A Guide to Personal Change

how we heal and grow

Dear Readers, my new book, How We Heal and Grow: The Power of Facing Your Feelings is available now on Amazon. With it, I’m introducing a new way of making sense of why change is difficult and how to make it easier. It applies to all kinds of emotional problems from minor quirks to major personality issues. Instead of going further with a description, I’ll just give you the book’s Introduction. In addition, I’ll reproduce the first chapter at the end of the introduction.

HGCover1600In case you are wondering about the cover image, it refers to a story at the beginning of chapter 1. I think you will enjoy it so please read on…

INTRODUCTION (Excerpted from the book)

Why change is not easy, but less hard than one might think.

Why do self-help readers often end up with a collection of books and new knowledge but not much change in their lives? The answer is that when we try to make changes in our dysfunctional ways we find ourselves pitted against a formidable adversary, our own mind. Evolved over millions of years, our mind uses many tricks to protect us from the pain it associates with change. The aim of this book is to tip the balance in your favor.

Armed with the understanding and approaches outlined here, you will be able to follow the action in your own mind and your own life. You will be able to push harder in ways you need to and understand why and how your mind resists. Even more important, as you encounter the feelings you have avoided, an amazing phenomenon I will call catharsis will detoxify those feelings. It will take away their power to stop you and will give you strength to keep your change process moving ahead.

This book is a product of my passion for precise understanding. Maybe another way to describe my quest is that I am even more interested in what I don’t know than what I do. One of my early memories is watching a neighbor riding her tricycle on the sidewalk very fast. I must have been about three because I couldn’t yet do that. I was amazed by her speed, but what really caught my attention was wanting to know whether the pedals were going straight up and down as it appeared or around in circles as they normally should.

When I was about eight, my father traveled to New York and brought me back a crystal radio kit. How could the music and voices of radio come out of a wire touching a small stone connected to a long antenna wire? I couldn’t resist my curiosity and soon began to read books on electronics and build measurement instruments from Heathkits. By the end of high school, I found there were many more subjects just as complex and fascinating. When I started college at Stanford, I took liberal arts courses aiming towards an English major and expected to dig into the depths of literature.

It took me until the spring of my freshman year to realize that I was much too restless to bury myself in the fine points of obscure works. I needed to be part of the “real world” and interact with people. I had read Catcher in the Rye and discussed psychology in my family so when, for no fathomable reason, I found myself waiting till the last minute to do my work, I saw a psychiatrist. With these experiences, the idea of a career as a therapist was not so foreign, but what really made me want to change my major was a transforming moment in my own life.

I had to write a paper on Dostoyevsky’s Crime and Punishment. I really liked the book and had written a paper on it in high school. My brain refused to come up with an idea. It was 11 p.m. on the night before the twelve-page paper was due. I began to panic. My world was about to come crashing down around me. It felt like an unthinkable, unspeakable disaster. Then, from nowhere, I suddenly felt a wave of serenity. With it came the thought that, even without the paper, in the morning I would wake up and have breakfast. I would still be myself and alive. There would be a mess to clean up, but somehow, even if I flunked out of college I would manage. As I calmed down, an idea came and I wrote the paper.

I had experienced change. It came in a moment and left me feeling like a different person. The experience energized my desire to learn more about how change happens and to help others as well. With my interest in science and desire to get in close, going to medical school and then psychiatry was the clear choice. Even with the practice of therapy as a goal, I wanted to understand the details of anatomy, physiology, and everything about being human. I wanted to participate in people’s lives and understand them so I could help them flourish and find their own unique fulfillment. This passion has continued unabated to the present.

You will notice that I am using the word mind instead of brain. In this age of technology and science, many self-help books are saying that a better understanding of the brain is the key to change. This isn’t wrong, but the study of the brain does not include its contents. It doesn’t take into account the specific experiences that have shaped our feelings, behavior patterns, aspirations, and values. Mind covers how our thoughts and feelings are organized, how they interact, and how they grow out of our personal history. Some of what we can learn about the mind comes from understanding how it affects the brain and vice versa, but more of it is about how individual experiences shape and influence us. This book will focus on the mind. At times we will look at the brain but when we do, it will be in order to better understand the individual mind.

