ambivalent about counseling.” That’s the old stereotype about psychotherapy – someone telling you how you feel – but with me it’s exactly the opposite: you’re here to tell me that. On top of its invisibility or the lack of acknowledgement is impatience, usually with the process of counseling itself. People who are ambivalent about going to counseling are umpteen percent more likely to quit before things get better. I’m not going to pretend I have statistics, but in my experience, it’s a major issue I’ve seen play out over and over again. I can’t count how many times I’ve heard, “Oh, I tried that, and it didn’t work,” but I can tell you that, when this is said, it wasn’t by someone who gave it a lot of time or patience.
It’s a difficult concept, ambivalence, and hard for people of any age at any time to distinguish the feeling, let alone acknowledge or even accept it. I mean, is it even really a feeling, or is it more a state of being – usually, of being caught between two opposing feelings? Whatever it is, ambivalence usually involves opposing feelings, but they are also complicated by some mix of confusion, indecision, and uncertainty. This makes it especially insidious. And when it comes right down to it, a total bummer.
But no: ambivalence is not just an all-around, unavoidable bummer. It’s actually a step toward positive change. According to the Transtheoretical Model (also called TTM or the Stages of Change Model), developed by Prochaska and DiClemente in the 1970s, ambivalence must be part of change. Think about it: there’s a pattern in your life, a status quo that no longer works for you (e.g. TTM was originally developed to address addiction), and for a while, two patterns must exist – the old way and the new way. So you have this addiction to (alcohol, sugar, nicotine, etc) and you crave the substance, and you want to rid yourself of it. You feel two ways about it. It would be a lot easier, were this not the case, but if there were “no two ways about it,” you’d be either 1) unconcerned about change, because you still love to drink/smoke/binge, so why are we even talking about this? or 2) in the active stages of change, ridding yourself totally and easily of the clearly unwanted, unhelpful substance (so why are we even talking about this?).
But that’s just not how it usually goes, now, is it?
Let’s say your problem is not a substance, but a situation or relationship. It’s bad enough when you’re in the stereotypical “love/hate relationship” – classic ambivalence at its finest – because it is so painful, so intense. What about outright abuse? I met with a woman over several months who was very clear that her years-long relationship was unhealthy and not what she wanted. She didn’t like the lies, cheating, substance abuse, emotional instability and manipulation. That was for sure. In no uncertain terms, this woman knew what she was getting, that it wasn’t a new story, and that it would very likely continue unchanged. Just when things had reached “rock-bottom,” as they had for her before, and we were developing the plan of escape, and it was all going to change . . . she bailed. She was with him for years and it was going to take a lot to change her life and the lives of those involved. She felt two ways about it. That was for sure.
Timing is all-important in therapy: timing for change, for revelation, for endings and beginnings and decisions and goals. People don’t – dare I say shouldn’t? - give up their feelings before they’re ready. All shoulds aside, I often encourage people to process their anxiety while it’s hot, hold and examine the insecurity, wear the protective shell of trauma for as long as you truly need it. Feelings were developed by nature as signals for our minds to recognize, think about, and only then to do something about them.
If you’re looking to tackle a problem, set a goal, make a change, or just learn more about your feelings, you may want to say yes to therapy for a time. But please remember: you’re very likely going to feel two ways about it. Like ambivalence, you may love it and hate it. Maybe your first goal could be to learn to recognize ambivalence. Give it some time. Then you can tell your therapist or counselor when it happens. Then, and only then, can you do something about it. Maybe you’ll take a break from therapy. Or you can look at the TTM model, place yourself in the steps of change, and let it give you some hope that things can and will be different for you. The cloud of confusion will clear.
I am Lisa and I believe we create our reality. I hope to help empower people to create more mindfully, be kind to oneself and others including animals and the environment, and just generally feel better.