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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2 Responses to

  1. DJ says:

    Your blog dated, April 8, 2013 is curious to me. Do you agree that a therapist who does all of the talking while their clients do most of the listening, might need some supervision? I know a therapist who constantly reminds people that he has, “29 years of experience” and pontificates endlessly, just to hear himself talk. It’s painful. Twenty-nine years of experience does not make a good therapist.

    • jamesmatter says:

      The post is primarily about stages of change, so I’m curious how your comment relates to that particular post.

      Still, the essence of your comment is excellent, and it’s food for thought to me because I’ve been in some version of this line of work for over thirty years. There’s lots of research that shows that simply having more time on the job doesn’t automatically create a more skillful practitioner.

      I’m interested in how you know of this therapist. Is it your therapist? In which case, why not change therapists? Or at least tell the person, “You’re talking too much”and ask for what you want to change. If someone you know is complaining to you about their therapist, you might give them the same feedback. Your comment refers to someone who “…pontificates endlessly, just to hear himself talk.” Ouch! why would someone continue to sit through that when they can get someone else? That’s an issue for the person who is in therapy to work on, presumably with their next therapist.

      I’ve had clients tell me to change the way I work, and have been able to change in response. I’ve also had clients that just changed therapists. I’ve had people tell me I was the greatest– and I’ve had people tell me that I was the worst. At one point I thought highly of myself because of people telling me all the bad things their last therapist did– until I realized the obvious, that people who like their therapist are still with that therapist. Fortunately, I’ve worked mostly in clinic settings where internal referrals can easily be made. Therapists know that it’s a very personal thing & you can’t connect with everybody.

      There are also cultural differences that may come into play in how someone sees a therapist. Some people come from cultures where they expect the therapist to be more like a doctor– an expert who will tell them what to do. To a person like that, the therapist who only listens can be frustrating & seen as incompetent. It leads me to wonder about the ethnicity of the therapist, the setting, and if the therapist has done a lot of work with people from certain cultures.

      There’s also the question of what kind of therapy is expected or wanted. Some kinds of therapy are very directive and skills-based, like Dialectical Behavior Therapy. Some are highly manual-driven, like Seeking Safety. Cognitive Therapy is pretty directive, with the therapist assigning homework and going over written worksheets that can be very structured. If that’s not what someone wants, then that could be a problem.

      Also, but not least, there’s the possibility of burnout. It’s hard to work with other people’s problems for twenty-nine years. Clients who get better leave, so the therapist doesn’t have the experience of seeing people successfully getting on with life. Someone I know told me that when they told their therapist they had resolved the problem they came to therapy for and wanted to terminate, the therapist proposed working on wellness goals, or other issues, which to my friend seemed less than totally ethical.

      On the other hand, there are people who have chronic mental illnesses and who may continue to be impaired at some level for many years. This can leave both client and therapist feeling frustrated, stuck, and perhaps angry. One of the best therapists I have ever had (yes, therapists have their own therapists) proposed to me that I change therapists because the two of us were stuck. It was the right call.

      Which brings us back where we started. If you don’t like the therapist & feel you can’t ask for a change, then it’s up to you to make the change to a different therapist. Good luck.

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