Why is it so important to understand the mind and its unique contents? This brings me closer to the core of our subject and why it is such a privilege to be a therapist. In every other domain of medicine, treatment choices are determined by placing the patient in a category. A cough might be categorized as pneumonia, and that fact, far more than the individual patient, determines treatment. Other factors like the strain of bacteria or general state of health might play into the choice of which antibiotic, but the patient’s individual story is peripheral.

Healing the mind is different. Catharsis, the amazing process mentioned above, happens when we share our humanness with another human and are understood—not categorized but understood. Carl Rogers coined the term accurate empathy. That is the essential element in the personal connection that allows healing of the mind. Helping catharsis happen—that is, understanding people in their own unique context—is not only central to the processes of healing and growth but also a great privilege for the therapist.

Teaching was in my blood. With a grandfather who was a missionary and a father who taught at Stanford, after residency it was natural for me to teach and natural to teach the subject of my greatest interest, psychotherapy. Teaching pushed me further to formulate what I was learning in the clearest, most accessible terms possible. The precursor of this book was the handout I developed for my course on psychotherapy for psychiatrists in training.

Perhaps it sounds odd that I refer to “what I was learning.” One might think the eight years I spent learning medicine and then psychiatry would have taught me the bulk of what I needed for a career as a therapist. I had devoured what was taught in residency, but therapy is taught mostly as a series of procedures and rules to follow. Concepts help give a rationale to what therapists do but don’t really get to the bottom of what is happening. Traditional therapists learn to “make interpretations” based on ideas such as “making the unconscious conscious.” Behaviorally oriented therapists learn that erroneous ideas lead to uncomfortable feelings and that helping people correct their thoughts can change their feelings. Neither approach goes far enough to capture the full reality of how therapy works. If becoming more conscious or thinking more rational thoughts is helpful, how exactly does that work and why, then, does lasting change remain so difficult?

In residency at Albert Einstein College of Medicine I was exposed to the study of child development and attachment. Close observation of two-year-olds and their mothers under Eleanor Galenson and Herman Roiphe seemed to point towards the bedrock from which true understanding could come. From that time on, childhood experience, as best we can understand it, has become for me the touchstone of understanding.

After residency, my career soon brought me into territory where my training was of little use. First I was confronted with the emotional consequences of early life sexual trauma. Since the thirties, trauma in general had been relegated to the back wards of veterans hospitals. The field was still in denial about childhood sexual abuse, and what little I had learned was not of much help with my patients. I began to look further afield.

Not too long after that I took a job as director of alcoholism services. My new boss sent me for training at the Smithers Institute, where physicians were taught by members of Alcoholics Anonymous. Recovery appeared to represent a different kind of change. I realized then how little attention my training had paid to problems of action or behavior. I would have to seek understanding from a much broader range of sources.

My own process in coming to the understanding presented here was somewhat of a surprise. During forty years of interest and practice I assumed that someday I would be able to assemble a full picture of how problems develop and can be resolved. As I taught my students, I found myself groping for a new way to conceptualize the work of therapy. I wanted to understand the basic change processes that were taking place and how to encourage or foster them directly, rather than following a procedure and waiting for results to appear. Recognizing that people change in important ways on their own as well as in therapy, and that different schools of therapy seem to accomplish the same results, I believed there must be universal pathways to change. The surprise was that only with the writing of this book did the final pieces come into focus.

Making sense of how people change has been something like what I imagine to have been the experience of trappers of the early American West. At first, they probably observed many things in the woods around them and learned from Indians. Only gradually did they come to see more and to understand cause and effect. With time, their understanding could be put into words and concepts to share with others.

Working with the mind is at least as challenging as the wilderness. There are different parts of the mind and different ways they interact, but the partitions and pathways are not visible. They only become apparent as minds interact with one another. Therapy provides an excellent laboratory in which to observe these interactions, but even there, cause and effect are not obvious. In actual practice, important things happen without our being able to say quite why.

One basic reason is that much of the operation of the mind is beyond the reach of consciousness, allowing only educated guesses about just what is going on. In addition, emotional reactions are inherently nonverbal. Only when we happen to notice them can we try to describe them in words. Much of our internal life goes by as background music outside of our explicit conscious attention and out of reach of language. So it should not be a surprise that really understanding even those limited parts of the mind that relate to our irrational and dysfunctional patterns turns out to be seriously challenging work.

