Making Changes Last

Jeffrey A. Kottler

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135895914
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Based on original research conducted by the author over the past twenty years, this book is a definitive investigation of enduring change. Hundreds of therapists and change agents, in addition to a diverse group of people who have self-initiated experiences, or structured therapy, have been interviewed about their most dramatic growth and the factors that contributed to making their changes last.Written for helping and leadership professionals, as well as the public, this book will give readers the knowledge and tools they need to understand the mechanisms and processes of lasting change.

1

CHAPTER

What Do We Really Understand About Change?

People constantly make resolutions about ending relationships or beginning new ones, ceasing bad habits, giving up addictions, changing jobs, and stopping self-destructive patterns. Efforts are initiated to get things rolling. Yet, so often, the changes just don’t last.

The challenge of promoting and maintaining permanent change is one that befuddles experts, as well as the general public. Even professional change agents such as therapists, teachers, consultants, and business leaders struggle with ways to maintain progress that has been attained, as well as to prevent relapses—not only in their clients but in themselves.

Stop Me Before I Do It Again

I have resolved numerous times to handle certain situations in class differently, such as when a student rambles incessantly. I know from past experience that confronting such a person publicly, even in the most diplomatic, low-key way possible, often creates more problems than it solves. Even if the rambler does take my cue without feeling resentful, others in the class often feel vicariously censured.

Maybe it has something to do with my confrontive style, the students’ need for approval, or some other factors I can’t begin to understand, but I have accepted that I am just not as skilled as I would like to be in handling these annoying critical incidents. It is for this reason that I have promised myself over and over again that I won’t use direct, public confrontation for these situations any longer but will, instead, rely on alternative means.

The problem, however, is that I quite enjoy being direct and I’m good at identifying behaviors that are counterproductive (except sometimes my own). So, as much as I understand that I must change my interventions, I feel powerless to do so. I keep repeating the exact same routines that get me in trouble. Furthermore, time and time again, I notice the same pattern with the therapists I supervise: we keep doing things that don’t work very well but do them anyway because we don’t seem to be able to stop. Furthermore, it often feels like we can’t help ourselves.

The Prognosis

We are often not all that honest with ourselves, much less with our clients, about the realistic prognosis for lasting change as a result of our helping efforts. There may be heaps of evidence to support the effectiveness of our interventions, but precious little to measure their sustained impact over long periods of time.

Steps Forward and Backward

All too often, people who wish to end destructive or self-defeating behaviors, cease bad habits, or make major lifestyle transformations do not persist in their efforts. In the case of addictions, for example, up to 80% of participants in recovery programs relapse, two thirds of them within three months (Hunt, & Barnett, & Branch, 1971; Laws, 1999). Lest you think this is a result of a population notably weak in impulse control, consider that in studies of high-functioning adults who make New Year’s resolutions to stop smoking, lose weight, or begin exercise programs, 75% of them experienced success for the first week, but then, fully, 60% of the sample relapsed within six months (Norcross, Ratzin, & Payne, 1989). Considering that these people were prepared to receive follow-up calls from the researchers, even this result is optimistic.

These studies, as well as research conducted on the outcomes related to treatment of addictions and impulse control conclude that “there is no reason to expect that the effects of a treatment designed to moderate or to eliminate an undesirable behavior will necessarily persist for very long beyond the termination of that treatment” (Laws, 1995, p. 447). In other words, rather than fully expecting that our clients will maintain their progress after they leave our offices, it is far more reasonable to assume that the changes will probably not last.

How many times have you attended a workshop and were absolutely delighted with the material presented and determined to integrate what you learned in your practice, but found that a few weeks later you forgot most of what you learned? How many times have you participated in a retreat or intensive group experience and discovered that the glow lasted only about three days after you returned to daily pressures? How often have you gone on vacation or taken a break to rejuvenate yourself and found that whatever rest you experienced or goals you attained were completely nullified within a week after your return? More often than not, whether in therapy, on vacation, or during moments of quiet reflection, changes initiated do not persist without considerable preparation, rehearsal, and support.

Counseling, therapy, and workshop experiences are specifically structured to promote personal transformations and major growth. As such, they may be effective in producing positive results, but not nearly as successful in making the outcomes last. Before long, people often resume their maladaptive behaviors, bad habits, and destructive relationships. This might be very good for therapists, teachers, self-help writers, and other change agents who get lots of repeat customers, but it becomes an extremely frustrating and discouraging situation for those who would desperately like to move more than one step forward before they take another step backwards.

