Food for thought

Derek waylaid me on the way to the lavatory.
‘How many psychiatrists does it take to change a light bulb?’
‘That’s an old joke, Derek.’
‘Go on – how many?’
I sighed. ‘One – but the bulb must want to change.’

‘Okay. Well, do you realise this old joke shoots a poisoned arrow into the Achilles heel of psychotherapy?’
‘Derek, what are you talking about?’
‘They’ve said it to me; they must have said it to you: the therapist can do nothing unless the client truly wants to change.’
‘Well?’
‘Don’t you see! It is the ‘catch-all’ copout: If you don’t get better it is not my fault – it’s because you don’t want to get better. It’s because you don’t want to change.’

Now, I must admit it is something that I had raised during my training. Something I was a bit uncomfortable with. But I had not received a satisfactory answer. I was actually told that I was ambivalent (that’s the word they used) towards the course.
I didn’t tell Derek this.

He continued. ‘I once replied, when they said this to me: well can you show me how to want to change?
‘The answer I got was “You are not ready for therapy.” And they gave me more pills.’

Of course, anyone with a working knowledge of Transactional Analysis could explain this apparent paradox using the ego-state model. But, crudely put: one part of your mind wants to get better, to change (the part that brought you to this consulting room), but another – deeper, more powerful - part does not want to get better, does not want to change.
Why? Because this ‘unconscious’ part is frightened to get better.
Why? Because your ‘illness’ is a defence mechanism, a series of strategies that are actually protecting you. Or, more precisely, protecting a vulnerable, scared inner child. To be still more accurate: these ‘strategies’ were effective at some time in the past in protecting you.
They have now become counter-productive or, at worst destructive. But, deep down, you are afraid to let go of them.

All the same, Derek is right. It should be the therapist’s job to explain this, and then work on it – with you. And not just say I can only help if you really WANT to change.

I wanted to change the subject – but Derek did it for me. ‘I suppose you’ve heard the rumours?’
‘What rumours?’
‘Amanda – she’s pregnant’