Why Insight Isn’t Enough, Part 2

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For many people, just coming to a greater level of insight is not enough for them to make significant, lasting changes in behavior patterns that have been part of their preferred style for many years. Here’s how one man found success with a systematic approach to changing both his thinking and his behavior.

I’ve written before on how different from traditional psychotherapy the work of change is for individuals who have significant personality and character disturbances. (See “The Work of Change: Why Insight is Never Enough”.) Traditional “insight-oriented” therapies operate on the premise that most folks struggle with fears, insecurities, and other emotional conflicts that derive from past trauma and which — although largely out of their conscious awareness — underlie their dysfunctional behavior. So, providing them with an atmosphere in which they feel safe to let down defenses, sort through their innermost feelings, and reach new levels of awareness is key to helping them change and grow. But as I’ve pointed out, most disturbed characters are already quite aware about the things they do, why they do them, the consequences these things frequently incur, and the discomfort most other folks have with their behavior:

Even in those cases where they might be lacking to some degree in awareness, just coming to a greater level of insight is usually not enough for them to make significant, lasting changes in behavior patterns that have been part of their preferred style of coping for many years.

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Having focused for so long on helping people with various degrees of character disturbance change their ways, I’ve dealt with many individuals who were well versed in traditional therapy. It’s quite common for a person with a character disturbance to have been pressured into getting professional help of one type or another several times, most often with disappointing results. One such individual, whom I’ll call “John,” had been in some form of insight oriented psychotherapy since early adolescence. (Note that for the purpose of ensuring anonymity, details of “John” have been altered and possibly combined with details from other, similar cases.) His autism features were so mild that despite the chronic difficulties he had as a child functioning in the social realm (many simply regarded him as introverted or “shy”), he was well into his late twenties before he was properly diagnosed as being on the autistic spectrum. (Only recently has the professional community come to recognize that autism exists on a continuum of severity.) In addition to the biologically based aspects of his personality, he’d been raised in an abusive and neglectful environment and as a result learned to cope by becoming even more emotionally detached than he naturally tended to be, more than a little mistrusting of others, and extremely “controlling.” John was also very intelligent and had good insight capacity. So, after many years of counseling, he’d become acutely aware of his socially dysfunctional proclivities. But the fact that he had such awareness but still had profound problems in his interpersonal relations made him quite depressed. He knew all too well the things he needed to do differently, but try as he may, he simply didn’t know how to change, a circumstance that would naturally get anyone down.

Now in his mid-forties, and being in his first serious relationship, John was having some major problems, especially on a new job he’d managed to secure. He wasn’t getting along with his co-workers or supervisors. He was a stickler for details and knew his policies and procedures manual like the back of his hand. But he also had a tendency to be intolerant with those who didn’t do things strictly by the book and would annoy others by presuming to correct them. Because he was so used to doing these kinds of things, he wouldn’t give his actions a second thought. Later, however, he would reflect on how hard the day had been, how he’d gotten into trouble, and how on the line he felt with his job and how unskilled he still was in dealing with others on an emotional level. This really depressed him but he didn’t know what to do. On one of his first office visits, he said something like:

I know what you’re going to say: I just should mind my own business and not be so suspicious and quick to go off on people but I just can’t seem to help myself. I try to be more aware, and sometimes I do better for a while. But I’m always slipping back into my old ways. I try not to let folks see how this gets to me. In fact, they probably think I just don’t care. But I don’t know how to make myself do differently. Sometimes I wonder if there’s any hope for me.

As I’ve mentioned before (“CBT and the Thinking Patterns of Disturbed Characters”), some of the fundamental guiding principles of the cognitive behavioral approach to helping people change are that the ways we think about things influence both our emotional states and the behaviors in which we’re likely engage, and that we can always change the way we think. I’ve also spoken about the stepwise process some cognitive behaviorally oriented therapists employ to help folks “practice” newly learned behaviors more reliably:

John found renewed hope and comfort in the new approach we took to helping him cultivate better social interaction skills. He already had plenty of insight. What he needed was a systematic way to change both his thinking and behavior. He had some real difficulty with one of the key components of the method, often balking at the notion of affirming and reinforcing himself for all his efforts to challenge dysfunctional beliefs and initiate new behaviors. He’d seen himself as “defective” and unworthy for so long it simply didn’t feel right to engage in this kind of self endorsement. But with encouragement, he “got with the program,” learned to spot and correct his thinking errors, and in the process not only improved in his ability to relate to others but also developed a more positive mood than he’d ever experienced before in his life.

Now I don’t mean to suggest that the work of change was easy for John. It wasn’t. It would take several years before new behaviors became more second nature for him. But he eventually bridged the gap between what he’d long known needed to be different in his life and the tools he needed to make real change happen. John is perhaps today more insightful about himself and the nature of his unique challenges than he has ever been. But it’s not his insight that’s made all the difference. Acquiring the skills to relate to others in a manner that he once feared was impossible is what’s really changed his life and in the process brought him both a confidence and joy he never thought possible.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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