One expectation of young people coming to therapy is that they likely harbour fantasies, both conscious and unconscious, of things being different after therapy. This, of course, is a good expectation to have and may influence or shape motivation to attend therapy in the first place. However, there is always the concern that these expectations may not be realistic, or that they require more than just investing in a fantasy.
Here is the thing: fantasised change can be gradual. Change can be slow and take a long time. Now, if someone were to say, “Hang on, you're a professional mental health clinician—surely you should tell me how I can change?” I wish it were that simple. I wish all these years of studying and clinical hours led to just knowing what to say to meet the young person's expectations. Unfortunately, this is rarely the case.
To use a creative and geographical metaphor: every human has a rich and layered internal world. In this internal world resides terrain full of thousands of landmarks, formations, plants, buildings, ecosystems, etc. It’s hard to imagine just how unique and distinct these worlds are for each of us. To help someone change, one needs to understand their internal world. For example, how has this young person developed this particular part of their world?
Change is challenging because existing structures may prevent one from doing things differently. These structures developed for a particular purpose and reason—sometimes unbeknownst to the young person. Demanding change is no different than telling a young person with OCD, "just stop having these intrusive thoughts" or "just stop self-harming." Unlikely to work. Therefore, I come to an understanding with young people that understanding must come before any solution.
One particularly challenging area of therapy is determining whether to encourage someone to take action or remain passive and allow insight to develop before meaningful action can be taken. Whilst I place high value on insight, I often note that it may not lead to change. For instance, if someone realizes they vape when they are told off by a teacher because they feel embarrassed and humiliated, rather than simply disliking being told off, this is new insight that may have developed in therapy—yet it doesn't stop them from vaping when they get told off. Interestingly, they have the insight, yet no action is taken.
In contrast, pushing oneself to physically go for a walk when their mind is screaming at them to do nothing (i.e., taking action) may lead to insight being developed during the walk. This includes realising that when the mind screams to do nothing, it is still possible to do something, and that action can lead to change as the internal voice gets quieter.
In short, change is challenging and, ironically and rather paradoxically, one needs to accept things as they are in order for change to gradually develop in therapy. It’s also helpful to discuss with your clinician whether you prefer to spend more time exploring and understanding your internal world or whether you want a more action-based therapy (e.g., cognitive behavioral therapy). In my experience, the best outcome for the young people I work with is often a balance of both aspects. Yet everyone’s internal world is unique, and a good understanding of the young person in front of me will always be my priority if I am to help someone make meaningful, enduring, and lasting change.
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