How Many Changes Do You Want to Make?

From NY Times

“Nobody wants to buy therapy anymore,” Truffo told me. “They want to buy a solution to a problem.” This is something Truffo discovered in her own former private practice of 18 years, during which she saw a shift from people who were unhappy and wanted to understand themselves better to people who would come in “because they wanted someone else or something else to change,” she said. “I’d see fewer and fewer people coming in and saying, ‘I want to change.’ ”

I’ve been thinking about this for some time. Perhaps it’s because I’ve done a lot of work over the years with people who had problems that put their lives in danger– suicidal depression, out of control addiction– or made their lives a living purgatory, if not hell– crippling anxiety, bipolar disorder; psychoses.  But I’ve also worked with a goodly number of couples and families, and it is true that when  you get two or more people sitting in a room with a therapist, the biggest issues usually are about how each person wants the other to change. I might not tell you this to your face as a client in a couple counseling session– no, I would– you can’t make the other person change. Sorry. Why do you think all the 12-step meetings in the world (or the overwhelming majority) start by saying, “God, grant me the serenity to accept the things I cannot change…?”

Nevertheless, if you enter into a therapy process, you have chosen to change. So let’s talk for a moment about how people change. Interestingly enough, there’s a good consensus on  how the process works. It was developed by Prochaska & DiClemente and is called the trans-theoretical stages of change model.  They arrived at this not by doing original studies, but by looking at all the other studies– thousands of them– that had already been done on how people change. here’s how it boils down:

1) Precontemplation– “Problem? What problem? I don’t need to change because I don’t have a problem.”

2) Contemplation. “Maybe there’s an issue that I need to look at. I’m not saying I actually have a problem, and I don’t know if I need to change. I just need to look at some stuff.”

3) Preparation. “If I was going to change, would I be able to? What resources would I need? How would I do it?”

4) Action “OK, I am going to do something to change. I’ll go to the gym, make a therapy appointment, see a doctor, or whatever is a place to start.”

5) Maintenance. “I have successfully made the changes I want and will continue to do the things that keep the change going.”

And in some cases,

6) Relapse. “I quit doing what kept the change in place, and I’m backsliding.” The person who relapses doesn’t go back to precontemplation, they go back to contemplation. “Maybe I should start my change actions again.”

Of course, what person has only one issue? We want peace of mind, better relationships, to lose some weight, or in more severe problems, we want to be able to go out of the house without overwhelming anxiety, or we want to stop thinking about suicide.  Or we may think, “If I can’t lose some weight, I’ll kill myself.”

So all the changes I want to make– or don’t realize yet I need to make– are connected. Duh. What do they all have in common? Me. More later.


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).
This entry was posted in behavioral health, change, choices, cognitive therapy, Couples and relationships, dealing with change, mental health, Recovery, Therapy processes, Uncategorized and tagged , , , , , , , . Bookmark the permalink.

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