The Art and Science of Change
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Steve Mackey is a cognitive-behavioral, exposure based, and motivational coherence-based mental health counselor and psychotherapist who offers individual counseling and psychotherapy services for issues related to anxiety, depression, fear, mood problems, low self-esteem, anger, habits, and relationship struggles for adults at 2020 Capitol Ave., Suite 5, Sacramento, CA 95811, serving the Sacramento, Elk Grove, Folsom, Roseville, Citrus Heights, Orangevale, Carmichael, Davis, and Galt communities. For more information contact 916 549-5772.
The information provided on this website is not intended to diagnose or treat any condition. Visiting this website does not constitute a therapist-client relationship. Information found on the internet is not a substitute for individualized evaluation and treatment by a mental health professional. All written and visual materials are the exclusive copyright of Steve Mackey, © 2011-2016.
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How Does Change Happen?
You might have noticed. Change is hard. Most of us seeking to make a change in our lives find it difficult to do, especially on our own. We look toward counselors, psychotherapists, coaches, psychiatrists, social workers, psychics, and psychic healers of all sorts, for guidance.
We in the healing professions see our role as facilitators of that change, whether it be with individuals, couples, or families coming to us to make a difference in their lives. Change is what our business is all about. Each of us may have very different means of supporting this change (facilitating awareness, debating beliefs and thoughts, prescribing medications, tapping the body, providing encouragement, empathy, or positive reinforcement, to name a few among countless possibilities). However, some change processes are more comprehensive and effective than others.
Fortunately, the overarching process of change is no longer a mystery, but rather a series of predictable stages you will move through when seeking a lasting change in emotions, behaviors, or life circumstances. Often you will move through some of these stages, if not all of them, more than once during this process.
Different methods and tasks move you through the various stages toward the goal you’re hoping to achieve. As well, different roadblocks appear at these stages to potentially thwart this process of change. Knowing what stage of readiness you’re in during the journey toward change, and what tasks and roadblocks are prevalent in each stage, can be crucial in making the smoothest and longest lasting change possible.
Have You Made a Difficult Change?
If you think back to a thorny personal problem you've resolved, it's unlikely that you will remember waking up one day and finding that with some quick action the problem went away for good. Rather, you probably ignored the problem for a while, maybe denied that it was even a problem, and then thought more and more about tackling it, realizing that no one else was going solve the problem for you.
After some time, the pain of the problem, or your disgust with having it your life any longer, prodded you to make definite plans to do something about the problem, and after gathering some information and resources, took action against the problem and toward a solution.
You probably then struggled to maintain your life without the problem, i.e., you had periods of backsliding. Perhaps, after some time the problem was once and for all resolved, or just as commonly, you found a way to sufficiently keep the problem at bay. If you did not succeed, you likely gave up for a while and then decided to try again. This process of change is applicable to all people with all types of problems and will be described more fully below.
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The Process of Change
As first spelled out by James Prochaska and others (Prochaska, J.O., Norcross, J.C., and DiClemente, C.C., 1994, Changing For Good, New York: William Morrow and Co.) there are six stages within the process of change:
1. Precontemplation (What, me have a problem?)
2. Contemplation (Houston, I may have a problem)
3. Preparation (I've got to do something about this problem)
4. Action (I'm going to resolve this problem)
5. Maintenance (Change isn't easy, gotta stay focused)
6. Termination (Wow, I've really changed for good.)
1. Precontemplation. People in this stage do not see a problem, though others might be keenly aware of one. Precontemplators do not have any plans to change and deny the existence of a problem, or are firmly convinced that others are the problem. If they seek a change, it is the desire for others to change. Often only dire negative consequences and/or compassion and consistent caring pressure from significant others can get precontemplators out of this stage and into the next.
2. Contemplation. Those in this stage are becoming aware of a problem within themselves and often feel stuck. They acknowledge the existence of a problem and are aware of at least some of their own role in the problem, and they begin to think seriously about taking steps to solve the problem. They may struggle to understand the problem, begin to see its causes, and start to think about possible solutions. They may talk to others, read articles or books, or make decisions to do something to bring about change.
Conversely, others may stay in this stage for years hoping that if they understand the problem well enough it will resolve (an unlikely, though not impossible, occurrence). As this stage comes to a successful close, denial is largely a thing of the past, but much work still needs to be done to prepare for attaining the eventual goal you have in mind.
3. Preparation. Most people in this stage have decided that they play the largest role in creating and/or maintaining the problem, and are planning to take action to solve the problem within a very short time. You'll likely have a growing sense of awareness of the problem, your role in keeping it alive, and your responsibility in eliminating or decreasing the severity of the problem. A vision of how things could be different comes into view.
