Tuesday, December 19, 2006

When the "why?" isn't crucial...

I would like to point you to a brief article by Sally Satel in today's New York Times Science Section that mirrors my own sentiments about the usefullness of insight into how a maladaptive behavior, such as drug use or over-eating, might have originally started. Insisting on finding a cause can be an excuse for not working on changing a maladaptive behavior, and knowing a cause doesn't guarantee that behavior will change. There is no convincing data for the effectiveness of insight therapy, while there is such data for cognitive therapy - which trains one to note what isn't working when it starts up and choose to do something else. Satel says "It is time to retire the myth that insight is a prerequisite for change," and she offers two case studies:

"...the grail-like search for insight can backfire when it becomes a way for patients to avoid the hard work of change. This was my experience with Joe, a 24-year-old heroin addict. At every session, Joe would talk about his childhood relationship with his father, seeking new clues for how it damaged him and drove him to heroin...When I tried to change the topic to on-the-job stresses, which he linked to heroin craving, he said he’d rather “do psychotherapy.” Joe was forestalling the need to make practical changes. The many-layered drama with his dad doubled as an excuse for using heroin, absolving him of the responsibility to quit. When I proposed that possibility to him, he said, “Maybe you’re right.” But nothing really changed. He died of an accidental overdose a few months later."

"..insight has no guaranteed relationship to change. A colleague of mine treated a 45-year-old woman, Joan, who came for therapy because she hated her chunky body. Joan firmly believed that once she discovered The Reason for her overeating she would stop...After a few months, Joan told my colleague that her father had developed cancer the year she went off to college...“You know, I never made the connection until now,” she announced triumphantly, “but I started overeating when he began to waste away. It’s like I was trying to nourish him through myself.” ..A poignant metaphor, yes, but months later she hasn’t lost a pound."


  1. Anonymous10:58 AM

    Hi wonderful Deric..yes I thought about your posting something on this when I read it in the NYT. Actually, the whole idea behind understanding something is that we then have a choice to do something about that thing that occurs for which we do not have understanding. Don't you think? Understanding (education/learning) provides a basis for making choices about changing things in our lives rather than falling victim to them. The idea that this woman still had not lost a pound was probably due more to her not "wanting" to for one reason or another...and not directly attributable to her gaining (no pun intended!)understanding about her eating habits.

    Thanks for the post as always...and I so appreciate your thoughts and ideas...Myrna

  2. I'm not sure I'm getting your sentence "the whole idea behind understanding something is that we then have a choice to do something about that thing that occurs for which we do not have understanding." It certainly is better to have insight into a behavior than not, but I guess the simple point of the article is that we have the choice to change that behavior in the presence or absence of insight.

  3. People need to feel that they understand the reasons for their own behaviour, particularly destructive behaviour. Whether they actually do understand is irrelevant. As long as they think they understand, they are satisfied.

    Their "understanding" then too often becomes justification for their dysfunctional behaviours.

    Religion, Scientology, Cults, Political Ideologies, Addictions . . . and so on. We can justify them all if we need to, with the application of enough "insight."