Keeping Resolutions

The general public is not the only group confused by the challenges of making changes last. Therapists, counselors, and teachers, who are, after all, professional change agents, also struggle with finding ways to keep momentum going once initial changes are implemented. The relapse rate treating addictions is depressingly high. The likelihood of enduring success in working with many other presenting complaints is also pretty dismal.

Take, as an example, your own experience making simple New Year’s resolutions. It is an easy hypothesis to test empirically. Just review the number of times you have resolved to change your life in some significant way, or even just to lose a few pounds or start an exercise program. Now recall the enthusiasm and determination with which you began your change efforts. Maybe you purchased some new “props” to make the job easier—a brand new pair of running shoes, an exercise machine, or a membership in a health club. Certainly you announced to the world your intentions. Alas, before you knew it, your motivation vanished. The wheels of daily routine reduced your change resolutions to faint memories.

Advice from experts (Presbyterian Healthcare Services, 1999; Texas Medical Association, 1999) about how to keep New Year’s resolutions appears sound. Get plenty of sleep so as to minimize stressors. Reduce alcohol consumption, which lowers inhibitions. Reward yourself for small measures of success. Remind yourself of the benefits you will enjoy. It is hard to argue with these suggestions. Unfortunately, relying on standard interventions and conventional wisdom is equivalent to facing a ruthless, vicious enemy with a few pebbles to defend yourself. Although they may give you the feeling that you are doing something constructive, ultimately these tools don’t do the job nearly as well as needed during such desperate circumstances.

Confusion and Conflict

Every therapist has a fairly well-articulated theory and set of assumptions by which to explain how change takes place. Various schools of thought identify the specific conditions and variables most likely to produce desired changes. It is, of course, fairly confusing that so many of our theories appear to conflict with one another. While some advocates believe passionately that change efforts are best directed toward understanding the past, others concentrate on the present or future. Many clinicians advocate, without the slightest doubt or uncertainty, that change takes place primarily on a cognitive level—through the altering of underlying thought patterns. Others, however, are just as convinced that real change can occur only after addressing affective arousal and resolution (accessing and expressing feelings). Still other clinicians believe with all their hearts that all therapeutic interventions take place on a behavioral level.

The debates among various therapists about the best way to promote change are long-standing and apparently impervious to change themselves! Practically every year a new theory appears on the scene that promises to render all others obsolete. Thus practitioners are admonished to abandon their previous attempts to uncover unconscious desires, access unexpressed feelings, dispute irrational beliefs, or realign family power structures and instead to focus their energies on reconstructing different narratives or reprocessing images that occur during eye movements. The fact that we do not really understand how these approaches promote apparent changes seems less bothersome than the doubts of the heathen nonbelievers who persist in using their older, “archaic” methods.

Yet such conflicts are part of the very fabric of change. “Change means movement” declares 1960s radical activist, Saul Alinsky (1971). “Movement means friction. Only in the frictionless vacuum of a nonexistent abstract world can movement or change occur without that abrasive friction of conflict.”

To add further to the confusion and conflict is the fact that lasting change is not necessarily related to the length of treatment. What is important, Mahoney (1997) contends, is not how long therapy lasts, but what is done with the time spent together.

Don’t Ask

A mistake that therapists sometimes make is to ask an elated client who is rejoicing at recent progress attained what it was that made the most difference. More often than not, the answer is not what would be expected or desired. All too often, therapists hear about something we supposedly did or said that we can’t even remember. Worse yet, people often mention some incidental thing that happened, completely unrelated to the intended treatment.

I recall basking in the pride of a client’s excessive exuberance over a breakthrough. She was absolutely ecstatic about progress she had recently made. While she was relating the things that would now be different in her life, I was reviewing in my mind which of my many brilliant interventions had made the ultimate difference. I was torn between the poignant metaphor I created the week before and a delayed reaction to my confronting her vigorously a few sessions back. My big mistake was asking her what helped the most.

“It’s your shoes,” she told me shyly.

“My what?” What the heck was she talking about? I hadn’t created a metaphor about shoes.

“Well, it’s just….”

“Go on,” I urged her, now genuinely curious about some “shoe technique” that I couldn’t even remember trying. No matter, I thought; there were lots of things I did in sessions about which I had little recall that still had a big impact. That, I said smugly to myself, is the value of being a veteran therapist. There are literally hundreds of things I do every session, most of them effortlessly and unconsciously, that produce dramatic gains. But I still couldn’t remember anything about shoes.

