We would work much differently with a person in a therapist’s office than in a restroom. We’d begin by carefully inquiring about the problems that they are seeking help with, listening for the perceptions, beliefs that may explain their problems. At a “surface” level, we’d look for the perceptions of the SITUATION wherein their problems occur. For example, an upcoming college exam is met with intense anxiety. Has the client prepared/studied for the exam? Have they been keeping up with the readings and assignments? Do they understand the material? Have they been procrastinating? Essentially avoiding the course work rather than engaging?
Again, anxiety is produced by the perception of RISK. Answers to such questions may explain why they see risk in the exam: they’re not ready and risk doing poorly. Going deeper, we discover some depression, some helplessness and hopelessness about passing the exam. This suggests that something more than poor performance is occurring. Perhaps some IDENTITY ISSUE, some beliefs about WHO they are and what they are capable of. For example, “I’m no good at…”. So why bother to study? It won’t make any difference.
Not studying makes sense if you believe you are “incapable” of learning the material. Trying to study probably produces the discomfort of feeling “incapable”. To avoid such feelings, a student may put off studying. And avoiding studying only increases the sense of how overwhelming the project is. Reinforcing even more procrastination and more “this is impossible, why bother?” Meaning the perception of risk here is accurate: don’t study, don’t learn, don’t pass, do feel humiliated and as, in their own estimation, a “total failure”.
It seems obvious, to an outsider, that studying could improve understanding and learning. But when studying confronts one with a deep sense of “inadequacy”, “incompetence”, even “stupidity”, most of us would avoid studying to avoid those intensely painful feelings. So the risk of failure goes deeper than the lack of effort to a CONVICTION of one’s “absolute (yes “absolute” in their eyes) inability” to succeed at this task. And that conviction is probably rooted in a long history of harsh criticism and failures.
For therapy to be effective then, for change to occur, there must be a change in their identity. Otherwise they will remain paralyzed at the mere thought of studying. Their depression makes sense given their conviction that success is impossible for them. And if success on this exam is impossible, worse outcomes lay ahead: being expelled from college, never finishing the degree necessary for the career that will redeem them from past failures, ending up a “total loser, a total F’ up”. Hence, feeling hopeless and helpless, or depressed.
You can see that behind “I’m incompetent” lie the beliefs that “I NEVER succeed. I ALWAYS fail”
Unlike Susan and Ellen in the restroom, the therapist is allowed, expected to GENTLY, DELICATELY explore and challenge those convictions. The more resistant the client is to the obvious (join a study group, seek tutoring, set up a study schedule), the more certain an OBSTRUCTIVE IDENTITY says “that won’t help. Because I KNOW it’s impossible.” LIMITING BELIEFS about oneself prevent the effort that would undo those limiting beliefs.
So where to begin undoing this dilemma? They can’t study because they are convinced of failure ahead. And failure does lie ahead because they don’t study.
Notice the extreme, exaggerated language they use to describe themselves. “Absolutely incapable”, “never succeed”, “always fail”, a “total loser, total F’up”.
They are not saying that to get our sympathy. They are CONVINCED that those descriptions are correct. But are they?
So we begin by empathizing with how terrible that must feel, how defeated and hopeless they must feel. That, given those beliefs, we understand how pointless it feels to study.
In all this defeatism, WE must be careful to not absorb their pessimism ourselves and feel there is nothing anyone can do,
It would help us to recall the statement by Henry Ford: “Whether you think you can or think you can’t- you’re right.” Making the point that our beliefs are critical to success or failure. Because they determine the amount of effort that we make. If we believe success is possible we will try to succeed and try something else if that first approach doesn’t work. In other words, we’ll persist. If we believe we’re going to fail, we’ll give up, not even try and inevitably fail.
We must be skeptical about the “absolute” impossibility of their succeeding and be open to the great likelihood of their having had some success.
We cannot suggest that we know them better than they know themselves. That’s crazy. But being “outside” their convictions, we MAY be able to see some things that they miss. And we can explore those while they exaggerate their negatives and see there’s a good possibility that they also MINIMIZE their positives.
We might try something like “I’m confused. You say you ‘always fail’ yet you’re a sophomore in college. How could you get that far if you failed at everything?”
Here we open up the door to learning about their DEFINITION of failure. Maybe we discover that a “B is failure”. And we’ve found some (using the football term) “daylight” to making some change in their conviction of being absolutely incompetent. Now perfectionism is no easy “lift”. But it’s more promising than abject pessimism.
We must be their advocate. Arguing for the side they minimize and against their exaggerations. But never arguing with them.
And we must be open to the possibility of an even deeper negative identity. Such as “I’m NOT WORTH being positive about myself.”
If we stayed at the level of “it’s too hard. I’m no good at..”, we’d probably get nowhere with this client.
We might think that a positive identity would be eagerly embraced. But a different, even a positive identity can be frightening: “What if it’s not true? What if I can’t live up to it?”
Focusing on identity can be very effective. But it can also be confusing and difficult. And it may be the first time a client has seen their problems through the lense of their identity. Shining new light on years of dark feelings. It does not exclude tried and true methods: rapport building, empathy, non-judgement, history taking, etc.
Essentially we are trying to help them see they are not “wrong”. How they see themselves is in some ways wrong.