This assignment is based on my training and within it’s framework I had a session with a client. In this thirty minute session I follow the Padesky’s context to explore and understand better the issues of my client. In this assessment I present a brief history of my client, I introduce the Transtheoretical Model and I discuss the use of this model in regard to my client. My client’s first issue was the anxiety about his job, he was afraid of losing it. During the session my client shared that he didn’t have close friends or relatives, he had a lack of important relationships and he felt lonely and sad. From the discussion it is occurred that his mother worked a lot of hours, she was a detached person and for this reason he believed that he was a burden for her.
2. Integrative Psychotherapy
Integrative psychotherapy is an effort to combine concepts and counseling for more than one theoretical approach. It is not a specific blending of theories but rather it consists of the framework that it is considered to be more useful and effective for working with the clients ( integrative psychotherapy, ). There are four popular routes toward the integration of the psychotherapies. The technical eclecticism, theoretical integration, common factors and assimilative integration. Although recent research shows that each of the four are hugged of self-identified eclecticism and integrationists. The technical eclecticism chooses for the client the best treatment for his problems. This search is guided by data on what has worked best for the others with the similar problems. The multimodal therapy of Lazarus and the systematic treatment selection of Beutler are exemplars of technical eclecticism. On the other side there is the theoretical integration. Two or more theories are combined to treat the client supported by the premise that the result will be better than the constituent therapies alone. The transtheoretical approach of Prochaska and Di Clemente is an exemplar of this theory ( Norcross, J. C., & Goldfried, M. R., 2005 )
3.Transtheoretical Model as a Model for integration of theories
The Transtheoretical Model is an integrative model of behavior change. This model begins with a comparative analysis of eighteen major systems of psychotherapy within the integrative spirit of seeking the best that each model has to offer ( Prochaska, J. O., & Norcross, J. C, â€¦). Each system provides a conherent ,connotation and effectiveness theory of understanding human fuction and dysfuction, trying to give assistance and fostering the individuals that suffer from any kind of problem. Î¤he core construct of this model are the stages, levels, processes of changes and a series of outcome measures like decision balance and temptation/self-efficacy. The stages of change show the temporal and intentional aspects of change and include seven stages. Precontemplation, contemplation, preparation, action, maintenance, termination and relapse. The levels of change depict different levels of psychological layers that could be related. There are five of them, symptoms /situation, maladaptive cognitions, interpersonal problems , family/systems problems and intrapersonal conflicts( Norcross, J. C., & Goldfried, M. R., 2005 ). Moreover, there are the processes of change which are activities that individuals could do to pass from one stage to another or to move through the stages and levels. In this category there are ten activities, consciousness raising, dramatic relief, self- reevaluation, environmental reevaluation, self- liberation, social liberation, counterconditioning, stimulus control, contingency management and helping relationship ( Shinitzky, H. E., & Kub J., ). This model includes, also, different measures as the decision balance reflects the pros and cons of changing and the temptation scales/self- efficacy reflects the intensity of desire in a specific habit in a difficult situation ( Cancer Prevention Research Center).
Strengths and Limitations of Transtheoritical Model
The transtheoretical model has many positives characteristics. First of all this theory could be applied in a wide variety of behavioral problems like smoking cessation, alcohol and drug abuse, exercise, low fat diet, stress management. For these issues there are a lot of evidence-based facts that prove the high grade of efficacy of this model ( Prochaska, J. O., & Norcross, J. C, â€¦). Subsequently, the transtheoretical model recognizes that different individuals will be in different stages. The therapist has to intervene separately because this model isdesigned to develop intervention that match to the individuals needs. For this reason the participation is high enought and there is a small amount of dropouts ( Cancer Prevention Research Center).Transtheoritical model focuses on individual decision making. It could help people that would like to change but it isn’t for people that not have the consciousness to change. Moreover, this model couldn’t help people that don’t have the responsibility from what they do. This model is not sufficient for feelings and emotions that are caused from trauma like , death, crisis, crime, cancer, sexual assault. Many theories claim that this model is mainly a theory for behavior change for addictions and habits and not a psychotherapeutic theory. In addition to, this model isn’t a multicultural model because change as a progress is more common on Western and especially on American ideology but not on the other cultures. For this reason it is an unambiguous theory that can’t be applied to the entire population( Prochaska, J. O., & Norcross, J. C, â€¦).
3. The Transtheoritical Model and the client
The Transtheortitical Model(TTM) , also known as the Stages of change model, uses the stages , the level and the process of change to integrate principles of different theories of integration.
