Ginger Campbell host of the Brain Science podcast, after a great interview with Norman Doidge about neuro-plasticity, said that doctors often don't prescribe behavioral therapies because they have the experience of patients not following through (1:05:00). "Many patients would rather take pills than follow treatment regimens that require them to do most of the work themselves." I will write about Doidge at some point soon, but I thought a lot about Ginger's statement about homework and follow through.
Recently, I have been finding that the most interesting moments in therapy come when I ask a client to try something that he/she/they won't or don't do and we unpack that resistance. I have said before that on a handful of occasions, I have given people really good advice in therapy. But much more common are people who know more or less what they need to do to make changes in their lives but resist it for reasons they cannot fully understand.
I recently told a client who was feeling ambivalent about his marriage -- he couldn't commit to it and couldn't leave -- that he should try being fully invested in his relationship for 3 months. At the end he could still leave or stay or continue being undecided, but in order to see what the relationship might be, he should try actually working at making it good for a limited amount of time. He physically writhed at the idea. He almost began to twitch. What makes committing to the relationship, even provisionally, so hard?
I told a couple that they should spend ten minutes a day talking about something tough in the day and supporting one another. When I asked them about the exercise he said, "It feels weird because we see each other all day, she knows everything about my day." They began to see how her being available to him for almost all his emotional needs throughout the day was not so great for their relationship.
I told a client to meditate so that he could be a little more present to his partner. "Sitting still for ten minutes is my idea of hell," he said. She began to cry because she wants him to be able to be still for her. It turns out that he has missed some crucial hurt feelings of hers because sitting still with emotions is so painful for him.
People have reasons for not changing. Sometimes it is a cost benefit analysis: "This requires a lot of work and I don't have enough confidence that it will make a difference." I think a lack of confidence that medical science actually knows what is good for us is an important and neglected part of that cost benefit analysis. It is hard to take your doctor's prescription seriously if you don't think s/he understands what is going on with you and what you want. That doesn't come in 15 minutes. Sometimes the road to such confidence comes from taking the time to unpack what else makes change hard.
It is ironic that most doctors probably know that just prescribing behavioral change is unlikely to get people on board, yet they still do it. Another opportunity to ask the question, "What makes it hard to do this?" And perhaps the beginning of real change.