Yes – it is about change
In general, in any given time when a person decides to modify his thinking (“maybe I will try spicy food for once tonight”), feeling (“I never liked the Beatles before but now they’re ok”), or behaviour (“I’ll give it a go with salsa dancing tonight”), each one is basically a change process.
In other words, whether we recognise it or not, we actually do change on a regular basis throughout life. Some changes are significant, others less so (the sizes and colours of change as shared above). Thus, even with change being a normal and regular aspect of life, why do we often hear the following comments when we ask a loved one, a friend or work colleague to consider counselling: “people can’t change,” “I’ve tried stop smoking before, nothing works, ” “change is way too difficult,” and the universal favourite one: “you can’t teach an old dog new tricks?”
We believe the answer lies in the following quote: “the first step towards change is insight (increasing one’s knowledge on a topic that will facilitate change in attitude and then behaviour). The second step with change is acceptance.” Regarding insight, most people as we stated previously are unaware that change is actually an everyday reality for all of us. Therefore, regardless of why a person comes to counselling (by choice and/or by the nudge), we enhance our clients’ sense of awareness/insight with not only what type of change options are available to increase their well-being (for example new ways of thinking or new ways of behaving), but we also ensure the client is aware of what change stage they are in throughout the counselling process. With respect to acceptance, once a person is aware of the dynamics (the desire as well as the fear) of the stages of change, we then collaborate with our clients on defining what areas of life they desire to change: if you will, their map of orientation (who am I) and their map of direction (where and how do I want to go).
As a Buddhist monk once said to a young student, “If the road you’re on is without stones & pebbles, then clearly you’re on the wrong road.”
Change in a less than perfect world may not always be a smooth journey. As a Buddhist monk once said to a young student, “if the road you’re on is with no stones and pebbles, then clearly you’re on the wrong road.” We accept that change we desire or change that we must enact upon (sometimes with resentment) is not always an easy process, but our 38 years of counselling experience reminds us daily that with a bit more insight of how the brain denies, resists, fears or desires change, getting a person to accept he or she needs to change becomes a greater reality and actually a more optimistic and positive journey. Give change a chance.
Six Stages of Change
We understand that for counselling to be successful, both the client and the counsellor need to understand what change stage they are in. There are six (6) stages of change (Prochaska & DiClemente, 2005) in counselling, each one having an importance in allowing each and every one of us to move from the unpleasant to the pleasant state of living (the happy life). In an almost perfect world these six stages of change proceed in a linear manner, other times stages may need to be repeated due to various nature/nurture factors that are discovered in the learning and growth dynamics of counselling. Some change stages even occur simultaneously.
Stage 1: Pre-contemplation
This stage is characterised by two distinct elements: a) the person not being able to see or understand what the problem is, and/or b) the client wanting some other person to change (the problem is them, not me). Pre-contemplators usually come to counselling because of some form of pressure from another person (spouse, employer, the courts, school, friends). Concurrently, pre-contemplators also resist change and therefore employ denial-minimisation tactics to disown any responsibility for their contribution to the issue(s) at hand. Thus, one of the initial goals in counselling is to determine how much denial or minimisation the client is experiencing that prevents change.
Stage 2: Contemplation
This stage is characterised by the client wanting to better understand what the “bump in the road” is, to see the causes and as well to explore what options are available to resolve the demise. The key point to remember here is that even though a person may know what is the issue and what needs to be changed, contemplators are not quite yet ready to make a commitment to action (fourth stage of change). The second stage is a critical time for those in counselling to better understand two (2) key themes before action is undertaken: who am I (their map of orientation) and what strengths and resources do I have to support my journey (map of direction)? Hence, in counselling the client and counsellor will know when the time for action arises when the language and thoughts in counselling focus around the “solution versus the problem” and a “view more about today and the future than the past.”
Stage 3: Preparation
This stage is characterised by the client going through additional areas of mindfulness in areas of mindfulness, learning and growth. Sometimes the client needs to improve their communication skills, career goals, parenting behaviours, intimacy practices, and further strengthening their self-esteem. In particular, we use this stage as an opportunity to identify the client’s values and supporting behaviours in four key areas of life: defining the self, self-development, work and relationships. The primary goal here is to actualise individual awareness so that a sense of self-control, comfort and security are present when the client goes from preparation to action. In short, a mindful sense of well-being.