I have borrowed wisdom from many traditions as well as used my own experience. Sifting through concepts from different sources I wanted to pull together the ones that had power and simplicity and could fit together into a cohesive whole. When an idea was awkward or failed to pass the test of time, I would look for a better one. What is presented here has been honed and tested against the best standard I know—Einstein’s dictum to “make everything as simple as possible, but not simpler.”

The starting point for what I have learned is that childhood is when we first begin to avoid painful feelings. Adult dysfunction most often reflects the style and level of sophistication of the person who first made use of a given pattern. Some patterns are reminiscent of very small children with their simple ways, while others represent the problem-solving skills of a more advanced stage of development. The more specific and accurate our understanding, the better we can relate to the child who first got stuck. Even coping with stresses and trauma that happen in adulthood can be seen as building upon layers of experience and learning from earlier phases of development, each layer built on what was before.

To me the idea of an inner child is far more than a gimmick. One of the very best ways to look at our own change process is as a dialog between a child who is afraid of change and the adult who knows change is not so dangerous and will lead to greater happiness. Just as an understanding of children’s development helps us guide our own children when they are in unfamiliar and scary situations, our understanding as adults of our inner child’s world helps us take a compassionate yet firm approach to our own life learning.

As you are beginning to glean, the thesis of this book is that emotional and psychological problems, at least those that are not primarily biological, are the result of instinctive childhood needs to avoid feelings that were once too painful or uncomfortable to face. Patterns that were first developed to protect us from such daunting emotions have become embedded in our personality and functioning. Much later, when their origins are no longer obvious, these patterns continue to operate in ways that constrict and limit our lives. When we try to change, our minds are ready with powerful and subtle layers of resistance to thwart our efforts. As we overcome each layer of protection and face each layer of feeling, healing by catharsis will allow us to go on to the next layer—until we are no longer afraid.

The aim of this book is to share with you an understanding that is broad enough to cover the range of emotional and psychological problems that cause our human dysfunctions but specific and precise enough to apply to your own unique situation. Once again, it is my sincere hope that what is presented here will truly be “as simple as possible but not simpler.”

 –See cover, contents, foreword, and all of Chapter 1–


  • I’m looking forward to reading your book.

    This post and the first chapter read well.

    It must be exciting for you to get your book published!

  • I look forward to reading your new book.

    This post and the first chapter read well. Thanks for putting them here.

    It must be exciting to get your book published!!

  • Dear Jeffery, I can feel your sincerity through your writing, and I am looking forward to read your book, thanks for your work!

  • Congratulations on an amazing book! I’ve just put up a review of the book on my blog and am planning on recommending it to anyone who will listen (I must confess I have bought an extra three copies for gifts). I truly hope this is a smashing success as I think so many people would benefit from reading it.

  • Sounds great. I’m currently going through therapy. It can be a very uncertain, even confusing, process. This book sounds like it will help.

  • Speaking as someone who is currently at the mid point of the ‘bridge’ I just burst into tears when I read that allegory. Beautifully described and gives hope in itself to someone like myself, that the pain is worth it. Excellent, will be purchasing!

  • Just put in my order at Amazon. I know what I’ll be doing this weekend.

    Have been following your blog along w/AG’s and CM’s. They and you have helped me beyond words to understand the therapeutic process. Went in for work issues and a year later dealing w/all you speak about. The cathartic experience is not an easy one, but I am encouraged by all of you to continue through it because there is no way around it. Thank you!

  • Dear Dr Smith,
    In your book in chapter 3 under a section headed “Trauma therapy and feeling alone” you say the physical presence of empathic other is necessary for catharsis and healing to take place. Does that mean therapy via video call is not effective? Because of the pandemic I have not physically met my therapist for 9 months now. I know I desperately want to be on the same physical space as her.

    • Good point, David. The post was written pre-Covid-19. What I’ve found as I work remotely, is that the human drive to connect is powerful enough to travel through wires and space, and even via the disembodied voice. I would like to amend my statement to say that “the experienced presence of an empathic other” is necessary. Actually recent neurophysiology is elucidating the healing process in new detail, but the essence remains that the antidote to aloneness is empathic connection. JS

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