People who seek out therapists for help with depression, anxiety, and other life struggles have often wrestled with these issues on their own for long periods of time. The decision to seek help may come as a result of feeling frustrated and helpless to resolve a particular issue or because of chronic unhappiness with their lives.
Many people have been living with anxiety or depression for much of their adult lives, if not since childhood. They may have had previous therapies that were helpful, enlightening them and contributing information to their quest for self-understanding and improved wellbeing. Too often, however, patients report that they have acquired a great deal of insight and understanding but have not been able to make some of the changes in their behavior that they originally entered therapy to achieve. One can think of this as being "insight rich and change poor."
One reason for this may be that some people see their difficulties as conditions, rather than problems. Conditions like diabetes, for example, are not usually solved, cured, or eliminated. Instead, they are managed and monitored so that they do not get out of hand. Sometimes, this may be true of one's depression and anxiety. It can be chronic and difficult to control, and good management and regulation may be the best that one can do.
However, sometimes it is more helpful to treat anxiety, depression, and other afflictions as a problem, not a condition. A problem, by definition, needs to be solved and, therefore, stimulates action. People tend to become more involved in their therapy when they believe that with help, they can do something about their situation. Seeing one's situation as a condition might invite passivity that could undermine the motivation necessary to make desired changes.
Comments from patients like "Well, that's just the way I am," "Nothing I can do about that" or, "I've been this way so long, I'm sure I can't change," often lead to feelings of resignation and defeat. When these beliefs are challenged and reconsidered, a more productive therapeutic effort leading to meaningful change is more likely to occur.
Judith, a successful executive in her early forties, was referred by her physician because of her concerns about her chronic anxiety and frequent depressed states. In her first session, she spoke only of her troubled marriage, saying nothing about the reasons her doctor sent her to me. When I asked her about this, she replied, "Oh that! I'm a very anxious person and I get really depressed. It gets pretty bad at times, but that's just me." When she was helped to see how the "condition" she had simply accepted for so many years could possibly benefit from action toward change, she became intrigued, then hopeful, and better able to work toward becoming a much less anxious and depressed individual.
I have also observed this attitude on the part of many couples who come for help for a chronically troubled relationship. Often, one or both partners express doubt about the likelihood that they can do much about their situation perhaps due to a history of failed attempts to improve the quality of their union and the resulting belief that they might be "stuck" in a permanent rut. Despite their lack of hopefulness, it is, as I see it, a good sign that they are willing to try again and this time around and I appreciate that I have been chosen to be—as one couple expressed it—"the designated driver in our broken-down jalopy." If I believe that there is hope for the couple who sits before me, I tell them that and ask that they borrow my optimism until, hopefully, they have been able to develop their own. I do what I believe is helpful and necessary to reframe the sad "condition" of their relationship into a "problem" that perhaps the three of us can solve together as a team. This usually encourages a different way of thinking and behaving and often succeeds in mobilizing them to work hard to bring about meaningful, durable changes in their relationship, rather than view our efforts from the outset as another unlikely successful therapeutic venture.
Psychotherapy and counseling are more effective endeavors when someone is actively engaged in the process, believing that change, where possible, is the objective, and that even difficult, chronic emotional states can be aggressively challenged and improved...even if it takes heroic efforts on all of our parts to help bring that about.