Progress Is Not Linear
For a society so fixated with improvement — of our homes, our morning routines, our bodies, our finances — it is remarkable in what limited ways we define progress.
Geometry was not a subject I found particularly compelling during my school days, but just this week I found myself reaching for the term “sine wave” as a patient and I discussed the difference between his expectations of progress and the nonlinear path progress often takes. I wanted him to understand that, like the sine wave, progress oscillates and undulates with unpredictable frequency and magnitude. We all want to put in X amount of effort over Y amount of time and watch as our progress take the shape of a gradual, upward course. That perspective is very human, but it’s also very far from the truth.
The truth is, when it comes to the trajectory of recovery and healing, progress rarely looks the way we expect.
For a patient of mine a few years back, progress looked like this: her in the fetal position on our office floor, shaking and crying after a mindful relaxation exercise sent her into a paradoxical anxiety vortex. She’d been through significant childhood trauma, and as a result, she’d long been stuck in a frozen physiological state. Those of you who do trauma work are more than familiar with this type of response, which is a form of nervous system release. The patient was finally, years later, discharging the “fight or flight” energy — the neurochemical bundles that had been trapped in her body since those early life events.
In other words, even on that floor in the throes of anxiety and discomfort, the patient was making progress. Though, as I’m sure you can imagine, it didn’t feel that way to her.
In my first few years as a psychiatrist, it wouldn’t have felt like progress to me either. It took experience, supervision, and both personal and professional work for me to trust enough in the process, and in my own abilities, to recognize progress where others may not — like in the relapse that prompts a patient to finally accept and name their alcohol use disorder, or the depression that feels — for the first time — manageable and short-lived.
Similarly, it took time and experience for that patient to realize that her setbacks, slow downs, regressions and stalls — even those that left her in tears on the floor — were ultimately moving her closer to her healthy, authentic self. She’s in a loving relationship now, and has a full-time job. I see her every three months, and each time I’m impressed with her continued growth.
She never would have believed me, when we first starting working together, that her recovery could take her to where she is now — happy, healthy, and thriving. Just as she didn’t believe me, when she got up off that floor, and I told her that it was a step in the right direction.
I believe that it is our role, as providers, to hold this expanded vision of progress….not only for our patients, but also for ourselves.
I find so much value in discussing topics like this with colleagues, and I would love to hear your thoughts, if you’re willing to share. How have you helped patients to reframe their vision of progress in the face of a “setback”? Have you ever felt discouraged with a patient’s progress and needed to be reminded that healing often looks much more like a sine wave than a straight line?
