Magazine article Psychotherapy Networker

FROM RESEARCH TO PRACTICE; Transformation Now! (or Maybe Later): Client Change Is Not an All-or-Nothing Proposition

Magazine article Psychotherapy Networker

FROM RESEARCH TO PRACTICE; Transformation Now! (or Maybe Later): Client Change Is Not an All-or-Nothing Proposition

Article excerpt

According to conventional wisdom, people enter therapy to actively resolve their problems, reduce their symptoms and retool their lives. That's a dangerous assumption, say research psychologists James Prochaska and Carlo DiClemente. Their large-scale studies suggest that people progress through several predictable, well-defined stages on the way to change, and are apt to take resolute action only toward the tail end of the process. This means that only a small percentage of new therapy clients are ready to actively resolve their difficulties--a reality that clinicians can't afford to ignore, the researchers say. They urge clinicians to assess each client's readiness to change and to tailor therapy accordingly, or risk alienating clients who may conclude that the therapist is clueless about their needs.

Prochaska, professor of psychology at the University of Rhode Island, and DiClemente, professor of psychology at the University of Maryland, have examined the stages of change that people traverse in dealing with such problems as depression, anxiety and panic disorders, marital discord, eating disorders, smoking, alcoholism and delinquency. In cross-sectional studies (studies that take place only once) involving more than 3,000 individuals, they asked people to identify their major problems, their plans for change and the specific actions they were taking to bring change about. Most of these subjects came from household samples, while others were in treatment for medical or mental health problems. Regardless of their family and cultural background, the nature of the problem they faced and whether they had enlisted professional help, Prochaska and DiClemente found that, across studies, people negotiated five discrete stages as they progressed toward change:

Precontemplation. In this initial stage, individuals are largely unaware of their problems and have no intention of changing their behavior. People who go into therapy at this stage typically do so in response to pressure from others--a spouse who threatens to leave them, an employer who threatens to fire them, a court that threatens to jail them or parents who threaten severe consequences. Precontemplators often wish other people would change, as in: "How can I get my wife to quit nagging me?"

Contemplation. Contemplators are aware that they face problems and are seriously thinking about grappling with them within the next six months. But they have not yet made a commitment to take action, usually because they still feel daunted by the effort required to overcome the problem, or because they still feel positively about some aspect of their troublesome behavior. Bad habits die harder than we may realize: when Prochaska and DiClemente followed 200 contemplators who were considering quitting smoking, most of them were still "thinking about it" two years later.

Preparation. Individuals at this stage intend to take action within the next month. Preparers may have already made some small attempts to modify their behavior--such as trying relaxation exercises when they feel anxious--but these attempts typically have been sporadic and only partially effective. They may be developing strategies for a more committed program of change, such as mapping out an action plan, going public with their intention to behave differently and getting social support. Most still feel twinges of ambivalence about taking the plunge.

Action. In this stage, individuals are taking concrete steps to change their behavior, experiences or environment in order to overcome their problems. Actors endorse statements such as "Anyone can talk about changing, but I am actually doing something about it." Because action often brings up feelings of guilt, failure, coercion and yearning to resume the old behavior, clients typically need a lot of support during this period. A sobering statistic: At any given time, only 10 to 15 percent of people in the process of change are engaged in the action stage. …

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