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Clinical Models. Week Thirteen. Transtheoretical Model (Stages of Change). James Prochaska and Carlo DiClemente. Stages of Change. This model has been applied to a variety of problems including:. condom use organizational change use of sunscreens drug abuse medical compliance
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Clinical Models Week Thirteen
Transtheoretical Model(Stages of Change) • James Prochaska and Carlo DiClemente
Stages of Change This model has been applied to a variety of problems including: • condom use • organizational change • use of sunscreens • drug abuse • medical compliance • mammography screening • smoking cessation • exercise • low fat diet • radon testing • alcohol abuse • weight control
Stages of Change:The Temporal Dimension • Pre-contemplation • Contemplation • Preparation • Action • Maintenance
How Change Occurs • Experiential Processes • Consciousness raising • Dramatic relief • Social liberation • Self re-evaluation • Environmental re-evaluation
How Change Occurs • Behavioral Processes • Self-liberation • Counter-conditioning • Stimulus control • Reinforcement management • Helping relationships
Stages of Change Pre-contemplation • The stage in which people are not intending to take action in the foreseeable future • Reluctant: Uninformed or under-informed • Rebellious: Resistant to change • Resigned: Demoralized • Rationalizing: In denial
Stages of Change Contemplation • The stage in which people are: • intending to change in the next 6 months • more aware of the pros of changing • acutely aware of the cons
Stages of Change Preparation • The stage in which people: • are intending to take action in the immediate future • have taken some significant action • have a plan of action • should be recruited for action-oriented programs
Stages of Change Action • The stage in which people: • have made overt modifications • are facing triggers • are gaining confidence • are in more danger of relapsing
Stages of Change Maintenance • The stage in which people are: • working to prevent relapse • more confident
Constructive Living Overview • Created by David Reynolds • Combines teaching from Morita Therapy and Naikan Practice • Focus is to develop a relationship with reality • What is controllable? • Accepting my feelings, yet finding the action that is implied • Correcting my view of reality with gratitude
Constructive Living Basics • Constructive Living aims at helping a person see the world realistically and act on that knowledge in practical and constructive ways. • what is controllable and what is not? • Control indicates that something is possible. . .all the time. • Having control does not necessarily mean that it is easy, only that it is possible. • We use the words "can" and "can't" to reflect this meaning and urge our students to be clear in their speech. "I just can't seem to exercise lately," says Mary. I point out that she is not speaking accurately. She actually can exercise; she simply hasn't recently, I remind her.
Constructive Living Basics • Lets look at the list of what is not controllable: • the weather, • other people's actions, • other people's opinions, • the outcome of events, • What is controllable, then? My own behavior is always controllable. I do it because it needs to be done. • Realistically we know that life can't be perpetually easy, comfortable, "exciting" all the time. • The "good news" is that my behavior is in my control at all times. I can act now. My behavior is always controllable.
Constructive Living Basics The five principles of feeling. • Feelings are uncontrollable directly by the will. • Feelings must be recognized and accepted as they are. • Every feeling, however unpleasant, has its uses. • Feelings fade in time unless they are restimulated. • Feelings can be indirectly influenced by behavior.
Constructive Living Basics • If we accept that feelings are not controllable, it follows that the best thing to do with them is to accept them -- as they are. • This does not mean that one need be passive. If I am angry over some injustice I might work to change conditions. • But not every feeling requires action. • Some feelings do point to something that needs doing.
Constructive Living Basics • Constructive Living's perspective derives from a Japanese practice called Naikan. • This form asks the participant to use three powerful questions to correct their view. • These questions may be asked concerning individuals- family, friends, mentors, enemies, even strangers. • The questions may also be asked with reference to a day or an event in ones life.
Constructive Living Basics • These are the questions for reflection: • 1. What have I received from ____? • 2. What have I given to _______? • 3. What troubles and bothers have I caused________? • Called "Daily Naikan" practice, these three questions provide a frame for assessing the day • Answering Naikan's questions and the simple exercise of saying "thank you" starts a new habit of mind.
Cognitive Behavioral Therapy (CBT) • Modern adaptation by Arnold Lazarus
Cognitive Behavioral Therapy • Draws from • cognitive therapies (Albert Ellis’ Rational Emotive Therapy, Aaron Beck’s Cognitive Therapy) and • behavioral therapies (Pavlov, Wolpe, Skinner, Eysenk) • Here-and-now orientation • Briefer and time-limited (efficacy within <16 sessions) • highly instructive nature and the fact that it makes use of homework assignments. • the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. • Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. • The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change.
CBT Techniques • Techniques include: • Validity testing • Cognitive rehearsal • Guided discovery • Writing in a journal • Homework • Modeling • Systematic positive reinforcement • Aversive conditioning
CBT Techniques (cont’d) • Slow-talk/slow walk/slowing down • Stopping automatic negative thinking (ANTs) • The acceptance paradox: how we keep the fires burning and how to put them out • Rational and helpful self-statements that can become permanent and "automatic”
CBT Techniques (cont’d) • Continuing to move our self-statements up • Whose voice are you listening to, anyhow? Do we have to listen and believe all those old lies? • The determination factor: becoming more focused and gently determined • Focusing: What are you paying attention to? • Later, it’s important we address: • perfectionism, anger, frustration, setbacks, and our view of the world
Transactional Analysis • People are OK; thus each person has validity, importance, equality of respect • Most everyone has the capacity to think • People decide their story and destiny, and these decisions can be changed • Freedom from historical maladaptations embedded in the childhood script is required • The aim of change under TA is to move toward autonomy (freedom from childhood script), spontaneity, intimacy, problem solving
Client Centered Therapy • Carl Rogers • This technique uses a non-directive approach. • This aids patients in finding their own solutions to their problems.
Client Centered Therapy • Rogers stated that there are six necessary and sufficient conditions required for therapeutic change: • Therapist-Client Psychological Contact • Client incongruence, or Vulnerability • Therapist Congruence, or Genuineness • Therapist Unconditional Positive Regard • Therapist Empathic understanding • Client Perception
Narrative Therapy • Michael White • From the post-modern branch of counseling • Narrative therapy holds that our identities are shaped by the accounts of our lives found in our stories or narratives
Concepts ofNarrative Therapy • The narrative therapist is a collaborator with the client in the process of discovering richer ("thicker" or "richer") narratives • “The person is not the problem, the problem is the problem.” • Operationally, narrative therapy involves a process of deconstruction and "meaning making”
Common Elements in Narrative Therapy • The assumption that narratives or stories shape a person's identity • An appreciation for the creation and use of documents • An "externalizing" emphasis • A focus on "unique outcomes" or exceptions to the problem • A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles • Responding to personal failure conversations
