Blue-Collar Therapy

The Nitty-Gritty of Lasting Change

Magazine Issue
November/December 2013
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Charles Dickens’s A Christmas Carol is one of my all-time favorite stories, as it’s been for millions of others since it was written in 1843. Who doesn’t start sniffling when reading this classic tearjerker about Ebenezer Scrooge, a cold, bitter old man dragged—by the ghosts of his past, present, and potential future—on a terrifying midnight journey of self-discovery, from which he emerges transformed and redeemed? Most people love movies about driven, selfish people who, struck by the life-altering experience of sudden love or near loss, eventually see the light and blossom into life-affirming mensches. Miraculous conversion stories appeal to the wishful thinker in all of us. We want to believe that hitting bottom—being forced into genuine awareness of one’s bad behavior and experiencing true remorse about it—is the key to transformational change, a comforting daydream shared by many therapists.

However appealing this view of human transformation may be, the reality is that it distorts what we now know about the foundation of lasting change. Falling in love, for example, doesn’t make us appreciate other people; appreciating other people makes it likelier that we’ll fall in love. Appreciation can be practiced and conditioned; love cannot, at least not directly. We don’t change our bad behavior by feeling bad about it. In fact, we usually don’t feel bad about it—much less understand its effects on ourselves and others—until after we’ve changed enough to achieve a more enlightened perspective. (That’s why it’s usually not until we become adults that we can transcend denial about the foolish things we did as adolescents.) Except for saints and literary characters, enduring change rarely happens as the result of being knocked off our feet by a spiritual or psychological whack upside the head. Perdurable change is gradual and mundane. It occurs by extending, supplementing, and altering the habits that shape perspectives and drive behavior. First comes the hard work; then comes the epiphany.

I began clinical practice some 25 years ago, firmly committed to what might be called Christmas Carol therapy. Although I didn’t make the conscious connection back then, I secretly believed that change for every client was always a transformational session away. I can recall many highly emotional sessions that did, in fact, shake many clients to their core; most left therapy changed forever, or so it seemed to me at the time. But the follow-up questionnaires I regularly sent clients a year after treatment told a different story. To my dismay, the clients who’d had the most dramatic experiences in therapy did the poorest a year later. A few were even worse off than before treatment. It had to be the fault of the questionnaires! So I tried different ones, and persisted with my version of Christmas Carol therapy—until I met Mattie.

Mattie showed up for an appointment that was actually intended for her husband, Patrick, who’d completed therapy with me five months earlier. Before coming to therapy, Patrick had been convicted of misdemeanor domestic violence for pushing Mattie into a wall and court-ordered into a batterer’s intervention program, after which he was referred to me by the group leader.

In therapy, Patrick relived his ghosts of times past, including when he’d witnessed traumatic scenes of his drunken father battering his mother. On the mornings following these beatings, while his mother’s face was bruised and swollen, Patrick would be smothered in affection by his now sober and remorseful father. The ghost of Patrick’s present soon became obvious: Mattie’s unhappiness reminded him of his mother and his own failure, as a boy, to protect her, as well as the guilt he felt for hating a father who, when sober, was loving. But rather than elicit a deep need to redo the past and protect Mattie from harm, he blamed her for making him feel bad. The slightest hint that she was unhappy, even a complaint that he wasn’t doing enough around the house, would scrape the old wound and prompt an eruption of anger. Although the incident that landed him in court had been the worst of his violent attacks, he frequently raised his voice, laced with contempt and disgust, bullying his diminutive wife. Through our work together, Patrick came to see the ghost of the future—divorce, isolation, desolation—and seemed to make some important discoveries about himself.

With honesty and sincere emotion, he mournfully recalled his childhood feelings of fear, guilt, shame, and helplessness. More importantly, he became aware that Mattie, then pregnant with their second child, was not a symbol of his failure, but his beloved wife, with a right to her own thoughts, feelings, and desires. He left therapy a new man, confident that he could use the fruits of our work, along with the safety plans learned in his domestic violence class, to give Mattie the kind of relationship she wanted and deserved.

