1/18/09: Boiling everything else away, there are four basic questions that we need to answer to move ourselves from a position of distress into strength and health. They generally look something like this:

1. What is happening?
2. Why is it happening?
3. What do I do about it?
4. How do I do it?

Depending on how much work has already been done, people can come to therapy with varying levels of answers. I have a lot of clients that see me after several courses of therapy with other providers where they get the first three answered very well, but the therapy stalls on the fourth, and they are hoping I can help.

Consider someone who may experience a moderate level of depression coming to counseling. After a couple weeks he hears: 1) you are experiencing a depressive episode, 2) a combination of a biological vulnerability and the current major losses in your life, 3) become more active, change your thought processes, create meaning out of the losses. However, the fourth is often unexamined.

The reasons the fourth question is so hard is because it takes creativity and courage to get right. There are unique factors in every type of happening, and at the end of the process we still have to enact the plan. When therapy can take all of the insight and planning of the first three questions and then get the fourth right, it becomes truly transformative.

We can also make mistakes if we skip any of the questions and move right into action. People who are less interested in understanding their feelings, the history of the situation, and how it fits into the larger context of their lives, may try to rush through something uncomfortable. The good news is that occasionally this can really work, but the danger is that without answering question 2, we are more likely to find ourselves in the same uncomfortable position in the future.

If you are in therapy and feeling stuck, write out your four questions for each issue you are working on and see how much you can answer so far. If you are struggling on the “how” question, really try and focus in on that with your therapist, and try to access your creativity and courage together. The result could be the breakthrough you are waiting for.