Now and then in my practice (and in my life, but that's another blog...) I am reminded that people come into therapy even if they are not ready to do the work. I see this regularly with couples. Who doesn't know somebody who went to marriage counseling these days? And of those couples, there is often one person that comes just to pay lip service to the idea-- "I went to marriage counseling, but it didn't work, so we are getting divorced". Cynical, perhaps.
The reality is that people enter therapy, whether as part of a couple, or individually, at different stages of change. Some people are ready to dig in and do the work, and some aren't even close. Some think they are ready, but find that when a certain subject is touched on that might be super painful that they really aren't ready after all and terminate therapy. Sometimes I see them again, and sometimes I don't.
What helps me ride the wave of come-and-go patients is to remember Prochaska's Stages of Change model, which explains that people are generally in five stages that explains where they are at when it comes to motivation.
The first stage is "Precontemplation"-- the "I'm-not-even-thinking-about-change" stage. In fact, these clients are often the ones who are still blaming outside sources for their struggles. In the case of a couple, one person is blaming the other party for everything rather than willing to take ownership. In an individual case, this stage of change can look very victim-like. The hard part of being the therapist in this case is that it is VERY easy to alienate clients at this stage, as they are just not ready yet to be open to taking accountability, and if the therapist tries to push that, the client will often become angry, defensive, and not want to participate in therapy anymore. The key is to meet the client where they are at, validate their feelings and viewpoint, and go for a soft approach.
"Contemplation", the second stage, includes people that recognize a change needs to be made, but they are only read to dip their toes in the water. You hear a lot of "Yes, but...'s" in their reasoning, and a soft touch is still required. This phase also requires hanging in there with the client, and holding his or her hand, encouraging them to get more of their foot wet.
The third stage is "Preparation". Clients in this stage are ready to change, and are ready to set goals and take ownership for their role in the problem. These are model clients, and often do the homework that you ask them to do. They also really want to be successful, and success comes in letting the client determine their goals and have some choice in the method involved in that change (hmm... sounds like parenting a toddler!!).
"Action" staged clients are committed and future-focused. They are making changes and doing the things needed in hopes of having a better life. This is a fun stage to be in with a client because you see the wonderful things happening in their lives. The downside is that you cannot forget all of the work that happened before, because sometimes people take steps backwards. Enjoy and encourage this stage!
Finally, we have the "Maintenance" stage. This is where clients have made the changes they wanted to, and are working on maintaining (duh!) the changes. The best thing the therapist can do here, other than being a cheerleader, is to help the client plan for any regression or relapse that could occur. This can be done in a hopeful and positive, but realistic way. It gives the client power to manage their lives, and have a plan "just in case".
So there you have it. Over this week, keep these stages in mind, not just for therapy, but for ways that you can use them in your own lives. Do you know people that are trying to make changes? Or people that you desperately wish would make changes? Keeping these stages in mind can help you understand and cope with people who are not doing what we would like them to. You have to meet people where they are at- not where you would like them to be.
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