May 2008
Why "Why change"?
This phrase reflects the central philosophy of my practice: people don’t need to know how to change; they just need to know why they haven't. Sometimes, people don’t really need to change at all - they just need to know why things are the way they are. Many schools of clinical psychology, such as cognitive therapy, solution-focussed therapy, schema-focussed therapy, or narrative therapy, are designed to provide you with a system to bring about change. What these models don’t really offer is a rationale for why that change should occur in the first place.
The most widely used reference among Clinical Psychologists is the American Psychiatric Association’s Diagnostic and Statistical Manual, currently in its 4th edition. It is typically referred to as the DSM-IV. The DSM-IV lists every mental illness, and describing each one in detail. This is an important guide, because it sets out universal definitions for illnesses such as depression, schizophrenia, and autism, so that psychologists in Sydney, London, or Mongolia can identify it using the same criteria. One of the main criticisms of the DSM-IV is that it is “atheoretical”. This means that it describes the illness, but does not provide any information about why has occurred. For example, the DSM-IV lists detailed criteria for the diagnosis of depression, describing symptoms such as depressed mood, sleep difficulty, and loss of interest in pleasurable activities. Yet no information is provided about why the person may be experiencing these symptoms. By comparison, other medical texts will describe not only the symptoms of the illness (say, coughing, runny nose, headache for the common cold), but also the cause of these symptoms (viral infection).
Most people know what they want to be different in their lives. Depressed people want to be happier. Anxious people want to be calmer. How does it help a sad person to be told that they need to be happy? A person who wants to quit smoking doesn't need to know how to quit; they already know: just stop smonking! What they need to know is WHY they find it so hard to stop. Once they know that, they will be able to find a way to quit on their own. It’s not my job to decide for them what needs to change, or even how they can go about making that change: my job is to do what the DSM-IV doesn’t: to help you understand WHY you feel the way they do, and help you answer the most difficult question: why change?
|