From the perspective of a psychologist in a state hospital treatment setting and a population of individuals who have struggled with recovery over time, I believe insight and understanding is a key to creating a desire to change. I believe it greatly helps people to see the big picture of their life and come to an understanding of why their life is like it is…that is, why they have lost “everything” or most everything they’ve ever loved or cherished…or why things always end up so bad…or why anything good never lasts. I believe folks need to grasp that this life outcome is a product of how they have tried to cope with upsetting life events over time…and the way their life is today…is because of the progressive and worsening consequences of their self-destructive coping mechanisms (drugs, alcohol, verbal and physical aggression, suicide threats and attempts, rebound relationships, and other emotion-driven coping choices). I believe that once they grasp that the quality of their life is based on how they attempt to cope with daily life and major life stressors…once they realize that how they cope with life is responsible for the current state of their life….once they really get this…motivation for behavioral change often follows. In the group I do, they are also taught that part of being wise (use of DBT’s Wise Mind) is not only knowing what to do (Wise Mind Game Plan), but it is about “following through with what we know to do”…because there is nothing wise about knowing what to do…and then not doing it! I believe insight and understanding is an initial part of behavioral change. I also believe that knowledge that change is possible is essential. I believe they need to really get it that other people have done it and have made it through. They have to have this knowledge…which breeds hope that the recovery process actually works…that people do recover and live satisfying and meaningful lives. I also believe personal empowerment is a key ingredient. They have to believe that they can do it…that they have the skills and understandings necessary to pull it off.
Thus, they have to understand why things are as they are..(insight and understanding), they have to recognize that change is attainable (knowledge and hope)…and they have to think they can do it (personal empowerment). Of course, they also need the knowledge, skills, and resources for getting through the tough times that are part of making and undergoing major life changes (life-enhancing coping skills, support system, hobbies and activities, busy-ness). They have to understand the concept of Distress Tolerance…that things will be hard, but they must Get Through It…that recovery is not easy…and in fact, it will be one of the hardest things they’ll ever do. They are also taught that change typically does not occur until we are sick n’ tired of being sick n’ tired…that we have to soooo hate the way things are…that we’re willing to do whatever we’ve got to do to change things…that we refuse to live like this any longer. I believe that people need to be filled with recovery attitudes…or rehab-itudes…and they need to be prepared for the fight of their life…which for many is the fight FOR a life (a decent life) and for others, it is a fight for life itself…because the severity of their consequences has escalated into things being so bad…that it comes down to “life or death”…
When the pain of living like we’re living is greater than the pain of change…that’s when most people decide to change…and the question for the rest of us is…how bad do we have to let things get before we’re willing to make changes! It’s a shame that we’re such stubborn creatures, that we have to let things get so bad…before we’re willing to make changes! If only we knew then…what we know now…how we could have spared ourselves of such long-term pain and suffering.
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~~~ ~~~ ~ The DBT-CBT Workbook ~ ~~~ ~~~ 