What is the real problem?
When a client comes in to see a therapist, they have usually identified their primary problem as they see it. Often their entire life view is centered around the presenting problem, and they have developed a well thought out and planned outcome when the issue is resolved. Often they view the presenting problem as their only problem, and when this problem is solved, everything will be great.
However, life is not just one problem. Life has many challenges, but one issue can get all the blame. When this happens, individuals often become hyper-focused on one issue and ignore what may be the actual issues. When a client presents with just one issue, I often ask, “what problem will you have when this problem goes away?” I get puzzled looks and responses like “I won't have any problems,” or, “my life will be pretty much perfect.” When you get a response like this, the client is typically dealing with a more significant underlying issue.
Let me share a case of “Megan” who was plagued with weight gain from overeating during the past several months. A physician who suspected that her overeating was stress-related referred her. After working with Megan for a while, I asked the “what problem will you have” question. Megan first said, “nothing, life will be good.”
The conversation lead to Megan telling me about her boyfriend, who she liked a "just ok" amount but was not in love with him.
Megan then told me about another man in her life, her father. She said that he was a good guy; however, he was opposed to Megan going to nursing school, which was causing tension in their relationship.
Megan saw that her unwillingness to resolve both of these frustrating problems could be related to her overeating. Eating comfort foods to soothe the stress of her relationships was easier than facing life without a boyfriend or risking her relationship with her father.
By redirecting her focus from the symptom of the problem (her overeating) to the issues that were the source of her problem (difficulties with her boyfriend and father), she was able to address both problems.
She is now thriving without the boyfriend. A careful talk with her father resulted in identifying that her father’s opposition was to save Megan from the pressures of nursing school and a nursing career. He realized that it was Megan’s desire to try and to find out if she could handle the pressure. He understood Megan’s carefully worded thought that it is better to try and fail than not to try.
Megan’s overeating ceased and she lost the weight that she had gained. She did identify another arising problem—the rigors of nursing school. Those problems she welcomed.