3.1 Stages of change
The stages of change come out of an empirical investigation of the process that individuals used to do for changing their dysfunctional behavior (Prochaska, J. O., & Di Clemente, C. C., 1982 ). Prochaska and Di Clemente found seven stages of change: precontemplation, contemplation, preparation, action, maintenance, termination and relapse. Each of these stages has a different characteristic. In precontemplation the person doesn’t have consciousness of his problems, in contemplation the person is aware of his issues but couldn’t act to solve them, in preparation the person intents to do an action in the near future, in the stage of action the person behaves fuctional for more than six months , in maintenance the person keeps what he tried and in termination the person’s dysfunctional behavior never return ( Sohn, A. ). Finally the relapse in which the person might returns from action or maintenance in the previous stage ( Prochaska, J. O.,& Velicer, W. F.,1997).
The main concern in the case of my client is the anxiety regarding his job. He recognized his anxiety and he tried to cope with it but he couldn’t achieve it. He is in the contemplation stage in which the person recognizes his problem and seriously intends to acts to solve them. For instance:
Counselor: What is your main concern that you would like to discuss with me ?
Client: I think my main concern is how to manage my stress and my anxiety in my workplace. Because feeling stress and anxious it’s not helpful.
The first stage is the precontemplation. In this stage the individual isn’t aware of his issues. My client couldn’t be in this stage because he has consciousness about his problem. The other stage is the preparation in which the person intents to take action in the near future and have unsuccefully experienced in the past years. My client had unsuccefully experienced but he has not intentional and specific plan to be in action. The other stage is the action where the individual modifies his energy and takes action to overcome his problems. Action concludes the behavior change of the person that becomes visible and externally recognized. In this stage the person has changed (Norcross, J. G., & Beutler, L. E., 2002). My client isn’t in this stage because in this stage the person achieved successfully altering problem behavior and my client couldn’t manage it. To confirm what I am saying:
Counselor : OK, you said previously that you try to be relaxed and calmed, I am wondering in what ways you tried? What are you strategies?
Client: I don’t have strategies
Counselor: What did you do?
Client: I said myself be calmed, be relaxed, don’t think about itâ€¦.
But I don’t think that is thisâ€¦
Client: Yes, helpful or efficient, because I cannot manage it, I cannot do it.
For the same reason than previously he isn’t in the next two stages maintenance and termination that include to solve the problem and to have a functional behavior because my client couldn’t achieved to diminish his stress. The other stage is a separate stage and in this the person return from action or maintenance to the earlier stage. There isn’t neither in the relapse.
For the other issue of my client the lack of essentially interpersonal relationships and close friends and relatives. He is in the contemplation, because he knows that he has a problem. He said that it is really problematic and he didn’t want that but he doesn’t do anything to change that yet.
Counselor: I am wondering if there is another concern that you have except from the anxiety of your job?
Client: Another serious concern is the problems that I have with my social life, I do not have a close friends , I cannot make an intimate relationships, I also don’t have a girlfriend there is really sad, there is really problematic, I don’t like it , I need the human touch , I need
Counselor: You tried to be more sociable? In what ways you tried?
Client: I am trying but I think that I am not succeed it
He isn’t in the precontemplation because he recognizes it as a problem. From what he said, he isn’t in the action because he didn’t do anything successful to change this situation and neither the maintenance and termination because he couldn’t achieved anything nor in relapse for the same reason.
The final issue of my client is the issues with his mother. She is a distant person and he get used it. My client believes that he couldn’t do anything to change this situation. He believed that he wasn’t be desirable and he feel desperate , lonely and worthless. For this reason he is in a precontemplation, he doesn’t have consciousness about his issues and the consequences of his mother. Because he doesn’t have consciousness he couldn’t be in another stage only in precontemplation.
The following short section demonstrates this:
Counselor: You said previously that your mother keep distance for you. What did you think about that.
Client: I thought I wasn’t desirable and I thought I am burden for her
Counselor: How did you feel about that
Client: Desperate, and I also think there is nothing or I cannot do something
Counselor: You believe that you cannot do something? You try to do something to change this situation?
Cilent: I think that I am not have the skills or the power or the strength.
3.2 Levels of change
The levels of change represent a hierarchical organization of five distinct but interrelated levels of psychological problems that can be addressed in psychotherapy. These levels are: symptoms/ situational problems, ,maladaptive cognitions, current interpersonal conflicts, family/systems conflicts and intrapersonal conflicts( Prochaska, J. O., & Norcross, J. C, â€¦). The first level is the symptom, the dysfunctional behavior of the client, the second is the maladaptive cognition this is the non- functional thoughts of the client. The next level is the interpersonal conflicts include the environment of the person and the relationship with it, the next is the family conflict the confrontation with the individual’s family and the last is the intrapersonal conflicts this level includes all the issues that a person has with himself. It could be the same client belong to different level of change considering the personality and psychopathology of the client. For choosing the levels in which the client could be there are three strategies that could be employed for intervening across multiple levels. The first way is the shifting way in which the psychotherapist begin from the first level and continue the levels according to the need of his client, the aim of this strategy is an effective therapy. For this reason for the first issue of my client, the anxiety in his work and the thoughts before and after that I might use the shifting strategy. I begin to interfere the symptom and afterwards I continue to the other levels if the treatment isn’t effective. Consequently, the second strategy to choose from what level you begin is the key strategy, this strategy focus on a clear -cut cases in which the symptom is clear and the psychotherapist intervene in the specific dysfunctional area. The second issue of my client, that he hasn’t closed friends, I set to the interpersonal conflicts because he has problems with his environment and he couldn’t have important relationships. This is an open-and-shut case and for this reason I try to interfere in a specific area with the key strategy.
