It means committing to do what's needed, according to the therapist, to get better. For some it means just showing up, others have specific homework to do outside session, etc. Sometimes it's really just a matter of not giving up. New things are tough. Leaving abuse is tough, changing old patterns is tough. If it was easy, we'd have done them long ago. The therapist has a particular view of if and how change can be done. But it would require that patient be on the same page. It's not as easy as taking a med. Involves the patient doing things differently, going out of their comfort zone, committing to this new way of doing things. Not everybody is motivated enough to go through with it. I had come to a position in my life when the motivation was finally there. If the motivation and commitment is not for someone, therapy won't "work."