It's at this stage that the awareness, or lack thereof, of all that is involved in enhancing the odds of success in the next Action step can make or break the process of change. Too often we, including change agents, want to move directly to taking action on the problem after identifying it, without considering the powerful factors that are keeping you stuck in old patterns that work against the change you seek.
Many factors can weigh against your change efforts, factors below the surface of awareness that are both biologically and environmentally influenced. It is no wonder that change is so difficult. Who hasn’t fallen off that eating or exercise program, gone back to blaming a spouse or child for the difficulties in family life, reverted to jealousy and insecurity in relationships, or procrastinated endlessly when change proved difficult?
Most of us are largely unaware of what keeps us stuck. If we were aware, we probably would have resolved the factors keeping us stuck, or would have accepted their benefits and given up our goal with a sense of acceptance (and often sadness) that the status quo is the best choice. We seem innately programmed to not know parts of our own minds, the parts whose desires often compete against our conscious desires. This is where a therapist or other change agent can be very valuable.
Having a friend, a guide or adequate information to help you discover, examine, and hold in your awareness the factors that compete against your desires for change can be crucial. We all have natural psychological immunity toward change, whether it be to new perspectives, beliefs, behaviors, emotions, patterns of communication, or all of the above.
Just as our bodies often provide us physical responses of immunity toward foreign objects, even if those object are placed in us to save our lives (such as in a transplant, necessitating we take immunity suppressing drugs, lest our bodies reject the new material), so do our minds. We have natural immunity to new concepts and ways of behaving that serve to protect us from the possibility that change will bring about worse circumstances. As the saying goes, better the devil you know (the status quo) than the devil you don’t (a changed you).
Despite our suffering, some part(s) of our mind fears that change could be worse. Becoming aware of these fears, honoring them and what they reveal about you, and allowing them to integrate fully with your conscious mind, is often a necessary step in the journey toward change. Once known, honored, and integrated, it is highly likely that the benefits of the change you seek outweigh any fears (real or imagined) you may have, leading to greater levels of motivation to change.
When this point in the process has been reached, significant changes in emotions or behavior may have already begun. To create enduring change, though, the subsequent stages in this process will likely have to be implemented.
4. Action. In order to make change reliably happen, and last, you must take action against the problem you want to solve or toward the goal you’re seeking. It is at this stage that at times the hardest and most uncomfortable work of the change process takes place.
Depending on the nature of the problem you may have to throw the cigarettes and ashtrays out of the house, pour the last of the alcohol down the drain, get your exercise equipment and apparel ready for when you wake, grieve past losses more fully, confront fears and limiting assumptions about yourself, practice communicating differently with one’s spouse, and question and act against faulty thinking and beliefs.
The field of counseling and psychotherapy has split into many factions over the decades, each emphasizing its own theories and techniques, leading to countless ways of solving personal challenges, far too many to mention here. However, an underlying process thought by an increasing number of clinicians to be present among all lasting change practices involves the awareness (Contemplation and Preparation stages) and confrontation (Action stage) of avoidance. Formally known as Transdiagnostic Treatment, this theory holds that it is our active, but often subconscious, avoidance of challenging emotions that leave us susceptible to our various emotional disorders.
It is the action stage that many therapists emphasize, and understandably so in my opinion. However, without the proper amount of awareness and preparation, - knowing what you're avoiding and why - most people experience too much ambivalence, fear, or negative pressure from others to make this stage work to bring lasting change.
5. Maintenance. This stage entails work to maintain the gains made during the previous stages, where one works to reduce lapses and prevent complete relapses, both of which are common without maintenance work. Maintenance can last from a few days to a lifetime. For example, some who quit drinking never have another urge to drink again after a number of months in the maintenance stage; others must guard against the temptation for the rest of their lives.
6. Termination. This stage is the ultimate goal most of us desire, when former problems hold no sway over us anymore. You are rarely tempted to revert to previous negative thinking, emotions, and behaviors, and feel confident that the problem will not return, even during periods of stress. There is no effort to change or maintain change any longer. The struggle has been won and the solution becomes a part of your being.
For many people, depending on unique individual factors and the nature of a particular problem, termination is not always possible. In order for change to last, some must remain in the maintenance stage, though often at ever decreasing levels of vigilance against the problem.
These 6 stages often do not occur in a linear fashion, but many times spiral. Most of us trying to change will suffer many lapses and even a complete relapse or two (or three or more). Sometimes these relapses will push us back to the precontemplation, but more often setback will only push us back a stage or two, especially if we have been made aware of the stages of change and have formulated a relapse prevention plan. Sometimes after taking action and making significant progress, then lapsing, further work in the contemplation and/or preparation stages may be needed to make the next action and maintenance stages stick. With each setback, you can strengthen your ability to make change last.