Psychotherapy can be a daunting endeavor for people seeking to gain a better understanding of themselves and how their thoughts and behaviors lead to recurrent maladaptive patterns in life.  I am often asked what needs to happen in order for someone to change in the therapy process.  I always lead with one of my favorite sayings: “The unexamined life is not worth living.”  The fact is many of our recurrent patterns in life are a result of complete naivity of what drives are own behaviors.  Essentially the world has become flooded with walking corpses who continue to eat the same food, partake in the same routine and incessantly make the same mistakes over and over agaain in their relationships, careers and all aspects of life.

Finding these patterns and recognizing them is always the first step.  Becoming self-aware is essentially the first goal in psychodynamic therapy.  While this is no easy task, it is also only the beginning of the process.  Don’t get me wrong, its not easy feat to put a microscope to your own life, unlock doors into deep, dark places of the mind that you did not know existed, and then talk about them openly with a therapist.  However from my perspective, this is something that is relatively straight forward. Identifying patterns and tracing back the source of the problems, which almost exclusively date back to ages 4018, is actually easier than one would think.  While initially difficult and scary for people to have their eyes opened to these truths, the question remains: What do I do now?

It is the execution of change which people struggle with the most and is the most common people leave therapy.  Unfortunately leaving therapy after exposing ” the pile of crap” as one patient put it, but before learning how to change things for the better, is the worst time to leave therapy.  However those that endure, get the pleasure of discovering how to put an end to the chronic pattern of poor decisions that have led to years of unhappiness, regrets and resentment; all of which are very common themes in everyone’s lives.

So how does vulnerability come into play?  As self-aware as anyone can be, no change can be made until complete vulnerability can be experienced. It is only in this terrifying state can one truly feel the whole range of negative and positive emotions their life has had to offer them.  Being completely open to these feelings finally allows one to start to understand them, understand the effect they had on their life and understand the power they have held over them over an entire lifetime.  Vulnerability does not happen easily and without trust it is essentially an impossible feat. Trust in who?  That is the special bond of a patient-therapist. No other relationship in the world offers a completely neutral relationship where a person can feel completely at ease knowing there is no expectations or pressures to do absolutely anything but speak your mind.  It is this extremely strong, trusting bond with a good psychiatrist that can allow you to be completely vulnerable to start the process of change.

As one learns to experience all of which life has to offer in terms of the full array of feelings, the more comfortable they become in tolerating all of the feelings that have plagued them in the past. With this new found confidence, they can begin the process of trusting other friends and family members and essentially “being themselves” which is the ultimate goal of therapy. If someone can leave therapy and feel they are for the first time in their life be completely themselves and completely self-aware, they have achieved the ultimate goal of which therapy can provide.  In the end they learn how to be vulnerable in life; for without vulnerability we cannot feel emotion, and without emotion, our compass which guides our life decisions simply cannot be properly calibrated.  Where vulnerability begins, positive change in patterns and behaviors begin to