Evoking Change in a Client
There are several therapeutic approaches which are useful to improve clients’ readiness to change. It is important, however, to realise that all these strategies are based on the same suggestion: motivation to change is elicited from the client and not imposed from without. Using coercion, persuasion or constructive confrontation will achieve little if the client is simply “unready” to change. It is the client’s task to articulate and resolve his/her own ambivalence in relation to change.
Stages of Change
Prochaska & DiClemente (1983) proposed a framework which comprised various stages of change. Putting such stages into the counselling perspective may help the counsellor understand the challenges within the process of change. Six stages were proposed, along with particular characteristics and techniques to support the client in moving forward:
- Pre-contemplation: the client is not yet considering the option of changing his/her life. Useful techniques in this stage include: validating lack of readiness; encouraging re-evaluation of current behavioural patterns; encouraging self-exploration and progressive thinking; understanding the risks and limitations involved in the process of change.
- Contemplation: the client is undecided about changing. Immediate change is unlikely to occur, however, it could occur within a month or so. Useful techniques in this stage include: clarifying to the client that the decision is his or hers; encouraging evaluation of benefits and disadvantages; promoting accountability; visualising positive outcomes.
- Preparation: change begins to develop, and the client is testing the environment in order to ‘get a feel’ of the whole process. Useful techniques in this stage include: assisting problem-solving and identification of obstacles; developing supportive networks through family, friends and others (particularly if the process of change is radical); verifying the client’s skills towards change; encouraging self-reward and gradual development.
- Action: this is the critical phase in which the client will change or return to his/her old habits. It usually lasts between 3-6 months. Useful techniques in this stage include: assisting the client in become more effective in the changing process and in conducting the behaviour; assisting the client overcome feelings of loss and nostalgia, whilst underlining the long-term benefits of the process.
- Maintenance: this stage refers to the continued commitment to sustaining the new behaviour. It is the classic period where new habits develop into routinely tasks. Useful techniques in this stage include: follow-up and motivational support; overview of values and benefits derived from new behaviours; discussing coping with relapse.
- Relapse: in this stage, old habits and behaviours resume which may affect the client’s self-confidence and beliefs. This usually involves a trigger, such as meeting an old friend from the period prior to change, or doing an activity which is perceived to have been part of the ‘old lifestyle’. Useful techniques in this stage include: evaluating with the client was triggered the relapse; reassessing motivation and establishing further goals and motivational sources; planning more effective coping strategies.
Motivational interviewing is a recent technique which aims to improve the client’s motivational levels, with an explicit focus on encouraging accountability and action from the client. This technique’s desired outcome is to make the client proactive and decisive towards change.
Five general principles of motivational interviewing include: expressing empathy, developing discrepancy, avoiding argument, rolling with resistance and supporting self-efficacy. By using these principles, the counsellor aims to develop the client’s self-confidence and ability to cope with the process of change. This is done both through the development of micro skills (similar to the coaching process) which are aimed to create efficient and effective behaviours, and the development of emotional awareness which well support the client in overcoming challenges as a result of change.
A crucial aspect of this technique is keeping constant focus on the positive side of things. Once this becomes a routine task, it is easier for the client to develop a positive mindset in order to achieve pre-set goals. Motivational interviewing strategies are particularly useful when integrated with the stages of change model.
Developed by Carl Rogers in the 1940s, this approach has proven useful for effective and constructive communication. It focuses on the client’s capacity for growth and change, using unconditional acceptance as a motivator (which encourages the client to also develop unconditional positive regard).
“The primary technique of client-centered counselling is to actively listen and reflect the client’s statements in a non-directive, nonjudgmental manner, thereby providing a safe environment for the client’s self-exploration. Client-centered counseling hinges on the development of a counselor-client relationship based on unconditional regard, often over multiple hour-long sessions. This relationship enables the counselor to clarify the client’s feelings without imposing external assessments or values.” (Sheon, 2004)
One of the aspects of this kind of counselling relationship is the perspective that the client and the counsellor are partners, moving together towards a common goal. This perspective of a partnership in the therapeutic process is a popular approach in life coaching and it has direct benefits to the client’s motivation and the relationship’s rapport building.