When Patrick called for a follow-up appointment five months after our therapy had terminated, I looked forward to seeing him again, but when I stepped into my waiting room and saw Mattie, one feature of her appearance shocked me: fading but still ugly bruises on her cheeks and around one eye. Patrick had beaten her up and was now sitting in jail. When I invited her in, she described the stress they were under with their new baby and the threat of downsizing at Patrick’s job. “He really has changed,” she added. “Therapy really did him good. He’s a much nicer guy . . . most of the time.” This beaten young woman was trying to reassure me.

Once the jolt of this dramatic treatment failure wore off, I began to focus on the question of what I’d missed in my work with Patrick and other clients that could account for the shockingly short-lived impact of our therapy. I’d always counted on the big bang of therapeutically induced emotional catharsis to create the kind of instantaneous “learning experience” that would result in a life lived differently. What I’d forgotten was that true learning doesn’t come in a sudden breakthrough: it takes most people years of trial, error, practice, reinforcement of some behaviors, and active discouragement of others to become civilized adult human beings. True, I dimly recalled some bare basics: we build internal inhibitions against certain behaviors by making mistakes (our mothers say no to chocolate milk, we scream in protest, our mothers get mad, and we feel ashamed) and by observing external constraints (your classmate sasses the teacher and gets time in detention with extra homework). But beyond these Stone Age truths, I was completely out of touch with the latest research in learning theory.

So I began holing up in libraries in those pre-Internet days, reading about how we learn and how we recall emotionally laden material. It soon became apparent that, for starters, my practice of Christmas Carol therapy didn’t account for what researchers call state-dependent and context-dependent learning and recall. Information learned in one mental state and social context is most likely to be recalled when in the same emotional state and social context, but unlikely to be recalled in other states and contexts. What we learn in a warm, accepting environment like therapy can hardly be accessible in aroused states and perceived hostile environments. To put it differently, Mr. Hyde probably won’t recall what Dr. Jekyll learned in therapy.

So Patrick, when resentful at Mattie, could recall every little thing she’d said or done to offend him since their honeymoon, but wouldn’t remember any of those things when he felt sweet and loving. By the end of treatment, he could clearly see issues with Mattie without blame, resentment, or entitlement; however, it was a different story at home. Mattie’s frowning at anything at all could get him aroused and ready for aggression, with little or no conscious awareness.

I began to realize that Christmas Carol therapy, dependent on deep, emotional exploration of clients’ past hurts and their connection to current behaviors, followed by a fireworks display of catharsis, might actually be making the problem worse by creating a special context of learning that was unlikely to be recalled at home under the stress of high emotional arousal.

Habits Rule

Continual repetition of behaviors and thoughts results in highly reinforced neural connections, which are experienced as habits. The brain loves habits because they conserve energy. Every day, the brain takes in all kinds of experiences and, based on those, makes numerous assumptions about the environment, which it uses as processing filters to make tacit judgments and behavior choices, most of which are outside of awareness. If there’s no obvious environmental exception to the string of assumptions underlying a given behavioral impulse, we act without conscious thought, emotion, or perception of the action. For example, you can walk across your living room and sit down without thinking anything about it. You don’t have to look for the chair because your brain assumes where it is. You can’t do that in a strange hotel room, which is why travel is exhausting. In unfamiliar environments, your brain must formulate new strings of assumptions for everyday behaviors.
For this reason, we tend to make more social mistakes at home—saying and doing insensitive, thoughtless things—than we do in contexts that require more conscious processing. In fact, the brain tends to tune out familiar tones of voice in its proclivity for autopilot functioning—which is why spouses, parents, and schoolteachers need to alter tonality when they want to relate an important detail. Hedonic adaptation explains how we flatten emotional salience, positive or negative, once we adapt to it: it becomes familiar by virtue of an underlying structure of habituated responses. This is how bad situations, like prison or a permanent disability, become bearable, and how good things, like pleasant marital interactions, once they become habits, become boring.

Researchers describe habits as a series of conditioned responses. By adulthood, most emotional responses and behavioral impulses are conditioned: we think, feel, and behave more or less the same in the same states and social contexts over and over. Habits and the conditioned responses that compose them are processed in the brain in milliseconds, thousands of times faster than conscious decisions. In fact, most of our decisions are made prior to conscious awareness, governed more by habit than deliberate choice.

