I Don't Just Want to Know What You're Struggling With. I Want to Understand Why.

By Michael H. Goldman, MSW, LCSW

After more than two decades working as a clinical social worker, I've come to appreciate that one of the most important questions we can ask about human behavior is not simply, "How do we change it?" but rather, "Why is it happening?"

Throughout my career, I've worked with children, adolescents, adults, and families navigating emotional, behavioral, developmental, and interpersonal challenges. While their concerns may differ, meaningful therapeutic work often begins in the same place: understanding the individual behind the struggle.

A child refusing to attend school, an adolescent withdrawing from friendships, or an adult experiencing persistent anxiety may appear to have very different difficulties. Yet beneath those behaviors are often experiences and perceptions that have not been fully understood.

Before we can meaningfully address someone's struggles, I believe we need to understand how they experience themselves, other people, and the world around them.

Looking Beyond the Behavior

One of the challenges in mental health treatment is that we often focus on what is most visible.

We see avoidance, emotional outbursts, difficulty completing tasks, or struggles maintaining relationships. Understandably, people want solutions.

But behavior rarely tells the entire story.

A child who appears oppositional may be overwhelmed by expectations they cannot effectively process. An adolescent who seems uninterested in friendships may desperately want connection but struggle with the unspoken rules of social interaction. An adult who procrastinates may fully understand their responsibilities yet struggle to initiate and complete them.

In my work with individuals with autism, ADHD, anxiety, and other developmental or emotional differences, I've learned the importance of questioning our initial interpretations.

What looks like unwillingness may reflect difficulty. What appears to be indifference may represent uncertainty. And what we interpret as resistance may sometimes be an attempt to maintain predictability or control.

Understanding these distinctions can fundamentally change how we respond.

Connecting Assessment Findings to Everyday Experiences

An important part of my clinical work involves understanding how psychological, educational, and neuropsychological assessment findings relate to everyday functioning.

I've worked with parents who struggle to understand how their child can demonstrate remarkable intelligence in one situation yet have tremendous difficulty managing something that appears relatively simple in another.

Testing may reveal strong reasoning abilities alongside weaknesses in executive functioning, language processing, cognitive flexibility, or other areas. These differences can help explain why an individual may understand expectations but struggle to consistently meet them.

However, test scores alone never tell the complete story.

A child may perform well in a quiet, structured testing environment yet struggle to apply those same abilities in a busy classroom, an unpredictable social situation, or an emotionally demanding moment.

A test score tells us something about how a person performed under particular conditions. Understanding that score in the context of their life helps us begin to understand what it means.

I find it particularly meaningful to help individuals and families connect these pieces of information. Assessment findings, developmental history, clinical observations, and everyday experiences all contribute to a more complete understanding of the person.

The goal is not simply to identify strengths and weaknesses, but to understand how they may influence behavior, relationships, emotional experiences, and daily functioning.

Understanding Is Not the Same as Excusing

Understanding behavior does not mean removing expectations or eliminating accountability.

Instead, it allows us to develop expectations and interventions that are realistic and meaningful.

If an individual lacks a skill, we can help develop it. If they possess the skill but cannot consistently access it under stress, we need to understand what interferes with its execution.

These are different clinical challenges requiring different approaches.

Too often, individuals are repeatedly told what they should do without anyone adequately exploring why they cannot consistently do it.

This can create frustration and misunderstanding for both the individual and those trying to support them.

The Importance of Being Understood

Many individuals enter therapy having spent years being described through the observations of others.

They've been told they're too sensitive, too rigid, unmotivated, anxious, or simply not trying hard enough.

Sometimes these descriptions become part of how they understand themselves.

But a description is not necessarily an explanation.

For individuals who discover their neurodevelopmental differences later in life, developing a more accurate understanding of their experiences can be particularly meaningful.

Experiences that once seemed disconnected begin to form recognizable patterns. Longstanding difficulties may finally have explanations, and characteristics previously viewed as personal shortcomings can be reconsidered within a broader developmental context.

This doesn't eliminate life's challenges, but it can change how someone understands and responds to them.

My Approach to Therapy

I don't believe effective psychotherapy can be reduced to a single technique or theoretical orientation.

Cognitive behavioral strategies, insight-oriented exploration, emotional regulation skills, developmental understanding, and practical interventions all have value.

The question is not simply which technique works, but which approach makes sense for the individual sitting in front of me.

Some people benefit from concrete strategies and structure. Others need opportunities to explore emotional patterns, relationships, or questions about identity. Many need both.

My role is not to impose an explanation on someone's experience, but to work collaboratively toward an understanding that is clinically meaningful and personally relevant.

I believe therapy should provide a space where curiosity replaces judgment and individuals can begin recognizing patterns that may have shaped their lives for years.

Understanding Creates the Opportunity for Change

One of the things that continues to interest me about psychotherapy is that understanding doesn't change what happened in the past, but it can change what we do next.

When we better understand our reactions, relationships, and the reasons certain situations feel disproportionately difficult, we gain an opportunity to respond differently.

Insight alone isn't always sufficient. Change often requires practice, support, structure, and time.

But understanding gives those efforts direction.

After more than twenty years in this profession, I continue to believe that people are far more complex than the symptoms they present or the diagnoses they receive.

And while helping individuals develop skills, improve functioning, and navigate life's challenges remains central to my work, I believe something equally important happens when a person begins to feel genuinely understood.

Sometimes, that is where meaningful change begins.

Michael H. Goldman, MSW, LCSW, is a licensed clinical social worker and founder of Goldman Clinical Services, LLC, providing psychotherapy, parent support, clinical supervision, and professional consultation in New Jersey. His clinical work includes a particular focus on autism, ADHD, anxiety, and the relationship between developmental differences, emotional experiences, and behavior.