Monday, February 28, 2005

A mind is a difficult thing to change: Part 2--Therapeutic change

In Part I I revealed my plans to write a series of posts about the process of intra-personal political change. I've got a bunch of posts planned on that topic, but this isn't one of them. Before I tackle political change, I think it would be helpful to offer an introduction to a generalized theory of therapeutic change as a foundation. So here is a somewhat dry (and, mercifully, relatively brief!) introduction to the topic of how therapists view the process of change in therapy.

Of course, like any other discipline, therapy has no lack of theories from which to choose. But the one that made most sense to me when I was studying marriage and family therapy was the idea that change can occur on any--or all--of the following dimensions: cognition, feeling, and behavior (another way to describe the three would be thought, emotion, and action). I would also add a fourth, the spiritual, but for the purposes of therapeutic change or political change we can safely ignore that one. (Although political change does have something in common with religious conversion in the sense that it involves leaving a social group and changing a deep and powerful belief system, spiritual change appears to occur by quite different mechanisms--and, what's more, I didn't study it.)

Different schools of therapy approach clients through different parts of this troika of cognition, feeling, and behavior. For example, (surprise, surprise!) cognitive therapists work on changing thought patterns, many psychotherapists work on feelings, and behavioral therapists work on--well, behavior. But a therapist can also work eclectically and choose to approach on any of these dimensions, and that's the method that made most sense to me, choosing the point of intervention based on the particular presenting problem. Intervening to change one dimension could end up changing another, and ultimately changing them all. The idea was that lasting change could start anywhere, but would then (at least, ideally) cause a ripple effect that would end up changing the family or individual on all three dimensions.

To use a very simple example with an individual: changing a thought ("I'm ugly") could lead to a change in behavior (going out more) that could lead to a change in feeling (from depression to joy). It usually seems much easier to start with either a thought or a behavior, because they are fairly easy to define and describe (to operationalize). Usually the change in feelings would follow the other changes.

Here's another way to conceptualize it, if you're familiar with old Broadway show tunes. The song "A Puzzlement" (lyrics here) from Rodgers and Hammerstein's "The King and I" is an excellent example of a person in the throes of cognitive change (actually, it's also an excellent example of someone in the throes of intrapersonal political change, but that's getting ahead of my story). The song "I Feel Pretty" from "West Side Story" (lyrics here) is an example of someone for whom feelings--in this case, of course, being loved--have transformed cognitions, and even behavior. And the song "I Whistle a Happy Tune" from "The King and I" (lyrics here) is a classic example of how change on the behavioral level--acting "as though"--can lead to change on the other dimensions.

Of course it's rare that things go anywhere near that smoothly. I have in my possession a text entitled, "Mastering Resistance," by Carol Anderson and Susan Stewart. The entire book is devoted to dealing with the roadblocks clients put up to resist change, because change is so hard. There's even a word for it in family therapy--homeostasis--the tendency of the family system to resist change.

So, that's it for today. Class dismissed. No quizzes.

[ADDENDUM: For Part III, go here.]


At 10:00 AM, April 15, 2007, Blogger Shario said...

very usefull post... thanks


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