“Nothing changed,” complains the wife, the husband, the parent, the teacher, the friend, the sibling.

It didn't?

Because the nothing-changed—client is sitting slumped in his chair in my room wondering how on earth he can ever convince anyone that he did—that he still is—when his gargantuan efforts have gone so spectacularly unnoticed.

In response to reaching out to my listserv at Nefesh International about change in therapy, here is the email I receive from a colleague, Miriam Adler, PhD, Executive Director of Park Avenue Psychotherapy & Neurofeedack Associates:

“I would also love to see an article about understanding the ebb and flow of the change process and encouraging the spouse of an adult and/ or the parents of a child not to despair or think "we are back to square one" or "nothing has changed" if the client makes positive changes- but in an inconsistent manner, or has a plateaued for a while while integrating and solidifying new behaviors etc....

Having a spouse or parent tell a client that "therapy isn't working"when the client knows they are working hard and has made themselves very vulnerable, is counterproductive and bears the risk of the client giving up because they can never be good enough anyway.

So I think it will help all us therapists to explain that it is natural to go forward and backward ( and the backward doesn't negate the forward) and it is normal to have spotty positive changes at first and also to sometimes have no obvious changes while very important internal work is done!”

Ari Sorotzkin, LCSW, agrees. “As I just had this issue today in my office with a discouraged (and upset) husband working very hard in therapy hearing from his wife that "nothing's changed" I second the idea...”

So here I am attempting to explain what change means, how change works, and how to evaluate whether or not therapy is effecting that change.

First of all, for each person, change means something else. So as therapists, we are challenged to identify the client, the behavior that needs to be changed, and the treatment that will be used to effect that change. So it's sounds fine to say, “My husband is the problem,” and the things he needs to change is to come home on time to help with the children instead of staying late hours at the office. And then dumping that husband in my office with the order to “change him!”

But what if it is really the wife who is the problem, that the husband cannot come home because he is either afraid of the wife, or his parnassah is dependent on precisely those late night hours when China is awake (Amazon, of course), or his wife is co-dependent, clingy, needy? So, true, the husband ends up my client because the wife refuses to, but the change he may be requesting is to become more assertive in face of his wife's unreasonable demands? Hmm. Sounds complicated, no?

But let us say that both the parent and teenager agree that the client is the unhappy teenager. And that the teenager is miserable because she does not have friends in school. What would change mean then? Sounds simple, right? Help her make friends. But what if the real deterrent to the teen making friends is worry that if she talks on the phone or brings home friends, they will hear her mother yelling in the background, or her parents fighting, or see the piles of dirty dishes from Shabbos still overflowing the sinks on Monday?

See the problem?

Okay. But let's move on to the type of change everyone recognizes as the purpose of therapy. The husband needs to detach from the phone and engage with his family. The mother needs to learn anger management skills. The teenager needs to obey family rules and act respectfully at school and at home. Agreed? Agreed.

And therapy begins. And out comes the underlying layers that create the phone attachment, the anger, the disrespect. The outward manifestations of change are still absent, but underneath, the client is beginning to feel a settling-down. Less anger or frustration. Increased awareness and hope. Other things begin to look different, feel different. Change happens in different ways. In teeny, tiny increments. For example, the husband, although he is still glued to his phone, brings home flowers one day. Or even smiles at his children when he arrives home. The teen is still surly and disrespectful. But the dishes are magically washed one Sunday morning. It's not what anyone cares about (the maid can do them, just act like a mentsch for goodness sake!), but yet...

Change often begins in the deepest layers of rock and sediment and can sometimes take months, even years, before the earth moves even a fraction of an inch.

When a spouse or parent is frustrated, unless the change is something big enough for them to see, obvious enough that it is therapy that has effected it and not some random situation, the frustration remains. “No change,” is what they adamantly insist. But the changes are there. Small. Barely imperceptible, but nevertheless there.

If the frustrated parent or spouse has the patience, here is what will happen with those teeny bits of change. Those bits will slowly begin to roll into that snowball, the type that slowly gathers up speed and begins to accumulate rapidly into a growing entity that will perhaps even cause an avalanche. It will most certainly deliver all the power of that change. Of the charge of the change. Because it will happen so slowly in the beginning, it appears impossible that it will even truly happen. There's a psychological term for that. The Generalizable effect. The change happens in little places, but then it generalizes to all areas.

Sometimes the parent says they want the change, but when it happens, it throws everything off kilter. The homeostatis of the family in which is was easy to blame the problems on the identified problem—the teenager. And the parent may balk at the change. Or, the wife may hate the change. Because now the father is the dependable, stable parent and her role has been upended and she doesn't know what to make of it, how to regain her equilibrium.

And sometimes, the change happens, and instead of the parent or spouse sighing with relief, their expectations rise sharply, and the frustration of their view of it being too little, too late (although two weeks earlier they had begged for just a little sign of change occurring), invalidates the client's work. “That is change?” they complain, “so you smiled at me when you came home. But--” and here they list what didn't yet happen.

If I changed your mind about change and its challenge, then that change can change even more!

(originally published by Binah Magazine)

Look me up on LINKEDIN  https://www.linkedin.com/in/mindy-blumenfeld-a8067583   

Check out my book THERAPY SHMERAPY,  available in bookstores and through Amazon

Browse through my previously published articles on my former blog Therapy Thinks and Thoughts at frumtherapist.com/profile/MindyBlumenfeldLCSW

Read current articles in my bi-weekly column THERAPY: A SNEAK PEEK INSIDE in Binah Magazine, available on newsstands every Monday.