It's possible to have a good understanding of yourself and still struggle with the same problems. Some people know why they tend to avoid conflict or why criticism affects them so strongly, and perhaps can even trace those reactions back to earlier experiences.
But that understanding doesn't always help much in the moment. Their manager asks them to take on extra work and they say yes, even though they don't want to. Maybe their partner seems distant one evening and they find themselves worrying that something is wrong.
They might only recognise the pattern afterwards, or sometimes notice it while it's happening. Either way, knowing what's happening doesn't necessarily make it easier to respond differently.
Understanding a pattern is important, but it isn't always enough
Developing insight into our experiences is an important part of psychotherapy.
Exploring earlier relationships and experiences can help us make sense of why certain situations cause anxiety, why we struggle to express anger, or why we find ourselves repeating similar patterns in relationships.
Research supports the value of insight in psychotherapy. A 2018 meta-analysis published in the American Journal of Psychiatry found a moderate association between patients' insight and better therapy outcomes.
However, insight is only one of several processes that may contribute to therapeutic change.
A 2024 systematic review and meta-analysis, examining 121 studies, also found associations between psychotherapy outcomes and emotional processes, including emotional experiencing and emotion regulation.
These findings suggest that change can involve more than developing a clearer understanding of ourselves. Working with difficult feelings and learning to respond differently may also be important.
Consider someone who has spent years reflecting on why they fear rejection or struggle to express their needs. They understand where these difficulties may have come from and recognise the pattern when it happens.
But when they disagree with someone, they still experience the same anxiety. They might know that expressing a different opinion doesn't necessarily lead to rejection, yet find it difficult to speak up.
In therapy, it may be helpful to explore what happens when that fear arises, what makes it difficult to express disagreement, and whether they can gradually begin responding differently, even while some of the anxiety is still there.
Why familiar emotional responses can be difficult to change
Many of our responses develop through experience.
As we grow up and move through relationships, we learn what tends to happen when we express particular feelings, communicate our needs, disagree with someone or depend on another person.
Research suggests that early relationships can influence how we experience relationships later in life. A 2007 longitudinal study followed participants from infancy into adulthood and found that early attachment experiences, childhood social competence and adolescent friendships were associated with how people experienced emotions in their adult romantic relationships, including during conflict.
These early experiences don't determine how we respond as adults, but they can contribute to expectations about other people and ways of responding that become familiar over time.
For example, someone who experienced frequent criticism or conflict when expressing disagreement may have learned that keeping quiet was the safest option.
Over time, they may become particularly sensitive to signs of disapproval. They might quickly notice changes in someone's tone of voice, feel anxious when another person seems unhappy, or automatically agree with things to avoid conflict.
These responses may once have helped them manage difficult circumstances. But the circumstances can change while the familiar response continues.
As an adult, the same person may be in a relationship where expressing disagreement is possible. Intellectually, they might recognise that their partner is unlikely to reject them for having a different opinion.
Yet when disagreement arises, they still find themselves becoming tense, losing their words or trying to smooth things over.
Research on habitual behaviour shows that repeated responses can become increasingly automatic, particularly in familiar situations. Although emotional and relational patterns are more complex than everyday habits, this helps explain why knowing what we would prefer to do doesn't always translate into doing it.
Importantly, not every recurring pattern originates in childhood or trauma. Current stress, ongoing relationship difficulties, learned expectations and repeated ways of coping can also shape how we respond.
Understanding where a pattern developed may provide useful context. But it doesn't necessarily change what happens when that pattern is activated.
How can these patterns begin to change?
Different approaches to psychotherapy work with these difficulties in different ways. In my own practice, I'm interested in how understanding our patterns can be brought together with exploring the emotional experiences that accompany them, including those we may not yet be fully aware of.
Understanding our defensive responses
Someone might recognise that they become defensive when they feel criticised, but have difficulty understanding why the reaction is so strong.
In therapy, we might return to a recent example and explore what happened. Perhaps the criticism brought up feelings of shame, a fear of being judged, or an expectation that the other person wouldn't understand their perspective.
Becoming defensive may help protect them from these feelings. Similarly, withdrawing during conflict or agreeing with others to avoid disagreement can be ways of managing emotions that feel difficult or threatening.
Understanding what these responses do for us can be helpful. Rather than simply trying to stop them, we can begin to understand why they developed and what makes them difficult to change.
Slowing down automatic responses
Many of these reactions happen quickly, sometimes before we've had much opportunity to recognise what we're feeling.
In therapy, we can take time to explore these moments more closely.
Someone who struggles to say no might recognise that they become anxious when asked to take on additional work. They anticipate the other person's disappointment, feel an urge to avoid the discomfort, and agree before they've had much opportunity to consider what they want.
Agreeing may provide some immediate relief, even though they later feel frustrated or resentful. Exploring this sequence can help them understand what they're afraid might happen if they respond differently, and whether those expectations relate to their current circumstances or earlier experiences.
Sometimes, though, the feelings involved in these responses aren't immediately clear.
