It would seem obvious that people decide to start psychotherapy because they want to change something about themselves. Maybe they're depressed and want relief. They might have some compulsive habits they need to break. Or they tend to over-react and want to gain control of themselves and their emotions. When clients consider changing, they invariably think about changing for the better; at least consciously, they view change in a positive light.

In general, if we strive to change our lives, it's usually in order to improve them. Sometimes we'll work very hard to alter the conditions that prevent us from succeeding in our careers or being fulfilled in our relationships. Most of us like that kind of change and believe we want it. Why is it, then, that so few people actually do change? Why do so many people stay in unsatisfying jobs and unfulfilling relationships? Why don't more people who need it seek professional help?

As I discussed in this early post, part of the answer is that authentic change takes a lot of very hard work over time and usually involves facing pain. But another reason concerns the very nature of change itself, its unpredictability: while most of us want positive change, we also know that giving up the status quo means confronting the unfamiliar and all the
unknown feelings that might arise. There's no guaranty that change will be for the better; you don't know for sure how you're going to feel when your world changes. For this reason, many people have a strong fear of change; they cling to the familiar, even if it's not especially satisfying. I find that most of the people who seek out psychotherapy usually do so only because they're in so much pain they can't bear it, so much pain that it overcomes their fear of change. People with manageable amounts of pain or whose defense mechanisms work for the most part rarely come for treatment. They stick with the everyday unhappiness they know.

I've also found, with nearly every client I've seen over the years, that change unconsciously (sometimes consciously) stirs up an unpleasant awareness of time passing. We all understand that time is passing, of course; but most people live in a kind of denial about where that passage will ultimately lead us. You can't live every minute with the awareness that you're traveling toward death, so you repress it. Change, especially dramatic change, makes the awareness of time more acute and for that reason, unconsciously links up with the idea of death. In order to escape that knowledge, many people exist in a kind of stasis, as if time has stopped moving for them. Because they dread real change and where it will one day lead them, they cling to routines and repetition, as if every day were the same, as if time stood still.

One of the ways you can see the fear of change, even pleasant change, is by observing people's behavior when they travel. I've know many people, both men and women, who become constipated the day before they go on vacation. If it were during the trip, you might say it was their body's reaction to an unfamiliar diet or climate; but when it happens prior to departure, it has to be a psychological event. Consciously, they're looking forward to vacation; on another level, they fear the impending changes -- in routine, environment, etc. In the clients I've seen, their constipation always involved an (unconscious) attempt to gain control over those changes, as if by clenching tight, their bowels could stop anything unpredictable from happening. In my personal life, all the people I've known who suffered from pre-travel constipation had "control issues", you might say: two neat freaks, another compulsively well-organized woman, a man who has his emotional life under severe restraint.

All of these ideas came up for me again this last week when I was having dinner with a friend I hadn't seen in about a year. We were discussing his young children, and in particular, his oldest daughter who left her beloved pre-school this past summer and started kindergarten. A little girl who had formerly been cheerful and outgoing, who looked forward to school, loved her teachers and her classmates and was popular with everyone had become anxious and miserable at her new school. She seemed to have undergone a complete character transformation. Getting her dressed and ready to leave the house each morning has turned into an ordeal; she now "hates" her teachers and classmates and never wants to go to school. She feels worried and unhappy much of the time.

My friend was also telling me that they have two aging dogs, one of whom will likely die in the next few months. He and his wife have been trying to ready their daughter for this loss, preparing her for the grieving process (which already seems to be underway). At first, she wanted to have the dog stuffed and kept on permanent display in the house (a kind of denial of death); now they've settled on cremation, with the ashes to be enshrined in place of honor.

This little girl is struggling with both the unpredictable nature of change (how your world can suddenly alter and present you with an entirely different set of experiences), as well as with the passage of time and the inevitability of death. I was reminded of a night about 14 years ago when my oldest son came downstairs at around ten o'clock, sobbing to his mother and me that he didn't want to die. Lying in the darkness, the fact of his mortality had suddenly come over him. He was six years old at the time. As with my friend's daughter, it was a time of major changes for him, as well: we'd moved away from Los Angeles and he'd left behind everything he knew.

My friend and his wife have taken the whole family to a therapist who seems to be doing an excellent job, advising them on how to establish routines and predictability, helping their daughter to feel as if she isn't entirely helpless in the face of change, with some control over her environment. As for the issue of death, the dog will soon die and I'm sure it will be traumatic for her. But with the help of her parents, she'll get through and the anxiety about her own mortality will succumb to repression ... as it did for my own son, as it usually does for most of us.