It may be complained that the CMHAP process described above is unduly centered upon symptoms and illness. However, I believe this complaint fails to acknowledge how most psychiatric or counseling clients come into a mental health setting in the first place. Few people seek out mental health professionals from a personal desire to change their lives. Many more are effectively coerced into evaluation after their bizarre or maladaptive behavior becomes unacceptable to significant others in family or work. Even those who come to therapy of their own volition are rarely seeking change as such. Rather more often, they face an unacceptable level of personal pain and they must either change or die. After entering a therapeutic relationship, many will continue to sabotage change that threatens their personal autonomy.