Someone might initially describe feeling angry when their partner becomes distant. As we explore these experiences over time, they may begin to recognise other feelings alongside the anger, perhaps a fear of being abandoned or a sadness they haven't previously been able to acknowledge.
These feelings aren't always available to conscious awareness at the beginning of therapy. Some may have been avoided for a long time, while others may be difficult to recognise or put into words.
As therapy progresses, people can sometimes begin to experience feelings they previously had little awareness of, or had difficulty allowing themselves to feel.
This doesn't necessarily happen through deliberately searching for hidden emotions. Feelings may become clearer through reflecting on particular experiences, noticing emotional and physical responses, or exploring what happens in the relationship with the therapist.
Exploring patterns within the therapeutic relationship
The relationship between the client and therapist can be an important part of this work.
Some of the difficulties people experience in their everyday relationships may also arise during therapy.
For example, someone who finds disagreement difficult might notice themselves agreeing with their therapist, even when something doesn't feel quite right.
Exploring this together may help them understand what makes disagreement uncomfortable. They might worry about disappointing the therapist, being misunderstood or having their feelings dismissed.
At times, the experience may bring up emotions that hadn't previously been apparent to them. They may become aware of fear, anger or sadness that they have struggled to recognise or express in other relationships.
Being able to discuss these experiences openly, and having their perspective taken seriously, may offer an opportunity to relate differently. Sometimes the therapist may have misunderstood something, and acknowledging and working through that can also be important.
Research consistently finds that the quality of the therapeutic relationship is associated with psychotherapy outcomes. A 2018 meta-analysis involving more than 30,000 clients found a significant association between therapeutic alliance and treatment outcomes. Another 2018 meta-analysis found that successfully working through difficulties or strains in the therapeutic relationship was associated with better outcomes.
Over time, therapy can involve both developing a clearer understanding of familiar patterns and having different emotional experiences within a relationship. These experiences may help someone become more aware of what they're feeling and more able to respond differently when familiar difficulties arise.
Having opportunities to respond differently
As people develop a better understanding of their responses and become more aware of what they're feeling, they may begin to approach familiar situations differently.
Someone who usually agrees to things because they're worried about disappointing others might begin by taking a moment before responding. Instead of automatically saying yes, they might ask for some time to think about it.
They may still feel anxious or guilty about saying no, particularly if they've spent much of their life trying to avoid conflict or disapproval. Sometimes the other person will genuinely be disappointed, and learning to manage that can be difficult.
Over time, experiences like these can begin to challenge some of the expectations a person has developed about themselves and others. They might discover that disagreement doesn't always lead to rejection, or that they can express their needs without damaging a relationship.
These changes aren't always deliberate. Sometimes people notice that they're less inclined to apologise, more comfortable expressing anger, or better able to remain engaged during difficult conversations.
What does change actually look like?
Change doesn't necessarily mean that a familiar response disappears completely.
Sometimes the feelings themselves begin to change, and situations that previously brought up intense anxiety, shame or fear may gradually become less difficult. Someone might find that criticism no longer affects them as strongly, or that they feel more secure in relationships where they previously worried about rejection.
Change can also involve recognising reactions earlier and becoming more able to respond differently, even when the familiar feelings are still present.
Someone who previously withdrew during conflict might begin to recognise what they're feeling and become more comfortable expressing it. Another person might find that they're able to set boundaries without experiencing the same level of guilt they once did.
These changes can take time, and there may be periods when older responses return, particularly during stress or in relationships where established patterns are difficult to shift.
Over time, both how someone feels and how they respond to familiar situations can begin to change.
I'm Josh Wasniewski, a psychotherapist and PACFA Certified Practising Member with a Master of Counselling. I draw on relational and attachment-informed psychotherapy alongside somatic approaches, informed in part by my training in Somatic Experiencing.
I offer individual psychotherapy in Northcote and Abbotsford, Melbourne, and online across Australia.
You can read more about my somatic psychotherapy in Melbourne, or my article about what happens in a somatic therapy session.
If you're finding yourself caught in familiar emotional or relationship patterns that have been difficult to change, you're welcome to get in touch.
Research and further reading
Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519.
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.
Jennissen, S., Huber, J., Ehrenthal, J. C., Schauenburg, H., & Dinger, U. (2018). Association between insight and outcome of psychotherapy: Systematic review and meta-analysis. American Journal of Psychiatry, 175(10), 961–969.
Simpson, J. A., Collins, W. A., Tran, S., & Haydon, K. C. (2007). Attachment and the experience and expression of emotions in romantic relationships: A developmental perspective. Journal of Personality and Social Psychology, 92(2), 355–367.
Sønderland, N. M., Solbakken, O. A., Eilertsen, D. E., Nordmo, M., & Monsen, J. T. (2024). Emotional changes and outcomes in psychotherapy: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 92(9), 654–670.
Wood, W., & Rünger, D. (2016). Psychology of habit. Annual Review of Psychology, 67, 289–314.
