Leaving the Safety of the Psychological Home

“Failure is success if we learn from it.”
–Malcolm Forbes American Publisher, 1917-1990

Why do patients have such dismal results achieving goals, especially in weight loss? The main conditions that can be classified as early killers and are responsible for our declining quality of life—such as diabetes, metabolic syndrome heart disease, and crippling osteoarthritis—are also the primary drivers of unspeakable suffering and outrageous health care costs. New research suggests that failing to achieve important goals is not due to inertia, laziness, or lack of willpower.

Harvard professors Kegan and Lahey1 have discovered an emotional immunity system in play, which hinges on competing goals. The problem is that most change is adaptive, requiring us to change our thinking and perspective and our behavior. When we only focus on changing behavior, the competing goals that come from the old mindset will always win. Hidden, competing goals win because they have to protect the person’s identity.


One of the main reasons why people get stuck in reaching goals is that we approach the problem with the wrong remedy. If you have tried and failed at helping patients accomplish something important to their health, consider the 2 different kinds of change challenges. 

  • Technical challenges, such as learning how to monitor blood glucose, have a reliable way to achieve mastery through training. Technical challenges require learning new procedures and are accomplished with valuable content and skills. They involve new apps or files, but not a new operating system.
  • Adaptive challenges, on the other hand, require transformation and changes in the capacity of the operating system itself. The mind must grow in order to meet adaptive goals. They require risk and some discomfort at leaving the safety of our psychological home. Established habits must be broken and one must venture out into new unfamiliar space in order to transform and meet the challenge. Adaptive challenges will never be met by information alone. Hence, the low success rate in meeting New Year’s resolutions. Trying and not succeeding is an important sign that your patients have an adaptive challenge they are trying to meet with a new skill set—such as a diet.

 The patient has one foot on the gas and one on the brake. What’s the remedy? Unearth their competing, self-protective goals.

Such as:

  • “I will appear selfish if I start to eat healthily, therefore I can’t make my well-being a priority.”
  • “I am very uncomfortable when I attract attention to my body, and getting to my goal weight will do just that.”

Sinister in their singularity, these competing goals are often invisible. Yet, they drive people away from important goals. Rather than telling your patients what to do, ask them what worries them about getting to their goal. Once you consciously release these ideas, their potential can be fully unlocked and liberation waits.

Eileen O’Grady, PhD, RN, NP


1. Kegan R, Lahen L. Immunity to Change: How to Overcome It and Unlock Potential in Yourself and Your Organization. Boston; Harvard Business Press; Jan 1, 2009. Available at: http://books.google.com/books?hl=en&lr=&id=rbhlTRx5VusC&oi=fnd&pg=PR3&dq=immunity+to+change&ots=RV7j7XfMtI&sig=Z8o3p_A7bk808rm7r4Zve85zg#v=onepage&q=immunity%20to%20change&f=false.

Dr. Eileen T. O’Grady is a certified nurse practitioner and wellness coach who specializes in getting people unstuck from lifestyles that do not support wellness. She can be contacted at www.eileenogrady.net.