As Harvard researchers Daniel Gilbert and Matthew Killingsworth point out, nearly half our waking hours are spent on autopilot, in which a wandering mind predominates. The waves of intense emotion produced in catharsis inevitably fall back to a surface dominated by automatic thinking-feeling-behaving. We’ve all experienced moments of great joy, exhilaration, and excitement that make us feel as if we’re totally changed inside—bigger, kinder, wiser—but sooner or later, we fall back to earth and our ordinary mortal existence. In the end, lasting change is likelier to result from altering the small current beneath the waves of emotion—the habits and conditioned responses that rule our waking hours. This isn’t to devalue catharsis as a therapeutic tool: it can certainly provide motivation to develop the habits and practice the skills necessary to bring about lasting change. But without those habits and skills, any change prompted by catharsis is unlikely to endure.

The main reason that conscious control of habits is limited is that it requires the most easily exhaustible and metabolically expensive of mental resources: focused attention. As soon as we’re tired or distracted, willpower breaks down and habit or conditioned impulse predominates. As University of Southern California researcher Wendy Wood and her associates put it, when resources are limited, people are unable to deliberately choose or inhibit responses, and they become locked into repeating habits. Attempts at conscious control of habits are usually too little too late. Only after eating the whole cake will you remember, “Oh, I should have had a V8!” The V8 is stored as a higher-order judgment: “It’s good for you!” The cake is an autopilot, whereas the V8 is a manual override, requiring focused attention to prevail. In the long run, the autopilot, being virtually inexhaustible, wins the struggle more often. Similarly, the constraints that Patrick had learned in domestic violence class and the behavior-control skills I’d taught him were his manual override, with little effect on the habit of seeking the temporary empowerment of adrenalin, which came in the form of anger when he felt devalued by something Mattie had said or done.

What I hadn’t realized in my first round of therapy with Patrick was that while his states of failure and powerlessness may have had their origin in the ghosts of his past, they’d been evoked by thousands of less intense internal and environmental triggers over the years, each one strengthening the connection between the powerless states and the adrenalin-hunger for empowerment through anger and aggression. As long as Patrick maintained the habit of seeking the temporary empowerment of adrenalin when he felt shame, sadness, or any vulnerable feeling for any reason, he wouldn’t be a safe husband. The habit would continue to run on autopilot, independent of the original cause. To produce lasting change, his states of failure and powerlessness had to be associated with a prosocial habit of empowerment.

Patrick, Round II

In our second round of therapy, following Patrick’s release from jail, my treatment with him was organized by different principles. Patrick and I practiced associating states of vulnerability—feeling wronged, hurt, devalued, and powerless—with compassion for his wife when she too felt wronged, hurt, devalued, and powerless. The goal was to develop a habit of binocular vision: the ability to see both perspectives of an interaction simultaneously. At first, he objected to acknowledging that when Mattie was angry, she could be hurt and vulnerable. This called for a little psychoeducation about anger.

The primary condition for the activation of anger in mammals is a state of vulnerability with a perception of external threat. The more vulnerable we feel, the more threat we’ll perceive and the greater our anger—which is why wounded animals are so ferocious. Anger is the fire; hurt or vulnerability is the fuel. We had to practice conditioning, or associating, Patrick’s feeling wronged and hurt with compassion for Mattie’s feeling wronged and hurt. It was no longer Mattie “doing it to me.” Instead, it was “It’s happening to both of us, and I can help her.” Once conditioned, feeling wronged by Mattie would automatically stimulate compassion for her and inhibit abusive behavior. This would allow them to negotiate in safety about whatever had triggered their shared hurt and vulnerability. But to develop this habit, Patrick needed sustained practice, not just an occasional insight.
I concluded that to help Patrick change his rigid habit patterns, I needed to apply the following three fundamental neurological principles that guide learning.