Client: I think in my social life, when I am with people I can’t be touch, be more intimate. I think of myself like not say something improper or something good or not
Final, the third strategy is the maximum impact strategy, in which the situation isn’t unambiguous and many variables are involved at the problem, as a cause, an effect or maintainer. In this strategy the psychotherapist involved the patient at each level of change. And the third issue belong to the family system, he had problems with his mother but he didn’t recognize them very well I could use the third strategy and I engage all the levels of change because he has issues with his mother and enter into to this issue his belief that was burden for her and he wasn’t desirable and his thoughts that he cannot do anything good and his relationships to the others
3.3 Process of change
From a comparative analysis from eighteen leading systems Prochaska and Di Clemente reached ten processes of change (Prochaska, J. O., & Di Clemente, C. C., 1982 ).These processes are the covert and overt activities that people use to progress through the stages and occurred from the empirical research of how people change their behavior with or without professional assistance( Prochaska, J. O., & Norcross, J. C.,2010 ). The first activity is the consiousness raising this involves the raising awareness of personal problem, the consequences and the causes of the dysfuctional behavior. The second is the dramatic relief in which increases the emotions of the clients and fosters the identification and expression of feelings, this activity includes role playing and pcychodrama. The third reported activity is self reevaluation includes the cognitive and affective assessment of the person with or without the unwanted behavior .This activity includes the imaginary and healthy role models as technique. The forth is environmental reevaluation this presented the effectiveness of the no functional behavior in the person’s environment, in this process is used documentaries and family interventions. The fifth is the self- liberation this is activity that helps the person to consider his possibilities and to commitment in his choices these activities are related with the New Years’ resolutions, public testimonies, birthdays and important days for the person. The sixth is the social liberation requires an increased action in social opportunities, this activity includes the helping of the other person with the same issues, group therapy. The next is Stimulus control is the changing from the unhealthier behavior to healthier supported from self- help group, avoidance. Helping relationships include emotional support , acceptance , openness supporting the fuction behavior from the relationship of his environment and contains therapeutic alliance, counselor calls and friends. Contingency management include the internal and external rewards, this activities includes rewards and emphasized in reinforcement with the recognition from the others and positive self- statements. And the final activity is the counterconditioning includes the learning of the healthy behavior that help in the changing like relaxation for the stress, assertion for the peer pressure ( Prochaska, J. O.,& Velicer, W. F.,1997).
My client, for the two of the three issues that he has, is in a contemplation stage. For this reason I could propose he follows the self – reevavaluation and environmental reevaluation activities. In the early stages people could apply cognitive, affective and evaluative processes to progress through the stages ( Prochaska, J. O.,& Velicer, W. F.,1997). Self reevaluation could help my client to evaluate his behavior and to get through more successful behaviors. The environmental reevaluation helps him to understand more the effects of his behavior. I could try he follows activities like to imagine the ideal behavioral and healthy role models. For the stress they could be very helpful activities to understand what is the desirable behavior and for the socialize too. Movement through the contemplation stage, involves increased use of cognitive, affective and evaluative processes of change. To better prepare individuals for action , changes are requires in how they think and feel about their problems and how they value their destructive lifestyles. For the issue with his mother, because he is in a preocontemplation level and in family conflicts level I propose he follows the consciousness raising and the dramatic relief. With these techniques I could try to raising his feelings and to show him the consequences of his behavior.
Theories relate to the process
The theory that I use in my client depending from the stage and the level that he is . Specifically, my client has problem with his anxiety in his work, he is in a contemplation stage , at the symptom/situation and maladaptive cognitions level and he might guide the process of self reevaluation and environment reevalution for this reason I could use at the first sessions the psychodynamic and existential theories. According to the bibliography is most useful during the earlier stages in which is my client- to understand better his situation, when he started, his dysfunctional cognition and behavior and after that when he will be ready to be in action I will try to work in cognitive- behavior theory because this theory has developed specific methods at the symptom /situation level ( Prochaska, J. O., & Norcross, J. C, â€¦). For his social problem , for the problem to be in touch with other people at the beginning I will try to work with psychodynamic and existential theory to analyse more his situation and explore more his difficulty and after that I will work with systematic theory because we work better and the relationships with the every person that he related . For the last issue the problems with his mother because he is in