My web site is almost live, and I’m still thinking about the presumptuousness of telling someone “You have already begun to make the change you desire.” But it’s something that’s based in research, specifically the work of Prochaska and DiClemente,  about the transtheoretical stages of change.  Once you’ve heard the breakdown, it seems pretty intuitive: the stages are precontemplation, contemplation, preparation, action, maintenance, and (in some cases) relapse. So really, if someone is looking at a therapist’s web site, unless they’re my friends looking just to see that I have a web site up, whoever it is is at least at the stage of preparation. It could be argued that looking for a therapist is already action– the person is planning on doing therapy and the act of picking a particular therapist is, well, an ACT of change.  Practically speaking, however, the person who’s shopping for a therapist is still doing some preparation– preparing to get into therapy or do something else to deal with a problem/issue/what-have-you. On the other hand, they could look at a bunch of therapist’s web sites and decide to go buy self help books or join a meditation retreat or do something else– so the preparation could lead to some other action than getting into therapy. But the transtheoretical stages of change still apply.  And, being as most people have more than one thing they’re dealing with in life, they will have a different stage of change for each thing. So I may be in maintenance about the issue of getting regular exercise, action about lowering my dietary fat, and precontemplation about dealing with a lack of supportive friends (my existing friends are all sedentary), and in contemplation about taking up a new sport now that I’m in better shape. And I may be in preparation around getting new clothes (shopping web sites or checking out what looks good on other people). So how does this relate to therapists and clients? Well, studies have shown that if a therapist thinks a client should be in action around an issue but the client is in contemplation, they’re going to butt heads. In fact, if the therapist prematrurely pushes the client to change before the client has thought about it and prepared, the client will drop the therapist. AND if the therapist works with the client’s current state of change– getting a precontemplator to contemplate for example, or an action person to move to maintenance, that person will make the most fruitful changes. And will make them for the fewest sessions. The thing was studied in EAP (employee assistance plan) counseling where the people only got 3-5 sessions, and those who did stage of change counseling made the most change and were the happiest (I don’t have the reference or I’d include it). All material copyright James Matter 2013


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
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