The Cycle of Change

A particularly useful model for counsellors and clients is the cycle of change, developed by DiClemente, Prochaska and Norcross and described in their very readable book, Changing For Good. The video (above) is an interview with Carlo DiClemente co-developer of the model. The cycle of change is an excellent tool for understanding the process of change and for identifying where people are in the process. The model also provides a guide to the interventions that best support individuals at different stages in the cycle. The authors argue that the wrong intervention at the wrong time may actually hinder the process of change, raising defences and entrenching denial in clients.

Before individuals enter the cycle they are in a stage that DiClemente calls “pre-contemplation”. As the name suggests, individuals in this stage may be unaware of their problem or deny that the problems exists or affects them. Denial is an active process that involves pushing a problem out of awareness and a fascinating subject in itself. The appropriate intervention in this stage of the cycle is consciousness raising through the provision of information. A successful intervention helps the individual to the next stage of the cycle, which DiClemente terms “contemplation”.

When an individual begins to consider the possibility of change he or she has entered the “contemplation” stage of the cycle. This stage is marked by ambivalence, commonly expressed by clients in the form: “Part of me wants to make a change but another part wants to keep things as they are”. Resolving this ambivalence is the key task for individuals before they can move to the next stage of the cycle.

Two approaches to resolving ambivalence can be employed here. The first approach to resolving ambivalence is to create within the individual a psychological state known as cognitive dissonance. This state occurs when an individual’s actions are in conflict with his or her values. Cognitive dissonance is resolved when changes are made to bring a person’s behaviour in line with their values. The second approach is the decisional balance exercise in which clients are invited to consider the short-term and long-term positive and negative effects of their limiting behaviour. This also increases levels of cognitive dissonance in the individual as they recognise that the long-term consequences of their behaviour are negative.

Ambivalence is resolved when the individual moves to the next stage of the cycle, the “decision” or “commitment” stage. In this stage the individual decides to make a change or makes a commitment to the change process. It is commonplace for individuals at this moment to slip back into ambivalence or, more helpfully, to move round the cycle a little further to the “action” phase. The counsellor can reinforce the client’s commitment to change through genuine praise and by focusing on the gains that will be realised once changes are made.

The action stage of the cycle is the point at which the client prepares to make changes. Methodical preparation is a key factor in successful change. Counsellors can support their clients in this phase of the process by helping with goal setting and action planning. Effective goal setting and action planning can create a compelling future that pulls the client towards the next stage of the cycle: the maintenance of new and desired behaviours.

In the maintenance stage of the cycle the individual successfully creates change in their lives and sustains it over a period of time. If change is maintained then permanent change takes place and the individual leaves the cycle. Maintenance requires conscious effort. Permanent change has occurred when the new behaviour has become automatic, natural or effortless. Helpful interventions in the maintenance stage of the cycle include “old self” v “new self” comparisons, listing the gains and good feelings associated with the new behaviour and importantly relapse prevention.

Preparing clients for the possibility of relapse may seem like a risky thing to do, as though acknowledging the possibility of a relapse might bring it on. But exploring and planning for a relapse is preventative work and provides the client with the knowledge and skills the will need to manage a lapse and return to the maintenance phase of the process. If a lapse turns into a relapse the counsellor can reframe the relapse as essential learning - another piece of the jigsaw – on the way to permanent change. DiClemente discovered that individuals tended to go round the cycle a number of times before reaching permanent change, but each trip round the cycle is developmental and prepares the individual for their next more informed attempt at change.

PowerPoint as an On-line Resource

It never occurred to me before to embed links into my presentations for learners to access on-line. That's because I have associated PowerPoint with "front of the class" presentations. Embedding links turns PowerPoint into a powerful on-line resource. This is one simple way to introduce learners to connectivism and the edgeless university. So, with a PowerPoint I can present my slides with narration, include links to websites and videos and then link students to a wiki where they can write their thoughts and reactions. Just like I've done here. And although I am providing the links, once my learners click on them who knows where they'll go! I am going to complete the learning cycle now and develop my own enhanced PowerPoint.

Teaching in the 21st Century

I have just finished a thirty minute Webinar with students on my Working with Abuse course at the University Centre, Blackburn College and now I’m writing a blog about it. I have emailed a link to a recording of the Webinar to all my students so those who could not attend have an opportunity to see what they missed. In my Webinar I referred to a BBC radio programme, which I have now uploaded to Moodle, the University Centre’s virtual learning environment. I am creeping into the 21^st Century.

