17 March 2010

Facilitating Change

By Cindy Biding

(Published in’Campus & Beyond’, a weekly column written by Swinburne academics in the Borneo Post newspaper)

We often wonder why people don’t change. It is frustrating for teachers, counsellors, parents and all those who work in the helping profession to see that a person persists in the behaviour that is self-destructive.

One would think that hangovers, damaged relationships and memory blackouts would be enough to convince a person to stop drinking. Or one would think that low academic achievement and low self-esteem would dissuade a student from playing truant and not handing in assignments.

On the other hand, a fascinating question is, why do people change? Some people with alcohol or gambling problems escape them and go on to lead reasonably normal lives, often without assistance from counsellors, health professionals or help groups. In many problem areas, positive change can occur without formal treatment.

Sometimes people who want to change may be faced with conflicting thoughts, like: “I want to, and I don’t want to”. This phenomenon of ambivalence is often prominent in psychological difficulties. For example, a person who is socially isolated and depressed may expressed ambivalence like, “I want to go out and be with people and make friends, but I feel so unattractive and discriminated against”.

When faced with ambivalence and conflict, it is suggested that the person concerned seek help. It is possible that brief intervention speed or facilitate change. One or two sessions of counselling often yield greater change in behaviour than no counselling at all. The counsellor can help the person create a decisional balance between the benefits and costs of change. For example, a habitual drinker who wishes to quit and needs help may be asked to create a decisional balance sheet to weigh out the benefits and costs of drinking as well as the benefits and costs of abstaining from alcohol. By writing this down, the person can see clearly the costs and benefits of his current habit and that of the desired new habit.

Change is likely to occur when the person concerned sees a reason for change. Motivation is fundamental to change. Another reason for change is the faith and hope that counselling can help to bring about changes that is desired. It is this faith and hope that encourage people to seek counselling services.

An interesting area in the change process is the counsellor’s effects. Certain counsellors’ characteristics are associated with successful counselling outcomes. Counsellors need to create a therapeutic atmosphere and build a therapeutic alliance with the client from the start of consultation. Counsellors’ use of attending skills like reflective listening can help the counsellor to understand the client’s feelings and perspectives without judging or blaming. In fact this crucial attitude of unconditional positive regard for the client could increase the level of motivation for the client’s positive change.

In helping people to move from destructive habits to a desired positive habit, counsellors can focus on helping clients overcome reluctance or ambivalence through interpersonal communication rather than a specific therapy. Ambivalence is a normal part of human nature and as such the counsellor will need to help the client resolve the ambivalence by thinking and considering the costs and benefits of making the change as mentioned earlier on. This kind of approach promotes the use of self-motivating talk to address the costs and benefits or the advantages and disadvantages of making change versus not changing.

Although humanistic theories assume that people want to change, the counsellor will need to assess and increase the client’s motivation which is essential for effective counselling outcome. A major part of this assessment involves determining where the client is in terms of his or her readiness for change.

In any change process, there are typically six stages: (David & Diane M. Sue, 2008). The first stage is pre-contemplation where the individual is not yet considering any changes. The second stage is the contemplative stage where the individual is beginning to consider that he/she has a problem or that he/she would like to make a change in his/her life. The third stage is preparation or determination stage where the individual has made a decision to make a change and begins to prepare for action. The fourth stage is action stage where the individual begins to make changes in his/her life or to modify a problematic behaviour. The fifth stage is maintenance stage where there is evidence of sustained changed as the individual works to consolidate the changes made during the action stage. Finally, it is the termination stage where the individual has successfully maintained the change and has exited the cycle of change; this is the goal of all change efforts.

It is important to understand the stages of change because these will guide the counsellor regarding which issues to address with the client and help determine the most effective intervention strategies. Many individuals have several slips along the way as they move forward through the change stages. To help clients move through these stages, counsellors need to focus on the contemplation and preparation stages. It is important to allow clients to consider these basic questions: “How much of a problem does drinking pose for me?” “In what ways is my drinking affecting my life?” These questions help the client consider both the positive and negative aspects of his drinking habit. Then the next question will be: “What are the benefits and costs of changing my drinking habit?” “Will I be able to make the change?” ‘How would that change affect my life?” This is where the client creates a decisional balance as mentioned earlier in his/her attempt to make a desired change.

In helping people make a desired change, it is important to consider if the individual is ready, willing and able to make the change. The counsellor’s understanding of the stages of change and working through ambivalence with the client as well as counsellor’s unconditional positive regard and empathy are necessary towards bringing about desired change.

Cindy Biding is a senior counsellor with the Students Operations Department at Swinburne University of Technology Sarawak Campus. She can be contacted at cbiding@swinburne.edu.my.