WHAT DO I DO? Action, thought and change.

Over many years of listening and working with patients, I have come to differentiate various degrees of thoughtfulness which, when considered and allowed to steep, move people toward action and change. In treatment, there are those moments when something clicks for the patient, when some piece of behavior sincs with history or memory or something implicitly known, an aha! moment that one has to sit with and consider- no doing, just thinking and holding on to what feels right.  Sitting with it. Those aha! moments are saturated with knowledge that releases slowly and over time, and helps us to create new meaning and understanding perhaps leading us to act and behave in different ways.

Then there is sitting with not knowing what to do, holding onto what we have identified and allowing our curiosity to help us view it anew and perhaps bring some answers. Sitting with not knowing is harder to do than one might think. Most of us, when confronted with painful behavior and experience and knowledge that threatens to bring on the possibility (or need) for change jump out of our thoughts and feelings and go directly to:

“So what do I do about that?”

It is the question that obliterates thoughtfulness and moves one into considering action- although what it really does is attempt to engage another into telling us what to do. Out of our own subjectivity and experience into that of another. It moves one from being present in the moment to thinking about the future and what action we could take. It is a way out of the moment while appearing to stay in the moment. It is a way out of thoughtfulness by appearing to be thoughtful. Exit introspection enter fear.

I think of the “what do I do about that” question as a signal that one is not ready to think about that. Rather, by shifting to the question of what to do we ignore the information we have just come to, we stop thinking about it and we engage the other in their opinion of what must be done. Sitting with the thing without knowing what to do is hard to do, and yet, new understanding comes about through curiosity and openness and just sitting with it. This is what leads us into thoughtful action and potential change. Sitting with it keeps us present with what we need to know.

Here is what I mean. A patient arrives at the understanding that her eating disorder has been her way of managing her emotions, something she has known for quite some time but on this day it becomes clear through an event that has upset her and through her feeling as we talk that we have hit upon an essential truth about her relationships to others and herself. A good moment but a difficult one, as it puts her face to face with a part of herself she has not been able to recognize before- and she does not like it. I can see the understanding in her face, her struggle with it and then I can feel her moving away from that recognition as she says to me: “So what do I do about it?” She has moved from the ability to feel her truth and get to know it from the inside to action and her reliance on my expertise and direction. She looks to me to tell her what to do instead of allowing herself to struggle with what she wants and would like to do. But no matter, we will re-visit this again, and each time make a little more room for thought and feeling so that it may inform any action on her part.

When confronted with the question “so what do I do about that?” I often reply “I do not know”. This is because I do not know. What I know is what the patient has done about that in the past, and how that has worked out. I know his or her attempt to adapt, survive, make good, etc. A faulty solution that usually reinforces symptomatic behavior because it stems from a protective, adaptive and often defensive reaction to whatever threatens homeostasis and triggers early emotional solutions which were necessary then but are maladaptive now. Patients usually come to therapy flummoxed because even though they have been applying their best solutions to their problems they remain stuck and in pain. They have been trying to do something about that for a long time.

While I do not know what any patient should do about their particular that, what I do know is that it requires time and space to think about it in the context of one’s life – our history, relationships, choices, memories, and ongoing interactions. I know that patients have usually gone about living their lives in the best possible way available to them, and that only they can know what to do about their lives- but such knowledge needs to be arrived at on one’s own and in light of what has been processed and experienced relationally. To my mind this is what constitutes good treatment- the opportunity to sit with another, who has expertise in human behavior and motivation, as well as in listening, observing and staying attuned, and who, rather than foreclose space by telling the patient what to do can sit with the patient in not knowing, allowing their experience to lead the way.

Hard stuff, but well worth it.