1. Mental focus amplifies and magnifies whatever we’re thinking about, making it more important to us. As psychologist Silvan Tomkins put it, “With affect, the fuel of mental focus, anything is important; without affect, nothing is.” My initial efforts to help Patrick heal the pain of his childhood memories made those memories more important, rather than less influential, in the course of his life. Instead of outgrowing them, he was prone, in the stress of real-life interactions, to reactivate the habit of feeling victimized when Mattie would say or do something he didn’t like. I’d concentrated on the childhood roots of feeling powerless and inadequate, as if nothing else had or would ever make him feel like a powerless, inadequate victim. But as social psychologist Leonard Berkowitz first pointed out, negative emotional states themselves become conditioned to stimulate protective states of anger and aggression, regardless of what triggers them. Feeling sad because of gloomy weather made Patrick, like many of my clients, more prone to aggression, although he attributed his anger to something Mattie had done, not to his sadness, and certainly not to the weather. Over the years, his habit of responding aggressively to vulnerable states had garnered numerous reinforcements by different triggers in different contexts. The feelings simply had too many convoluted associations and triggers to make exploring them gainful. Whichever one we focused on during my initial work with him became more important because of the focus.

When I resumed work with Patrick, I focused not on how he felt, but on how he wanted to feel, how he wanted to think, what he wanted to do. This shift in focus moved him from trying to understand, explain, and justify feelings (which amplified and reinforced them) to changing them into what he wanted them to be; it amplified the desired emotional states, rather than the undesired ones. Patrick wanted to feel closer to Mattie, be more loving, and create a safe and happy household. This desire, reflecting his core values, ran deeper than the ego-defense that made him lash out when he felt disrespected. It’d become the new reference point of our therapeutic work, replacing ghosts of the past.

2. Neural connections forged by repeated focus grow physically larger and stronger, making them prone to automatic activation. This principle was first elucidated in Hebb’s famous law: “Neurons that fire together wire together.” In other words, anything we do repeatedly, we’ll eventually do on autopilot. I hadn’t accounted for this principle in my practice of Christmas Carol therapy. I’d asked my clients to keep journals to sort through their feelings, but although this sometimes gave them momentary relief, it reinforced their tendency to focus on pain, mistreatment, and diagnosis. In Patrick’s case, reviewing his feelings about his childhood abuse and relating them to present feelings had actually given him a sense of entitlement: because he’d endured so much, his wife owed him special consideration. She offended his sense of entitlement merely by having her own rights and desires. This unconscious cycle was the product of habituated associations of vulnerable states with expectations of special consideration. On the rare occasions when it became a thought process (she knows what I’ve been through, yet she . . .) Patrick could easily catch himself, but on the rapid processing level of habit activation, he had no verbal understanding and little chance for consciously overriding his hostility.

After Patrick’s stint in jail, I changed his journaling and feelings logs to go beyond mere validation, placing heavy emphasis on healing, repair, and growth. He couldn’t just describe what he felt: he had to practice binocular vision, the ability to see Mattie’s perspective alongside his. If Patrick wrote, “I felt rejected when she went on talking to her girlfriend on the phone when I came home,” he had to include her perspective: “She’d have felt rejected if I hadn’t understood that the conversation with her girlfriend was important to her.” In addition, he had to write a solution, such as “Next time I’ll blow her a kiss while she’s on the phone and hug her when she hangs up.” The formula is simple: validate the initial feeling, empower the growth in perspective that changes the feeling (without confusing the former with the latter), and practice behaviors that will build prosocial habits.

3. The brain can’t not do something—thinking about what you don’t want to do usually reinforces the impulse to do it. As the old behavioral adage states, “Where attention goes, behavior follows.” Besides the examples of forbidden fruit in the Garden of Eden and the failure of thousands of diets that focus on what you can’t eat, I have a favorite example that reflects this concept. It’s trivial, but it’s my favorite because it happened to me so often in Catholic school: the nuns would make me write a hundred or more times “I must not talk in class,” making it likelier that I would talk in class. After all, that form of punishment required two contrary prefrontal cortex operations: talking in class and not talking in class. Given the impulse to show off in front of peers—and the reinforcing attention of peers when I did so—you can probably guess which step was likely to drop out of my mental processing.

Patrick’s domestic-violence class had drilled into his head the behaviors he shouldn’t exhibit—hit, push, yell, threaten, verbally demean, attempt to control—while I’d failed to practice with him what he should exhibit instead. Now I focus almost exclusively on helping clients develop habits that are incompatible with what they don’t want. In other words, we can’t train clients not to be abusive, but we can train them to be compassionate, take the perspectives of their partners, sympathize with the distress of their loved ones, and invoke their deeper valuing and protective instincts. Once those actions become habits, the people holding them can’t
be abusive.

