The Path is Made by Walking: Insight is Optional

The New York Times had a very interesting article this week by Dr. Sally Satel, staff psychiatrist at the Oasis Drug Treatment Clinic and a resident scholar at the American Enterprise Institute. In the article, Dr. Satel discusses the role of insight in helping an individual overcome an addiction or other life problem and suggests that the need for insight may be over-rated and in some cases actually a detriment to further movement. I certainly recall a similar range of experiences from my own days as a therapist. While I worked with many clients who worked very hard to turn their lives around and made excellent use of psychotherapy, there were certainly exceptions to that rule. On more than one occasion I remember clients lighting up with some apparently life-changing insight into the roots of their behavior or emotional state only to come back the next week in the same place, stating that they didn't really think about the session again once they left my office. I distinctly remember confronting one client, much as Dr. Satel did, on how the quest for insight seemed to result in his stagnation in therapy rather than his moving forward. I asked him why he was in therapy. His reply?

"It's a great conversation for $5 a week."

That was his insurance co-pay.

The act, in and of itself, of seeking self-understanding with the support of a concerned individual, whether a professional or a friend, often makes one feel better. The client who enjoyed his $5 a week conversation is certainly not unique. This is an often unacknowledged downfall of the model of using insurance for psychotherapy. While many highly motivated individuals benefit from therapy that they could not have access to without insurance support, there are certainly individuals who abuse the system. Many of my clients were very aware of their mental health insurance benefits and were clear they wanted all the sessions they were "entitled to" and not a single session more. Who wouldn't want to talk to a concerned and devoted listener week after week on someone else's dime? Just that process alone can tap off enough stress to make the rest of the week go slightly better until the next "great conversation." Therapists are humans and they like to help. Some have nice-sized egos, too, like people everywhere. It can be an unhealthy "win-win" when a therapist feels week after week like progress is being made, in part because the client knows just where to stroke and both client and therapist get their superficial needs met.

But what about those clients who earnestly do want to understand themselves and the roots of their problems better in the hope of creating a better life in the future?

It’s tricky territory. As Dr. Satel points out, the whole quest is something of a fool's errand as we cannot go back and see what our lives would have been if one thing had been different. This is precisely why "It's a Wonderful Life" has such timeless appeal. We love the fantasy of it but in reality we don't get the chance to view all the different scenarios that might have played out in our lives. We don't get to look down the road to see the actual consequences of any of our actions much as we would like to.

To make matters worse, just as we are unable to test out multiple future scenarios, the fact is 20/20 hindsight is a myth and a seductive one at that. No matter how earnestly we search into our psyches, we are subject to our own revisionist histories. From a neuropsychological perspective, our brains are designed to make our stories complete, whether the story is accurate or not. And a complete story that makes sense to us will always feel “right”. Believe me, I know what it feels like to have the strength of one’s convictions that one knows, without a doubt that they have clear sight, both forward and backward. I’m an oldest daughter with Greek blood in my veins. You don’t have to tell me about conviction. But the strength of conviction does not increase the validity of a perception.

How you form your perceptions is a physiological, neuropsychological phenomenon. If you see a round line drawing, looking like a circle with the exception of a gap just before the ends meet, your mind will see a complete circle. We expect the arc to continue all 360 degrees once we see the trend. We think we know the story of the line and the story is "circle". We don't expect the missing gap to jut out like a pointy party hat. We do the same thing with our personal histories, the stories of our lives. We fill in gaps and weave together memories into narratives that make sense to us, often including our own perspectives on the motivations and thoughts of those who act upon us. Our brains conveniently discard information that is inconsistent with the storyline it has chosen, much as we like to think we are objective.

The same thing happens in relationships. When you've been in a relationship for a long time it is easy to believe you know what your partner will say once they start a sentence and sometimes even before. You see a twitch of the eyebrow and you say, "I know what you are thinking." It's a brain thing. We all do it. We do it when we imagine the course of conversations or arguments we are anticipating having and we do it when we look back and try to understand how life got to be the way it is for us.

What's the alternative? To reinvent the world anew every day by assuming that everything is unpredictable? We can't do it. We will always see patterns and once we see them, we start to plan around them. They provide a sense of structure in our lives. So, if our ability to predict the future as well as our memories of the past are both flawed, why the dogged pursuit of insight and understanding?

