In Existential Psychotherapy, Irvin Yalom, writing of conscious, directed, self-therapeutic change, writes of the ‘essential’ role of personal decisions and choices in ‘effective’ therapy, and invokes William James‘ five-fold taxonomy of decisions “only two of which, the first and the second, involve “willful” effort”:
1. Reasonable decision. We consider the arguments for and against a given course and settle on one alternative. A rational balancing of the books; we make this decision with a perfect sense of being free.
2. Willful decision. A willful and strenuous decision involving a sense of “inward effort.” A “slow, dead heave of the will.” This is a rare decision; the great majority of human decisions are made without effort.
3. Drifting decision. In this type there seems to be no paramount reason for either course of action. Either seems good, and we grow weary or frustrated at the decision. We make the decision by letting ourselves drift in a direction seemingly accidentally determined from without.
4. Impulsive decision. We feel unable to decide and the determination seems as accidental as the third type. But it comes from within and not from without. We find ourselves acting automatically and often impulsively.
5. Decision based on change of perspective. This decision often occurs suddenly and as a consequence of some important outer experience or inward change (for example, grief or fear) which results in an important change in perspective or a “change in heart.”
So three kinds of decisions are seemingly ‘automatic’; they are made for ‘no paramount reason’ or ‘accidentally’ or ‘suddenly.’ But they should not, for that reason, be understood as ‘spontaneous’ or ‘uncaused.’ After all, they are made by a patient in therapy, someone that has decided to go to therapy to ‘become better’ or to ‘be cured.’ Change, or an acute desire for it, already stirs within such persons. When the decision is made, therapy has already taken place for some time; narratives of the lived life have been constructed and edited for clarity; ‘suggestions’ for therapeutic change have been made; tentative drafts of new self-constructing narratives have been offered for emendation and rewriting in the clinic.
In these circumstances, the patient/client is not a passive participant in the therapeutic process but an active dynamic one, albeit with levels of interaction with therapy that are not always explicitly conscious and available for introspection. These levels of interaction, in ‘producing’ decisions,’ act in much the same way as unconscious modes of problem-solving do, the ones that prompt the anecdotal observation that ‘mathematicians do all their theorem-proving while they sleep.’ The ‘therapeutic decisions’ which result should be cause for optimism; in the same way that writers, artists, and creators of all stripes press on through moments of ‘block’, trusting that their unconscious creative processes will work out for them in the end, moving them past points of turmoil and stasis in their artmaking, the patient in therapy can continue to strive, pressing on, trusting that within them, directed processes, even if not immediately apparent, of self-discovery, invention, and construction are under way.