Stage 4: Action
Probably the most misunderstood and misapplied stage of all in counselling. The common problem here is that most clients and counsellors believe that change means action, and action now at the onset of counselling. However, if the first three stages of change are not properly addressed in counselling, failure in counselling and/or after counselling can occur (in fact, over 45% of all clients stop counselling before the third session as they feel their therapist or family want action before they are actually ready for action). This stage is characterised by the basic premise in positive psychology and cognitive behavioural sciences that before we can “change” a behaviour, we must first change or reframe our thought patterns (our mental tapes we play if you will). While most of us want to “see” some form of change, often times the more important change must occur in the way we think where we often don’t see that change until some future point and time. Once the action stage in counselling has allowed us to change our thoughts (reframing), then can we commence with the more visible desired actions, behaviours and feelings in and outside of counselling.
Stage 5: Maintenance
This stage is characterised by the counsellor and client (and in most cases his or her social support network) to identify what possible trigger points or other conflictual issues exist in the work and social/family setting that could cause a relapse. Whether a client is coming in to quit smoking or improve his communications at work or in the marriage, the counsellor and client in this stage shall develop a strong commitment to establishing positive reinforcement activities (validation, cheerleading, acknowledgement, praise, rewards) to sustain the change made in the action stage. In other words, change never ends in the action stage, it merely takes a new form and presence in our life.
Stage 6: Relapse/After-care
There are some thoughts, behaviours or feelings we wish never return (the former smoker who doesn’t take up smoking again when he gets stressed). However, some healthcare professionals believe there are certain behaviours, thoughts or feelings we never completely remove (traditional 12 step programs for example propose that alcoholics will always remain “an addict in recovery”). This stage is characterised by determining what types of behaviours, thoughts or feelings can realistically be terminated, and equally as well, what types require a lifetime of support and maintenance. The ultimate goal though in the after-care stage is to ensure that the client understands that by embracing lifelong learning he or she increases the chances for a more healthier and happier life. We believe that the lifelong learning process can be experienced both in counselling and other environments. In short, our doors are always open for tune-ups and new learning sessions.
Overall, by using the above mentioned six stage model of how we go through learning and change, our counsellors are able to work in a more understandable and believable way with each and every one of our clients. Our counselling model then ensures each change stage has its own correlating counselling process(es) that allow two short-term goals to be continually experienced in counselling: i) a greater sense of awareness and b) shift from focusing on problems to thinking about solutions.
For example, in the pre-contemplation stage (stage 1), the counsellor may need to work with the client over a period of time with cognitive, gestalt or psychoanalysis to replace the denial mindset with an ownership mindset. Stage 2, contemplation stage, the counsellor may focus more on traditional psychoanalytical and existential processes to allow suppressed feelings and thoughts that often times makes us feel “stuck” in unpleasant moods be identified and understood in counselling. In stage 3 (preparation stage), the counsellor may then shift to a rational-emotive or cognitive-behavioural model (CBT) to challenge non-effective thinking patterns that often times causes non-action or procrastination that often times prevents stage 4, the action stage, from being experienced. Stage 4, action stage, focuses on three areas for movement and change: thoughts, emotions and behaviours. Hence, this stage will require a focus on growth in our thinking patterns as well as modifying behaviours and replacing unpleasant emotions with pleasant feelings. The most effective process used in stage 4 is CBT (cognitive behavioural therapy). Maintenance, stage 5, is a key stage where we ensure the progress made is sustained for a lifetime.
We also focus on not only maintaining the change, but also how to ensure the client continues to use the change processes. The processes of rewarding positive behaviours and developing nurturing relationships are key here. Stage 6, termination, utilises similar processes like that of stage 5 whereby the temptation or threat of returning to old behaviours/thoughts are removed. Reinforcing the happy life model is key here to ensure the spiralling cycle of change is absent for most of life’s “bumps in the road.”
Prochaska, J. & DiClemente, C. C. (2005). “The transtheoretical approach”. In Norcross, John C.; Goldfried, Marvin R. (eds.). Handbook of psychotherapy integration. Oxford series in clinical psychology (2nd ed.). Oxford; New York: Oxford University Press. pp. 147–171. ISBN 978-0195165791.