“It’s your shoe,” she said again pointing at my left foot sporting my favorite pair of loafers. I have very flat feet and these were one of the few pair of shoes that actually felt comfortable.

“Yeah?” I said, looking down to where she was pointing, utterly convinced she was losing her mind.

“You’ve got a hole at the bottom of your shoe” she said, and looked at me expectantly, as if that explained the dramatic shift in her thinking during the intervening week and all the changes she was now initiating in her life.

“Your point?” I asked, a little more harshly than I intended. I couldn’t help it. This was so frustrating and not going at all like I had hoped, especially with a client who had just finished telling me how much she had been helped in therapy.

“Well…,” she started, then paused, as if embarrassed by what she was going to say. “It’s that hole you have on the bottom of your shoe.”

I twisted my ankle so that I could see what she was talking about. Sure enough, the leather bottom of my favorite shoes was worn in the center of the sole, showing a rather large hole that I had not really noticed, or if I had, decided to ignore. After all, I would never find another pair of shoes like this again. “Damn!”, I was thinking to myself when the client continued.

“It’s just that you always seemed so confident and poised to me, like you can see through me and know things that I’ll never understand. That’s part of my problem, you know….”

“Yes,” I said impatiently, interrupting her so that she would explain what the heck she was talking about. I still had no idea what the hole in my shoe had to do with her stunning progress.

“I figured that even though you look like you’ve got it all together, there you are walking around with a hole in your shoe. Either you didn’t know it was there, or didn’t care. You probably didn’t know that every time you cross your leg—and you do that a lot—your clients have to stare at that hole in your shoe.” She looked a little pleased with herself at that point, proud that she knew something that I did not.

I nodded my head noncommittally, or at least with what I hoped was apparent indifference. Inside, I was feeling utterly bewildered.

“So,” she continued at a faster pace. “I thought to myself during the last week that if you could walk around with a hole in your shoe, then surely I could accept the small imperfections that I have to live with. I mean, I’d never.…”

“Yes?”, I said, this time with a touch of anger. She was definitely pushing my button now. Not only was this woman telling me that none of my brilliant change techniques had helped her and it was this stupid hole in my shoe that got her attention, but now she was teasing me for the inattention I gave to my appearance.

I have little recollection about what happened during the rest of the session. One thing, for sure: this lady was clearly feeling and acting differently, and in a remarkably short period of time. Furthermore, the impetus for this change was a serendipitous moment that was completely unplanned and unaccounted for. In a hundred years of supervision sessions, I’d never guess what had helped her. Or what she said helped her, I reassured myself repeatedly.

When I had talked about this case to colleagues, they agreed with me that it was obviously threatening for her to admit that something I’d done had been instrumental in her progress. She felt some need to minimize, or even diminish, the power of therapy. “In one sense,” a colleague remarked, “she has a need to get some last digs in toward you. She obviously feels some degree of hostility and resentment toward you.”

I agreed with this assessment, not because I believed it, but because it let me off the hook. The more I thought about the case, though, the more convinced I became that so often incidental, unintentional, and unplanned events become the impetus for change. In spite of our best efforts, most elaborate treatment plans, and well-executed interventions, there really is no way to know for sure what it is we do that matters most to our clients.

Certainly I created conditions with this client that made it possible for her to have a magic moment of insight. I had worked hard over the preceding weeks to build a solid relationship. She had taken small, incremental steps that made her ready for that transformative event. I knew this all to be true. Yet I felt so humbled by this experience. Too often, just when I think I know what’s going on, something like this episode throws me for a loop. I begin to question, all over again, what it is about therapy that is most powerful and influential. My wonder and awe for this wonderful profession I’ve chosen is reborn all over again. I realize that no matter how long I study this field,...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Preface
• 1 What Do We Really Understand About Change?
• 2 Stories of Personal Transformation
• 3 Kinds of Change: Magnitude, Rate, Levels, and Significance
• 4 Why Changes Don’t Last
• 5 Some Universal Features of Change Efforts
• 6 The Process of Lasting Change
• 7 Conditions That Promote Enduring Change
• 8 Adjunctive Structures That Sustain Change
• 9 The Certainty of Failure and Uncertainty of Change
• Epilogue
• References
• Index
• About the Author