One of the most important lessons I have learned in helping patients is to really clarify what they want and for what they are asking.

Early on, this came up with people who wanted treatment to quit smoking. I noticed that everyone said they wanted to quit, but some did well and others not so much. What's the difference?

After some investigation, it became clear that, while some people actually wanted to quit smoking, others thought that they should want to make that change.

Treatment for those who really wanted to quit simply involves my supporting their process with treatment to minimize the physiological and psychological withdrawal. This does not work with people who only “want to want to” quit. They have not moved to the place of freely choosing their path and, without freedom to choose, there is not peace.

Not understanding this distinction can create conflict. If I provide them treatment that compels them to change when they are not actually committed, it is a subtle type of violence because they are not empowered to freely choose. Instead, I help to clarify this with them.

Often, their request changes to something like, "I would eventually like to quit, but I need help going from wanting to want to actually wanting. After I have reached that place, I may then like your help to actually quit. Can you help me?" This changes our interaction for the better. My job is not to compel them to do something they have not chosen, but to help them find the piece that needs attention, so they can freely move into a choice that feels comfortable.

Understanding the difference between wanting and wanting to want is extremely useful both personally and for the people with whom we interact. It creates less suffering for all involved.