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Chapter 10 Summary

Chapter 10 Summary

Chapter Review

According to Prout et al. (2022), a client who hesitates to change or is ambivalent about change has a mix of negative and positive feelings. This can be seen when clients are late to sessions or miss appointments. Ambivalence can also manifest in failure to make enough progress toward goals. This behavior is more likely to interfere with treatment progress, necessitating the need to examine a client’s motivation. The transtheoretical Stages of Change model can help determine whether a client is ready for change. The change model comprises five stages: pre contemplation, contemplation, preparation, action, and maintenance.

A significant cognitive element of change is creating self-efficacy. This is a person’s belief in their ability to perform a task successfully and achieve desired outcomes. One primary way therapists can enhance client self-efficacy is through treatment. Individuals can also develop self-efficacy through observational learning.

According to the authors, the TRA (Theory of Reasoned Action) and TPB (Theory of Planned Behavior) are primary models explaining how individuals form intentions to act. The TPB is built upon the TRA. It has been updated recently to include other variables, such as self-efficacy. The integrated model can help therapists explore the cognitions that contribute or block the intention to act. Further, Prout and colleagues (2022) explain the role of cognitive dissonance during change, how operant principles influence behavior change, and how to address ambivalence using psychodynamic approaches.

Transtheoretical Stages of Change Model

The transtheoretical Stages of Change model outlines the pathway to successful change. As indicated above, this model comprises five stages: pre contemplation, contemplation, preparation, action, and maintenance. Every stage in the model explains how individuals think about a problem and how they are likely to behave.

In the first stage, precontemplation, a client has not started to think about changing. The person is not aware of the problem and has no intention of changing. In the second phase, contemplation, the client has started to think about changing the behavior but has yet to make a serious commitment to take action. This may entail setting a deadline for change but failing to create a plan. In the preparation phase, the client intends to take action immediately and create a change plan. In the fourth phase, action, the client works actively to address the problem. For instance, the client could modify their behavior, environment, or experiences to make necessary changes. In the maintenance stage, the client has successfully made the necessary changes, for instance, reducing depression, weight loss, and smoking cessation, and has adjusted their habits and lifestyles to maintain change. While these stages are presented in a linear progression, people do not always move in a straight line during change.

Increasing Self-Efficacy

For individuals to try or do something new, they must have confidence in their ability to implement the desired behavior effectively. Albert Bandura created a social learning theory demonstrating how cognitive factors influence individuals' actions. Vicarious learning is one critical element of Bandura’s theory. This form of learning happens when individuals observe or watch others. That means individuals do not have to experience something directly to learn. Learning can occur by watching others. Another essential element in social learning theory is observational learning. This learning method entails watching and modeling another person’s attitudes, behavior, or emotional expressions. It depends on four processes: attention, retention, motoric reproduction, and motivation and reinforcement. Therefore, for observational learning to occur, a person must 1) pay attention to the action, 2) remember the modeled behavior, 3) reproduce the observed behavior, and 4) be motivated.

There are several approaches practitioners can implement to enhance client’s self-efficacy based on social learning theory. This includes mastery experiences, where a client successfully overcomes a problem or completes a challenging task. Observation learning is another crucial way to boost self-efficacy. Another technique is exposure therapy, where a client encounters a feared situation or object and experiences the fear without looking away or fleeing until the fear reduces naturally. Other approaches that help increase self-efficacy include social persuasion and improving mood.

Besides social learning theory, TPB and TRA can help describe how individuals act. According to the two theories, individuals’ intentions directly influence behavior. Further, a person’s attitude concerning the behavior, as well as knowledge of subjective norms, influence their intention to act.

Increasing Cognitive Dissonance

Helping clients to change and enhance their lives can be complex. While the approaches mentioned above can help enhance clients’ self-efficacy, there are instances where clients resist change. This often occurs when a client does not see convincing reasons to act or change their behaviors, and therefore, approaches focused on boosting self-efficacy will not be effective.

Cognitive dissonance emerges when a client has inconsistent thoughts. A good illustration of cognitive dissonance is of an individual who smokes cigarettes but believes that smoking can cause cancer. The two ways to address or minimize the dissonance is quitting smoking or changing the other cognition. According to research, the desire to minimize cognitive dissonance strengthens the intention to change.

One treatment method used to resolve or address client ambivalence about or resistance to change is motivational interviewing. This treatment method assumes that most clients are resistant to change, and therefore, motivation to change may increase or decrease throughout treatment. The treatment method is based on client-centered therapy, where therapists focus on understanding the client’s values and perspectives while showing unconditional empathy, congruence, and regard. Therapists also focus on recognizing and understanding the inconsistency between clients’ values and behaviors. Through the principles of motivational interviewing, a therapist establishes an environment where the client becomes the primary agent of change.

References

Prout, T. A., Wadkins, M. J., & Tatianna Kufferath-Lin, P. (2022).  Essential interviewing and counseling skills: An integrated approach to practice (2nd ed.). Springer Publishing Company.