Wednesday, April 6, 2011

Why – How –What

No, this is not an essay on important aspects of journalism. Rather, this is a brief essay about “change”. Some may say it is an essay about “psychotherapy”. Arguments can be made that the two are different or similar.

Historically, psychotherapy has focused almost exclusively on the “why”; the personal, emotional archaeology; a sort of psycho-Darwinism that suggests that what we do (presently) is largely informed, if not dictated, by past experiences.

I decided to write about this after a conversation with one of my patient/teachers today. He, like many others I’ve talked with, has an important task he wants to accomplish. The task is personally important to him. The task is not odious; it is not difficult, but for reasons which elude us, he does not perform the task. Like many therapists might, I have discussed with him, “why” the task is not done. Let me emphasize that many (myself included), have experienced a similar phenomenon. Almost reflexively, we pursue the answer to “why”.

I’ll offer one of my own experiences as an example:

For probably thirty years, I have been over-weight. As a therapist-in-training, I completed perhaps ten years of psychotherapy as the patient. You might well imagine that many years were spent therapizing “why” I am over-weight. I suppose the theory was (and is still popular today) that if I understood, “why”, that would lead to the “cure”, (i.e., I would lose weight.) Well, guess what; I’m still overweight, perhaps more so. I do have several interesting theories (we therapists do love our theories) about “why” I am over-weight.
  • I have a protracted adolescent rebellion against my father who, as a restaurant owner, made sure everything was the correct portion size.
  • I’m afraid of intimacy.
  • I’m trying to fill some deep psychic void with food.

While all of these why-theories have their germ of truth, none of it has helped me to lose weight.

Steve de Shazer, a former teacher wrote a book, “Words Were Originally Magic”. One chapter of the book was entitled “Getting to the Surface of the Problem”. Steve was a proponent of finding a solution to a problem; he was not particularly interested in finding a cause or a “why”.

Here’s another example of my quirky behavior:

Years ago, I despised the voicemail on my office phone. I had absolutely no problem with the voicemail at my private practice. For years I forwarded all my Clinic calls to my receptionist. “Why?” one might ask.
Honestly, I haven’t a clue. I can’t even make up a reason which, for a therapist, is remarkable. Then, about two years ago, a memo was issued from HQ stating unequivocally, that all providers were REQUIRED to respond to voicemail messages within 24 hours.

My “voicemail phobia” was instantly “cured”. No insight or introspection was needed. I did not seek help from a therapist. I now regularly and without hesitation respond to all voicemail messages.

Other patients have complained of cluttered homes, unpaid bills and derelict lawns. Without exception they have told me they don’t “understand” (i.e., have insight) about “why” the various activities remain untouched in their “in” box. Often it may be suggested they are “avoiding” the activity for some hidden reason. It is sometimes conjectured that the reason for not completing the task is due to an unresolved fear that almost always originates in early adulthood or childhood. These are attempted explanations to satisfy the "why" question.

It seems that while understanding “why” may take the patient on an interesting psycho/archeology dig and may yield interesting theories, it will probably not result in the expressed desire for changed behavior.

Let’s shift the focus from “why” to “how and what”. How can change be induced? What is associated with behavioral change?

Frequently, I consult with couples who explain that they frequently have “stupid and hurtful arguments”. Sometimes, one blames the other – sometimes they want to know “why”.
Sorting through the possible “whys” and trying to educate a couple that blaming is never useful, may go on for months. If however, I can convince them to audio record arguments – almost magically, the terrible arguments cease. I’ve listened to some recorded arguments – what I hear are two adults with mildly raised volume respectfully disagreeing. There is no name-calling, no cursing, no door-slamming. The “whys” can be various but more important was “how” the arguing changed or “what” changed the arguing. Alternatively, I may ask the couple to continue the arguing but I ask them to solemnly agree that one will begin the argument on even-numbered days and the other will begin arguments on odd-numbered days. 99% of the time, the couple stops arguing. Some will tell me that my suggestion was so absurd, they refused to do it… and didn’t argue.

Again we can generate numerous “whys” that attempt to explain but the truth is, explaining, understanding and insight have little or nothing to do with the change. More important was “what” and “how”.

The patient/teacher I initially referred to had, months earlier, done the needed task. I asked him to do it in my office. (It involved a brief computer task.) He immediately performed the task without a moment’s hesitation. Though the patient/teacher was equipped with at least four “whys” (involving his insecurity, childhood traumas and past failures) – he did the benign task. Those “whys”, regardless of their validity, did not stop him. Again, we may speculate a dozen “whys” but the how and what changed the behavior.

What then, is the “take away” from this brief essay? 

“Why” may be interesting (and be alluring to one's intellect) but it doesn’t lead to change – if you want change, think about “what” will change the behavior.