When clients can self-report concrete changes in self-awareness, behavior change, or both, it is wonderful to see. The following four recent exchanges led me to write this post:

1. "Hi Jenna, How have you been feeling?" Jenna's response: "Dr. Jeff, I still have some of the same things going on. My ex-husband is still a bit of a jerk. My boss still has an ego the size of my house. And my kids still really know how to nag. But I feel different now. I don't react the same way."
2. Nine-year-old James said, "It doesn't really bother me anymore when Chrissy (James's seven-year-old sister) imitates me and then follows me around."
3. Brenda, age 16, shared, "Dr. Jeff, I felt this crazy pressure to have these 'it girls' become my friends, but now it's like, I don't have to become them."
4. Phil, a 42-year-old, 6'5", 230-pound mechanical engineer came back to see me for a check-in after not seeing him for three years. The purpose of the visit was to update me about how he was coping with a new relationship, new job, and now almost two-year-old child. He led with, "I don't over-think like I did."

The common theme about the italicized six-word phrases is that they reflect self-awareness and behavior change that these clients attributed to the counseling process.

Keeping it real, not all of my clients make similar therapeutic gains. Some journeys for clients to rewrite their narratives, heal their wounds, and embrace self-compassion, purpose, and increased potential do not go as smoothly.

Uncovering Therapeutic Obstacles Can Still Be Helpful

As the saying goes, "You can lead a horse to water, but you can't make it drink." Now, if I may add, "But sooner or later, it will eventually get thirsty." What I mean here is that even if therapy does not sound and look successful, as exemplified by the clients mentioned above who rattled off six words attesting to positive changes, the counseling journey may still often be a productive one.

Success in therapy doesn't always mean complete resolution of all issues. Instead, it often involves gaining insight, coping skills, and improved emotional well-being. What works for one person may not work for another. And, as listed below, learning why progress is not being made in the conventional sense can still be illuminating and helpful.

1. Resistance and Defense Mechanisms: Resistance can manifest as a subconscious effort to avoid confronting painful or uncomfortable truths about oneself. Defense mechanisms, such as denial or rationalization, may be used to protect the ego from the discomfort of change. In cases of severe trauma, clinicians need to be very cautious when attempting to challenge resistance and defense mechanisms. Otherwise, clients may feel flooded and overwhelmed. I have made this mistake when trying to use interventions that my clients were not ready to embrace.

2. Habitual Patterns: Behavior change can be challenging because many behaviors are deeply ingrained as habits. Simply understanding why a behavior occurs may not be sufficient to break these habits. Changing behavior often requires concerted effort, practice, and time to replace old habits with new, healthier ones.

3. Lack of Skills: Insight alone does not always equip individuals with the necessary skills to change their behavior. For example, someone with insight into their social anxiety may understand its origins but may lack the coping skills to manage anxiety in social situations. Therapists often employ techniques like cognitive-behavioral therapy (CBT) to provide clients with practical strategies for behavior change.

4. External Factors: Behavior is influenced by external factors such as social environment, relationships, and life circumstances. Even with insight, individuals may find it challenging to change behavior if they are surrounded by situations or people that reinforce their old habits or if they lack the resources to make necessary changes.

5. Resistance to Change: People may be resistant to changing their behaviors, even if they have insight into the need for change. This resistance can stem from fear, a sense of identity tied to the behavior, or the perceived benefits of maintaining the status quo.

6. Time and Patience: Behavior change is a gradual process that often requires time and patience. The insight gained in therapy may need to be applied consistently over an extended period for meaningful behavioral shifts to occur.

Final Thoughts

Progress in therapy is unique to each individual. There is no one-size-fits-all measure of success. What may be significant progress for one person might not be the same for another. Putting the six-word scenarios at the beginning of this post aside, real and lasting change often takes time.

It's important to be patient and realistic about your expectations from therapy. Significant breakthroughs may not happen overnight. Therapy is a process that involves both ups and downs. Sometimes, you may feel worse before you feel better. Trusting your therapist and the process can be essential during challenging moments.