How Prosocial Learning Gets Subverted

Most parents, including Patrick’s, want their children to grow up to be good, kind, law-abiding, nonviolent people. In fact, most people want to be that way themselves. But from time to time, all of us become triggered by events or circumstances that at least temporarily disrupt our better qualities, and we become the angry, unpleasant, depressed, reactive people we don’t want to be. So what happens in the brain that scatters all our good intentions and well-meaning attempts to behave well?

Let’s say you’re living your life, minding your own business, so to speak, when something unpleasant or scary happens because of either an external cue from the environment or an internal cue from a random thought, image, or feeling. Then your partner snaps at you for not cleaning the lint filter in the dryer, or the driver in the next lane cuts in front of you, or any of a thousand different triggers happens. At this point, your brain immediately reacts with three distinct operations.

1. The primitive, limbic area of the brain generates an alarm: something bad is about to happen.

2. The prefrontal cortex interprets the alarm and assesses how bad the situation is, what it means, how it happened, how much damage has occurred, how much threat it represents.

3. A more advanced level of the prefrontal cortex begins acting to improve the situation: to neutralize the threat without doing further damage and repair any damage already done.

Patrick, like a lot of people stuck in a pattern of dysfunctional emotional habits, could never get beyond the first two operations to begin working on the third. He was caught in a self-reinforcing emotional loop between feeling bad as a result of some emotional trigger and negatively interpreting the trigger to justify his bad behavior—which then reinforced and amplified his bad feelings. His pattern went like this: alarm (I feel fear, anger, distress), assessment (I have every right to feel that way, given all the bad things that have happened to me), enhanced alarm (more anger, distress, fear).

In our initial work together, I thought that validating the intensity of Patrick’s states of vulnerability and relating them to the ghosts of his past would nullify the alarm that was blocking his brain’s move to the improve mode. Now I try to help clients merely acknowledge the alarm, without confusing it with reality. The alarm is not the fire! Then I help them assess the damage, and finally, we focus on improving. Clients rehearse the sequence repeatedly until it becomes a habit.

In Patrick’s case, he rehearsed: alarm (I feel ashamed and then resentful when my wife complains), assessment (I’ve lost no self-value from my wife’s complaint, and the shame I feel is a motivation to pay more attention to her, not a punishment for failure), and improvement (I’ll pay attention to her complaint and try to help or support her if I can).

The Power of Practice

Compared to the drama of Christmas Carol therapy, developing habits is repetitious and sometimes tedious. Thus, because of its assembly-line-like quality, I call it blue-collar therapy. The blue-collar therapy mantra is “To get big change, think small.” It has an equivalent in physical therapy and in the muscle memory that athletes strive to develop. Professional basketball players shoot hundreds of foul shots in practice sessions. Three-point shooters take so many practice shots per day that they never have to look for the three-point line in a game—they know in their bodies where it is. Essentially, daily practice of particular and discrete skills for incremental change will eventually lead to larger changes.

Blue-collar therapy requires high motivation on the part of the client to make the effort necessary to develop new habits. Of course, insight about the past can provide useful motivation to be a better partner and parent, but because I work exclusively with clients trapped in destructive habits, I prefer the shorter route of using their core values to motivate practice that will bring about long-term change. This is a necessary approach with most of my clients, whose anger and behavior problems stem from their habit of substituting power for value—perhaps the easiest and most destructive habit we can acquire.

Human beings are prone to learn early in life to associate vulnerability with powerlessness and to associate the adrenalin rush of anger with personal power. The problem is that states of vulnerability are more often triggered by the diminishment of self-value rather than by the loss of power. When people feel devalued, they try to feel superior by exerting power over others overtly through aggression or by mentally devaluing them. Naturally, this tendency backfires: most of the emotional distress that clients suffer—indeed, much of the psychological dysfunction in the world in general—comes from substituting power for value. Temporarily feeling more powerful by driving aggressively or shouting at your spouse is unlikely to make you feel more valuable. In fact, it usually does the opposite. It subverts the motivational function of devalued states, which is to get us to enhance the value of our experience. Substituting power for value is like eating when your body tells you to urinate, sleeping when it tells you to eat, or taking an amphetamine when it tells you to sleep.

