The Gift of Therapy

Decisions are expensive because they demand renunciation

Once patients accept that premise and own their behavior, then, in one manner or another, I pose the key therapy question: “Are you satisfied with that?” (Satisfied both with the nature of the decision and with their mode of making the decision.)

One of my first steps in therapy is to help patients assume responsibility for their actions

Or they force others in their life to make the decision for them: every therapist has seen patients who end relationships by so mistreating their partners that they will choose to leave. Others only hope for some overt transgression by the other

there is something much better to do with decision dilemmas. Decisions are a via regia, a royal road, into a rich existential domain—the realm of freedom, responsibility, choice, regret, wishing, and willing.

Because decisional dilemmas ignite freedom-anxiety, many go to great lengths to steer clear of active decisions. That is why some patients seek delivery from decisions and, through cunning devices,
inveigle unwary therapists to take the burden of decision away from them.

The information supplied by the patient is not only distorted but is likely to change as time passes or as the relationship with the therapist changes

What generally gets omitted in accounts of marital discord is the patient’s role in the process

THE MORAL OF this cautionary tale is, beware of leaping in to make decisions for the patient

We therapists have our little cunning ways—statements such as: “I wonder what blocks you from acting upon the decision you already seem to have made.” (And I wonder, what on earth would therapists do without the device of “I wonder”?)