The therapist’s first step in helping the patient take responsibility is not to apply one technique or another, but to establish their own position on which to base their subsequent choice of techniques. The therapist should always act based on the thesis that the patient has created his own problems. Not by chance, not because of an evil fate, and not because of genes, the patient is lonely and isolated, suffers from insomnia, and is constantly mistreated. The therapist must identify the role of this particular patient in his own dilemma and find ways to convey this knowledge to the patient. Until a person realizes that he has created his own dysphoria, there is no motivation to change. As long as we continue to believe that the cause of our unhappiness is others, or bad luck, or an unsatisfactory job–in short, something outside of us– why should we invest energy in personal change? With such a conviction, the strategy of action, obviously, should not be therapeutic, but “activist” – aimed at changing one’s own environment. The willingness to accept responsibility varies greatly from patient to patient. For some patients, this is extremely difficult and forms the main burden of the therapeutic task: after they accept responsibility, therapeutic change occurs almost automatically and without further effort. Others recognize their responsibility more quickly, but get stuck, and more than once, at other stages of therapy. Usually, the consciousness of responsibility does not grow evenly as a single front: a person can accept it in some matters and deny it in others. Self-awareness and tagging First of all, the therapist must pay attention to the topic, identify situations and methods of avoiding responsibility and convey this knowledge to the patient. Depending on the preferred style, therapists use a wide range of techniques that focus the patient’s attention on responsibility. The therapist responding to the patient’s justification of her behavior (“It wasn’t intentional. I did it unconsciously”) by asking “Whose unconscious is this?”, pushes her to realize responsibility. Just like a therapist who suggests that a patient “appropriate” what happens to him (not “he’s bothering me”, but “I let him bother me”). The “non-powerful” bell, which calls on the band members to change “I can’t” to “I won’t”, is a technique that should help to awaken responsibility. As long as a person believes in “I can’t”, he is not aware of his active contribution to his own situation. A patient who has been instructed to say, “I won’t change, Mom, until your treatment of me changes when I was ten years old!” is essentially being asked to think about her refusal (rather than inability) to change. Moreover, she is presented with the absurdity of her situation, as well as her tragic and fruitless sacrifice of her life on the altar of vindictiveness. Vera Gatch and Maurice Temerlin studied audio recordings of psychotherapy sessions and compiled a collection of confrontational (sometimes without sufficient sensitivity) interventions aimed at increasing awareness of responsibility.: “When one man complained bitterly and passively that his wife refused to have sexual contact with him, the therapist clarified the hidden choice by remarking: ‘You have to like this about her, you’ve been married for so long.’ The housewife complained: “I can’t handle my child; all he does is sit and watch TV all day.” The therapist made the hidden choice explicit with the following remark: “And you are too small and helpless to turn off the TV.” An impulsive, obsessive man shouted: “Stop me, I’m afraid I’m going to commit suicide!” The therapist said: “Should I stop you? If you really want to commit suicide, really die, no one can stop you except yourself.” One therapist, in a conversation with a man of a passive, oral-addicted disposition, who believed that life was not pleasant to him because he was suffering from the unrequited love of an older woman, began to sing: “Poor little lamb who got lost.” The general principle is obvious: in response to the patient’s complaints about his life situation, the therapist asks how the patient created this situation. It is often helpful for the therapist to keep the patient’s initial complaints in mind and, at appropriate times in therapy, relate them to the patient’s positions and behavior in therapy. Let’s say, for example, that a patient has sought therapy in connection with feelings of isolation and loneliness. During therapy, he discussed his sense of superiority, his contempt and disregard for others. His resistance to changing these positions was great – they are egotistical and stubbornly defended. The therapist helped the patient understand his responsibility for his own unpleasant situation – whenever the patient spoke about his contempt for others, commenting: “And you’re lonely.” A patient who resents the limitations present in his life needs to be helped to understand what contribution he himself has made to this situation, for example, by choosing to stay married, having two jobs, keeping three dogs, getting an English garden, etc. Usually, life becomes so structured that we begin to take it for granted, as a kind of solid habitation in which we must exist, and not as a web woven by ourselves, which can be re-woven in many ways. I am convinced that this is why Otto Will asked his shackled, obsessive–compulsive patient: “Why don’t you change your name and move to California?” He vigorously confronted the patient with his freedom, with the fact that he is really free to change the structure of his life – to constitute it in a completely different way. Of course, there is a ready-made objection to this: “There are many things that cannot be changed!” A person must earn a living, must be a father or mother to his children, must fulfill his moral obligations. He must put up with his limitations: a paraplegic cannot walk, a low-income person cannot retire, an aging widow has little chance of getting married, etc. This argument, a fundamental objection to the thesis of human freedom, appears at any stage of therapy and is so important that I will discuss it in detail below. Although these techniques of labeling and emphasizing responsibility have their place in therapy, their effectiveness is limited. “Dumb” bells and slogans like “Take responsibility for your life” or “Give your feelings” often stop attention, but for most patients, appeals alone are not enough, and the therapist needs to use deeper action methods. The most powerful methods known in therapy include analyzing the client’s current (“here-and-now”) behavior in therapy, demonstrating that under therapeutic conditions the client microcosmically recreates the same situation he is dealing with in life. Source: Irwin Yalom “Existential Psychotherapy”.