Tuesday, December 02, 2008

Easier said than done: what makes someone implement change?

What makes someone change? Here, I might align myself with the soft thinking side of many therapists. Science says relatively little about what creates change in a person. I have seen this documentary on this slimmed-down woman who lost 30 kilos and has kept her new weight ever, for several years. The journalist asked her: So what has made you change? She said that she was on a hike and just couldn't make it up the hill without constant stops. And at that moment she swore to loose weight by keeping on walking up this hill every weekend until she can do it without stops. And she never stopped pushing herself, and her weight dropped slowly. She also said that it was not about the diet because any sensible diet will work: eating a bit less, a bit more healthy, and exercise more and keeping it at this pace for ever will do the job.

What creates such a moment that sets in motion such a change? I am not sure. But it is not about that moment. That moment is only the start, the first spark. If you do not have the dried-out land with a hill next door, hiking- friendly social setting, competitive attitudes, friends with similar aims, no life-changing events like death of partner, the right genes, the ability to change quickly, right personality traits, and tools like sensible diet, the spark cannot live on and create a fire. You cannot model such behaviour in a sensible way in the same way as it is difficult to predict revolutions, wars or economies. 

So how can you as a therapist induce change? I have no clue. I fear that the answer is that they cannot. Maybe induce the spark, for who is not excited about starting a potentially life-changing treatment. But will it light the fire? Only the patient can. But actually not even the patient can. The time and place must be the right one. And then the right spark at the right time will light it up. However, therapists can help in that they create treatment that requires as little change as possible to be successful. Like a pharmaceutical treatment. Or improved behavioural therapies.


Anonymous said...

There is a ton of work in this area from other disciplines like psychology. Specific authors would include Seligman and Mihaly Csikszentmihalyi.

Check out Trish Zebrowski's work on factors responsible for change in pws. Her chapter from the Conture/Curlee book is a good overview.

Anonymous said...

Tom - your last two posts are right-on. Even if stutter-free speech is established in intensive treatment, the transfer of these skills into the real speaking environment is crucial. Without eventually making this the way you talk AND feeling comfortable speaking in the new way, stuttering will come back and relapse will occur.

Transfer needs to be a carefully monitored, gradual process with continual self-evaluations and contact with the therapist. The program that I went through in 1982 follows the client for a least one year - starting with easy speaking situations and short periods of talking and eventually talking with anyone all day long.

Since this process requires a whole lot of commitment and time, it is similar to a drug rehab or weight loss program that is successful.