As far as my willingness to use technology goes I’ve come a long way in just a few years: from a sceptic who refused to use PowerPoint to an enthusiast who advocates the use of technology enhanced learning (TEL).

My dislike of PowerPoint presentations grew out of the numerous probation service staff training days I attended. It was a struggle to keep awake during 150 slides on the Criminal Justice Act (2003) or some other bone dry topic. Each slide featured probation service corporate colours and fifteen bullet points - there was little relief from this monotony.

I now use PowerPoint as a backdrop to my lectures - pictures, videos and music punctuate the lesson and change the state of learners. My PowerPoint presentations are uploaded to Moodle for students to print if they wish. I’m currently experimenting with slideshare.net but my next real challenge is to begin adding a commentary so students can hear me expand on the bullet points I have listed and then the presentations will make much more sense.

The Webinar is another experiment and with mixed results. My students can see and hear me and they can write questions in response to what I am saying, but there is little interaction as yet. My job is to work my way through the PowerPoint students can see when I’m sharing my desktop. Unfortunately anymeeting.com has had a redesign since last week and I couldn’t get the desktop sharing function to work. This prevented me from sharing important diagrams and pictures. My experience of the Webinar is therefore pretty mixed. Interaction is limited and when the technology doesn’t work I am left with a strong sense of “just talking to myself”. Maybe a better way of transmitting knowledge is the tried and tested YouTube video – so popular that I’m about to go back into production!

The transmission of knowledge over the Web does allow more time for experiential learning in the classroom: discussion, exploration and interaction. I am using technology to enhance this too. I take pictures of students as they work in pairs and triads - capturing examples of rapport building that I upload to Moodle. I photograph work we have done on the whiteboard and on flipchart paper. Sometimes students let me take movies of their presentations and counselling sessions, which I also upload to Moodle. Finally the assessment of learning has incorporated technologies, including the audio and video recording of counselling sessions and presentations. The key question then – is this enhancing the learning experience of students? There is much more that I can do to make use of TEL and I shall keep you posted!

Facebook, Twitter and Professional Boundaries

Counsellors are increasingly likely to use Twitter, Facebook and blogs to promote their practice and communicate with other professionals but can appropriate professional boundaries be maintained when using social media?

Over the summer I signed up for my first ever Facebook account and began collecting ‘friends’. Some were friends I had known for decades, some were ex-students I’d taught over the years and many were current students.

My intention was to create a social network that would allow me to interact with my friends and connect with my students. I began by posting links to interesting articles and research papers, complimenting people on their achievements and posting supportive comments whenever any of my new Facebook family met with adversity. Very quickly I became a witness to my students' unfolding personal dramas: nights out, hangovers, family celebrations and emotional crises. I have to say it felt inappropriate and after just one week, following discussions with colleagues, I deleted my first Facebook account.

I learnt two lessons from my first experience on Facebook. Firstly, I ought not to have mixed professional relationships with social relationships. Secondly, even though I might have been circumspect about the information I posted, I was nevertheless exposed to personal information about others that crossed professional boundaries. I am back on Facebook now with much stronger boundaries. I only accept friend invitations from people who really are personal friends. My response to students, supervisees and clients who wish to add me as a friend is heartfelt: let's not jeopardise or sacrifice a valuable professional relationship for something that is likely to be fairly superficial.

So how can I use social networking to promote my practice, share information and connect with other professionals and the public (including students and clients)? I have discussed this with colleagues and need more feedback as I tentatively embrace this new technology as a teacher, counsellor and supervisor. Here are three "platforms" I'm currently using:

Facebook Pages allow me to post on Facebook as "Marsden Therapy". Individuals can “like” my page and receive my updates but they have no access to my personal Facebook profile and I have no special access to their personal information either. This is still a work in progress as I haven’t developed my page yet or added any interesting content.

Twitter allows me to follow and communicate with other mental health professionals, post links to articles and feel part of an international community of counsellors and psychotherapists. I occassionally comment on things I’m doing but the vast majority of my posts are about my work and research interests. I have encouraged my students to follow me but I do not follow them and so far there have been no boundary issues.

Blogging is something else I like to do and again I’m working out what is and isn’t appropriate for a counsellor to share on a public forum. I want my personality to come through but I don’t want the blog to become too personal. At the moment I’m sticking to book reviews and mental health topics. But as my confidence as a blogger increases maybe I will relax and write more freely about my experiences.