As counselors, we know the importance of using the right tool for the job. Our client’s often come to us because they’ve been using the wrong tools to help them cope with their emotional lives. They drink, get high, shop, gamble, self-mutilate, starve themselves, comfort eat, or binge to avoid the discomfort of feeling. Part of our job is to help them access or develop other, more healthy tools to cope with life. The problem is that the “solution” isn’t so simple. It’s not enough to tell our clients that their coping strategies are problematic and suggest new ones. Change is a process and clients often begin the process with denial, resistance or ambivalence. In order to help our clients make needed changes, we have to understand how people change, be able to assess a their readiness for change, and give them the tools they need to make and sustain these changes.
Stages of Change
Prochaska and DiClemente’s Stages of Change Model is helpful because it lays out the framework of how people change. This model reminds us that ambivalence is a normal part of the change process and helps us determine which tools to use and when to use them to help our clients resolve their ambivalence and work through the obstacles that are likely to keep them stuck or lead to backsliding or relapse. Prochaska and DiClemente’s Stages of Change Model lays out five major stages of change and make it clear that we have to tailor our interventions to match the client’s stage of change.
- Precontemplation (a client doesn’t recognize that they have a problem, doesn’t want or think they need to change)
- Contemplation (a client recognizes that they have a problem and is willing to look at making changes)
- Preparation (a client is willing to try something small)
- Action (a client is committed to making some major changes)
- Maintenance and Relapse Prevention (a client is incorporating changes and committed to making their changes in lifestyle permanent.)
- Relapse is an unofficial sixth stage (a client backslides or “falls off the wagon” and has resumed old, less healthy behaviors.)
How Action Methods Help
Developed by J.L. Moreno, Psychodrama, Sociodrama and Sociometry are particularly useful methods for working with change. These methods provide a wholistic set of tools that help clients resolve their ambivalence about change and develop more healthy tools to cope with life. Because they bring in the body as well as the mind, they cut through rationalization, denial, justification and various other defenses that people use to avoid change.
People in the precontemplation stage often lack awareness of the problem and/or feel ambivalent about making changes. Clients often raise their defenses of denial, rationalization or denial when we tell them that their behavior is problematic. The psychodramatic technique of role reversal is helpful in making clients aware of the problematic aspects of their behavior. Role reversal allows clients to step into the shoes of someone they love and experience how their current or past behavior impacts this person. More than simply helping clients think about how their loved one feels, role reversal allows clients to feel the impact of their behavior at the body level. This experiential impact often provides clients find the internal impetus to change.
Clients in the contemplation stage realize that there is a problem but are “sitting on the fence” about making changes. This stage is all about ambivalence. Techniques such as Coleman’s Angle of Opportunity and the Angel/Devil technique provide a great way to help clients explore their ambivalence by putting the pros and cons of changing into action. In Coleman’s Angle of Opportunity, a client is able to explore what the future might be like if they continue on the path they are on and compare it to what the future might be like if they change their behavior. Coleman’s Angle of Opportunity also helps instill hope by helping clients begin to imagine that change is possible. In the Angel/Devil technique, clients are able to give voice to the pull to change and the pull to not change. This process keeps clients from engaging in a mental bypass of the struggle of ambivalence and helps them find the motivation to take the next step to prepare making changes.
People in preparation stage have begun “testing the waters” by taking little steps towards changing their behavior but these steps have not resulted in significant results. The Future Projection technique is useful in this stage because it gives people a chance to experience what their lives might be like after they have made the change. By stepping into the future, people are able to identify the steps they took to successfully make the change. Not only does this technique instill hope, it also helps people create a plan to accomplish their goals. The experience of successfully trying new behaviors and having more desired outcomes provides a counterpoint to the lure of the older, less healthy coping mechanisms and can instill the desire to put in the work necessary to bring the change into being.
In the action stage, clients are consciously engaging in new behaviors and are facing challenges to these new behaviors. They need a lot of reinforcement and support. The mirror technique allows clients to watch scenes of success and/or struggle as if they are watching a play. This gives clients the ability to see their struggles and successes from the outside and note for themselves what’s working. The role reversal technique gives clients the opportunity to step into a significant other’s shoes and experience how their behavior change impacts this person. The social atom allows people to identify who in their social world is supportive of their change and thus able and willing to help them maintain their behavior changes and who in their social world is less supportive and likely to disrupt their efforts to change. This can help clients decide which relationships to nurture and which relationships to pull back from.
In the maintenance and relapse prevention stage, clients have been engaged in the new behavior for at least six months and are committed to maintaining this new behavior. Role training will allow them to practice dealing effectively with challenging situations that threaten to drag them back to their old behaviors. Doing so will help make the changes clients have made sustainable in the long run.
There is also an unofficial sixth stage – relapse. This is the “falling off the wagon” stage. A relapse is defined as resuming the old behaviors. If this happens, it’s helpful to employ a timeline by having them explore in action the thoughts, behaviors and experiences that led them to relapse. This enables clients to learn from their mistakes, have compassion for themselves and find the drive to change again.