From my own clinical experience I offer you these additional insights to Dr. Satel's article. What follows are common myths the seeker of self-knowledge may fall prey to. I offer these not to dissuade you from seeking self-understanding, which I do believe is a noble pursuit, but to help you avoid traps that will derail your process by giving you a false resting place on the journey. If you are willing to take the journey, you owe it to yourself to be sure of your destination and what you will need for the trip.

Understanding gives us a sense of control. If I know why something bad has happened, I stand a chance of preventing it from happening again. Likewise, if I see something bad happen to someone else and can determine why, I can keep myself safe. You may have read my recent article on Michael Schwass, who just passed the 31st anniversary of the injury that left him quadriplegic. He deliberately entitled his book, Don't Blame the Game. He knew that many would look at his quadriplegia and conclude, "Oh, but he was playing hockey, a notoriously brutal sport. Ah, I get it." His answer is, "No, you don't get it."

In Michael’s view, which is highly spiritual with a karmic perspective, pointing to hockey as the reason his life took the turn it did is too simplistic. Is his perspective right? Who are we to say? It may be a much more comfortable place for some to look at the risks of a dangerous sport than to think about life being subjected to such intangibles and mysterious forces as karma. Look at the flipside with Lance Armstrong's book, It's Not About the Bike. Same thing. If we seek to understand why someone does something well, we can increase the chances of our own success. When I put up my photography site, I got asked over and over what kind of camera I use. It's an old and extremely limited camera. It isn't about the camera.

Understanding helps us assign proper blame. This is an extension of the first point. If I know for certain that my mother is the root of every trouble I have, I have a reason that allows me to let go of some responsibility. If the work of turning my life around simply feels too hard to me (and it may be VERY hard), I get a sanctioned way out of it if I hang on to the belief that it wasn't my fault to begin with. Personal responsibility starts to feel like an option.

Let me just go on record saying, this: It isn't.

In the end, it boils down to this: Your life has always been, and will always be, a paradox. We all have flaws and blindspots. We are all capable of wickedness and brutality as well as extraordinary kindness and compassion. We have been influenced by the world in ways that we cannot possibly have a full appreciation of with multigenerational, cultural, historical, and biological influences acting upon us just to name a few.

Michael and I have this running joke in which I ask him in a fit of exasperation, "Guru or hockey puck?" His answer, before he wheels away leaving me to contemplate is "Yes." Sometimes that man is so wise it scares me and sometimes he is everything I would expect in a hockey player (read: a "typical guy and a good bit worse"). I have historically tended toward idealism, and I wanted him to be one or the other. I wanted the pattern to be consistent. Get thee to the mountain top and stay there! Same thing with his health. I wanted to know, "Are you living or are you dying?" Again, the answer is "yes" and it has been for years.

In the end, what difference does it make? It only makes the difference I think it will make, and when I gave up the need to label it a huge weight came off my shoulders. It only makes a difference when I feel the need to predict the future. It has only made a difference when I believed that if I could just study the map for a while that I would know what steps to take today. It's a way we deal with the fear of the unknown in our lives.

The future is always unknown. You never know what's around the next corner, and you'll never know all the reasons you are where you are today.

The path is made by walking. (Or rolling, as the case may be.)

Need help moving from insight, flawed though it may be(!), to integration and forward movement in your life? Visit Wellspring Coaching.

Comments

[Dick Rowan]

The active drunks and druggies at clinics like Dr. Satel's are the biggest liars on the face of the earth, which is why behavioral therapy is a waste of time for them. They will say and do anything to place blame or redirect responsibility.

For the rest of us, however, self-exploration remains the essential tool for enabling personal or societal change. I join those who argue that to know our selves is our ultimate purpose.

[Laura Young]

I agree, Dick. I've been like a pit bull with my own self-exploration and can't imagine living any other way. It takes tremendous courage and dedication to face down dragon after dragon. Not everyone is up to it and we have such poor models. In our culture of quick relief and denial of pain it's easy to be tempted to give up the work once we start to feel a bit better, which is what happens in therapy as we say things out loud. The trick is to not confuse relief with healing and true self-knowledge. Not a path for the weak of heart! And the seeking self-knowledge has to happen as an integrated process with the rest of life. It's a rare person who can escape for 10 years to a mountain top and find truth. It's not "either/ or." It's being in the confusion and the paradox and remembering to take the next step. Insight and action so often grow together.