Intimate partners motivated to feel valuable tend to show compassion and kindness. Those moved to feel powerful invoke shame or fear to get their way, or use force or coercion to dominate. In our first course of therapy, I hadn’t trained Patrick to do something that, when he felt devalued, would make him feel more valuable. By default, this left intact his habit of exerting power to escape the abyss of vulnerability he felt. The manual override—insight about how and why he felt vulnerable—was an unreliable regulator of this dangerous and entirely automatic habit.

Conditioning Core Value

The goal of blue-collar therapy is to develop the habit of moving beyond the feedback loop of alarm-
assessment-enhanced alarm to the more empowered improve mode of mental processing. The optimal conditioned response is an association of states of vulnerability-threat-injury with motivation to improve-repair-heal, so that occurrence of the former stimulates the latter. Rather than immediately moving from feeling threatened-exposed-weak to feeling angry-defensive-aggressive, the goal is to move from the former to a desire to soften, connect, and feel better.

Step one of blue-collar therapy invokes the high degree of motivation required to practice the behaviors that, with repetition, we want to become habits. Therefore, I first worked with Patrick to heighten his sense of commitment to becoming the person, partner, and parent he most wanted to be. We started the process by using the following questionnaire.

1. What are the three most important qualities about you as a person? (Patrick wrote: “passionate, loyal, hard worker.”)

2. What are the three most important assets your partner brings to your relationship? (Patrick: “sensitive to others, generous, cheerful.”)

3. What are the three most important qualities about you as a husband and father? (Patrick: “affectionate, loving, protective.”)

4. List three ways you’d like to improve as a husband and parent. (Patrick: “more respectful, engaged, and focused on the good moments.”)

5. List the five things you most appreciate about your marriage. (Patrick: “companionship, fun, sensuality, security, vitality.”)

6. Write a brief narrative about yourself, using the 17 items you described above. (Patrick: “My relationship brings me fun, sensuality, vitality, security, and companionship. My partner is sensitive, generous, and cheerful. I’m passionate about doing whatever hard work it takes to be more loving, respectful, loyal, engaged, protective, and appreciative of the good moments.”)

The next step of blue-collar therapy is identifying a repertoire of thoughts and behaviors that make the client feel more valuable. These will be practiced in association with the client’s recall of vulnerable states, with the goal of building new prosocial habits. I begin by asking about times in the past when the client felt more valuable. To help him or her recall these times, I give hints about four general categories that encompass value-enhancing behaviors:

• Improvement (when you’ve tried to make a situation a little better)

• Appreciation (when you’ve opened your heart to be enhanced by the qualities of someone or something else)

•Connection (when you’ve felt attuned to your partner’s positive emotional experience or felt compassion for his or her negative feelings)

•Protection (when you’ve looked out for the emotional well-being of someone else).

In this step, Patrick said he could improve situations when he listened to Mattie, but I had to point out that it was what he’d do differently that would actually make him feel more valuable. When he provided more information to Mattie instead of trying to refute her, for instance, she felt more valued and he felt more valuable. The corrective behavior he then identified was listening without contradicting—which he agreed to practice doing, especially when he felt devalued.

Patrick could vividly recall instances when he’d appreciated Mattie—like the time she stayed up with him all night when he was wrenched with intestinal flu—but he could recall only one example of connecting with her deeper vulnerability when she’d been angry, and that was a time when she’d been angry at her mother, not him. He had a lot of guilt, which led him to focus on how badly he felt when he mistreated Mattie, but he lacked compassion, a quality which would allow him to focus on how badly she felt and what he could do to help. After all, Mattie was just as hurt when angry at him as she was when angry at her mother. I pointed out to him that he seemed to feel more valuable when he regulated his guilt by focusing on compassion for what had hurt Mattie, and asked if he preferred that to being angry at her. Of course, he preferred the more valuing emotional state, so he vowed to practice regulating his guilt by focusing on sympathy for Mattie and offering to help her when she was angry at him.

Patrick easily recalled a time when he’d felt protective of Mattie. A man in the grocery store had called her a “bitch” when she’d inadvertently cut in front of him in line. The man instantly apologized when he saw Patrick, who was much bigger. With encouragement, Patrick recognized not only the fear and shame Mattie must have experienced when the man had shouted at her, but also how much more fear and shame she must have felt when her own husband shouted at her and called her names. He vowed to practice protecting Mattie’s well-being, even when he felt devalued.

