Most of my patients have a problem with doing things. When they feel good and energetic, they know what they want to do, they plan it, and they do it. But much of the time they either don’t know what they want, are unable to plan it, or just don’t do it. They call this a lack of motivation.
I believe otherwise (excepting prefrontal cortical compromise or dopamine-related problems with executive functioning). It’s usually not lack of motivation that keeps my patients from action—it is a directly oppositional force. That is, they are not just standing there, indifferently or perversely refusing to move forward. They are instead facing a strong headwind.
The opposition is usually anxiety or a fixed belief that keeps them from acting. Something about the proposed action frightens them, and the question becomes, “What are you afraid of?” Or they have a deep, sometimes unconscious belief that they are unable to do, or shouldn’t do, or don’t deserve to do the action. Ferreting out the specifics of the fear or belief is an essential part of making action possible—necessary but preliminary exploration with a patient.
The next step is to experiment with action despite the fear or the unproductive belief—that is, in the face of the headwind. Successful psychotherapy is all about experiential learning. Momentum occurs with even a tiny bit of success. But it is dang hard. How can I encourage patients to make that first effort? How do I transfer my faith in the efficacy of the new behavior to my patients, and then how do I get them to begin to move, to try it, to take a first step?
To switch metaphors in the middle of things—how do I lower the bar on change? How do I help make it less costly and therefore more possible?
This is a serious question (even though it is a bit abstract without the details of a specific person’s situation). And I just realized that the one person most likely to be able to answer it is the patient him- or herself.
Go to the source, and ask.