[Carolyn Manning]

Well, Laura, what does Dr. Satel suggest to replace insight? It would appear that a person looking to change some behavior pattern necessarily needs to understand why it needs to be changed; how can understanding happen without some degree of insight? It's not a fool's errand to search for and realize the cause of a problem.

[Dick Rowan]

Great comments, Laura and Carolyn. What stands out for me in Satel's article is her revelation that positive behavioral change and sobriety are likely to go together. I say revelation because I thought this was a given. Nevertheless, there is a paradox between clear-headed, fact-based insights and action. Sometimes, knowing less is actually better.

[Peter]

I agree with Carolyn – to a degree. Insight is necessary for change – to a degree. And that degree is that it’s good to know what you are moving away from and what you are progressing toward. But beyond that knowing WHAT needs to be changed and HOW to change it is enough. The only WHY the drug addict really needs to know about kicking the habit is “because it’s killing me.”

One of the great difficulties that therapy had during much of the 20th century was its reliance on classical psychoanalysis. While being “on the couch” might be a beneficial and fascinating (and long and expensive) exercise in self-awareness, there is nothing necessarily therapeutic about it. Which is why the various forms of Cognitive Behavioral Therapy have come to dominate the scene. I think the point that Dr. Satel and Laura are making is that understanding a problem and solving it are two very different things.

And I don’t think that anyone is saying that self-awareness or any other kind of awareness is a bad thing. I’ve had my cathartic “A-Ha!” moments in which I realized why a certain relationship simply COULD NOT have worked, which spared me further speculation and angst – and that was a relief.

But for true searchers like Laura, self-awareness is an end in itself – the measure of what it means to be fully human – not a practical tool for getting where one wants to go in life.

[Laura Young]

Yes, Peter. Well said. Carolyn I agree that the search is not, in itself, a fool's errand but searching with a goal of finding THE cause, THE right answer IS. As Peter suggests, it's a matter of gaining enough self-knowledge to know what needs to change and why, but endlessly drilling down without making concrete moves to reorient ones life practically can end up being like psychological fly paper.
I've seen coaching clients get caught in this with an intense desire to know their life purpose. "Once I have discovered my purpose, THEN I'll know what to do." For myself, intensely introspective as Peter accurately notes, I can tell you honestly that I JUST pegged "purpose" for myself TWO WEEKS AGO! LOL. I'm totally serious. Maybe some day I'll write a post on that but right now I'm just grooving on the clarity and content to bask in the warm glow. It doesn't really matter if I talk about it. The fact is I am living it and doing it continually. As Peter always says, "Show, don't tell."
It rises together, as Dick says. Get some insight, take some steps, gain more insight, keep walking.

[Carolyn Manning]

I didn't mean to imply one should drill for answers the same as one would drill for water, simply that there needs to be a jumping off point. An 'Aha, this is killing me' as Dick put it, is sufficient. It's true that getting stuck in the WHY can turn into a tail-chasing event; no argument there.

Maybe I'm reading something that Dr. Satel didn't say.

[Dr. Hal]

Dr. Sally Satel made a very strong and enlightening statement: "It is time to retire the myth that insight is a prerequisite for change". When I graduated with my degree in clinical psychology, I really believed that insight was necessary for lasting changes in people's lives. Although I've never identified the need for insight prior to change as a myth, I believe insight is not a prerequisite for change. It has been my experience that insight is the result of the success rather than the cause.

Painful dissatisfaction in living and a healthy desire for self-actualization are the prerequisites for change from my perspective rather than insight. When I focus on developing insight with my clients, I encourage my clients to look forward rather than backward. I want my clients to have insight into the consequences of their dysfunctional behavior and the benefits for changing their lives rather than developing insight into the causes of their dissatisfaction.

[Andy]

Thanks for submitting this post to the Carnival of Thoughtful Consideration. I started writing a comment and realized that you had started me thinking enough that I'm going to make it a full-blown post instead. Great work!

[Laura Young]

Thanks Andy. Do us a favor and trackback here when you do so we can see where you go with this. I'm anxious to see your expanded thoughts on the topic.
L