Blue-collar therapy strives to develop habits of choosing value over power through a process I call TIP.

Think repeatedly about the desired change, and if you journal, write about it. For example, “When she says I’m selfish, I’ll allow myself to care that she’s hurt and show her that I care.”

Imagine in detail how to overcome any barriers (usually guilt, shame, anxiety) to the desired change. For example, “I feel guilty about having been selfish in the past, but caring about Mattie and feeling connected to her is more important, so I’ll try to focus on what’s most important to me.”

Practice in simulated stress and in real life the specific behaviors likely to lead to the desired change.

In Patrick’s case, practicing in simulated stress meant that Mattie would deliberately provoke him with comments and behaviors that in the past had led to angry outbursts. For example, she’d voice her intention to buy something she wanted, and when he’d object, she’d point out that he was stingy just like his father. (Note that the practice incidents should be varied to achieve a generalized effect rather than just desensitization to one or two provocations.)

My experience of working with clients who habitually tend to increase their power when they feel devalued is that it takes about 12 repetitions per day of associating behaviors that increase value with feelings of diminished value, and it takes about six weeks of practice to form the new habit. Thus, each day while Patrick was at work, I had Mattie text provocative remarks with which he could associate behaviors that made him feel more valuable. For instance, in response to the previous example, he’d write, “Honey, you absolutely deserve everything you want to buy. I know I’ve had a money problem in the past, but money is just numbers, so let’s sit down together and count the numbers coming in and going out and decide together on a budget.” After each practice session, he had to make a mental note of how much more valuable the new behavior was making him feel compared to the old response of anger or aggression.

The frequent practice required of habit-building is likelier to be accomplished if done in a regimen at the same time every day. I urge clients to choose transitional times to practice the new thoughts and behaviors, because what we experience during transitional times—when we stop doing one thing and start doing another—tends to have more carryover effect. Each practice session should be about one minute, three at the most. Using traditional work days as a model, I urge clients to practice first thing in the morning, before they leave the house, before they go into work, at morning break time, at lunch time, at afternoon break time, before they leave work, before they go into the house, before dinner, after dinner, while preparing for bed, and once in bed.

Higher-order prefrontal cortex operations trouble us with thoughts about the meaning of our lives, but lower-order habits create meaning by default. Many studies show that people cite close relationships with family and friends as integral to the meaning of their lives, yet those in the habit of feeling devalued and responding with verbal aggression when they see a bath towel on the floor, for example, will devalue their loved ones who forgot to hang it up and risk damaging their most important relationships with accumulated resentment. To control the meaning of our lives, we have to train ourselves in new habits that make life better, not only for ourselves, but for those around us. Instead of automatically, habitually reacting to irritations and unpleasantness with resentment, self-pity, or aggression, we can train ourselves to respond in ways that will increase a state of genuine self-value while making other people feel valuable. In fact, this might be considered just a westernized learning-theory version of metta meditation, the ancient Buddhist practice of making oneself happier by wishing love, kindness, and happiness for others.

Education theorists consider novelty a primary motivator to learn. The joy of learning is apparent in infants and young children, to whom everything is novel, but even with advancing age, humans feel more alive when learning. Fortunately, as adults, we can invent our own novelty, and the most effective way to do that is by continually developing new habits and skills, while sharpening whatever old ones we deem beneficial. These new habits and skills can be applied to ventures in athletics, scholarship, arts, or psychotherapy. Learning sometimes means rejecting the familiar, but more often it requires going beyond it. Learning to make big therapeutic changes that will endure over time means going beyond the Christmas Carol model of practice and focusing instead on our smaller habits. In the long run, exorcising ghosts and experiencing catharsis didn’t change Patrick: it was the daily practice of behavior rooted in his deepest values that turned him into the loving and compassionate husband and father that he became.


Photo © Ocean / Corbis

Steven Stosny

Steven Stosny, Ph.D. is a well-known therapist and author of many books and articles. He’s appeared on all the major networks and national radio shows, most of the major newspapers and magazines. He has taught at the University of Maryland. His blog on has more than 21 million views.