Posted at 12.15.2018
The present article is a crucial evaluation of the client's account predicated on the therapeutic techniques using the transtheoretical model (TTM) as a platform of change. Specifically, I achieved this client in order to complete the first component of this lesson. Here it will probably be worth noting his delivering problems. In the first place, he told me that he worries about the future. To be more specific, he presumed that he doesn't have the abilities to keep his job. He identified that situation makes him feel troubled, sad and unworthy. Moreover, an other important issue is the fact his daddy has left behind him when he was a child. Therefore, his mom acquired to do two careers in order to raise him. He described his mother as a frosty and faraway person. Also, he feels like his mother has discontinued him as well, therefore, he identifies that he feels lonesome and unworthy. Loneliness is a feeling that he experiences in his current life because he considers that he has noone to share his issues with.
The present article is a critical evaluation of the transtheoretical model (TTM) which is based on my client's profile. To become more specific, to begin with, the TTM is presented briefly. Next, the transtheoretical model is critically talked about as a model for integration of theories as well as the advantages and limitations of this way. Then, the TTM's phases, levels, and processes in relation to my client's presenting problems are offered (Prochaska, & Norcross, 2010). Finally, this essay concludes by describing the knowledge that was received using the TTM as a framework for integrative practice, and present some suggestions for future studies (Glanz, Rimer, & Viswanath, 2008).
The transtheoretical model was founded by James Prochaska and Carlo DiClemente in 1982 (Prochaska & DiClemente, 1982). The transtheoretical model negotiates the behavioral change and how people change a problematic behavior or adopt a confident behavior. Furthermore, the key dimensions of this model are three: a) phases of change, b) the processes of change, and c) the amount of change. The levels of change are six. The processes of change are characterized by ten cognitive and behavioural activities that aid some change. Furthermore, the degrees of change are five. Here it is worth noting that it's very important to encounter in which stage a customer belongs and which one of the levels fits to him better. In this manner, taking in brain the particular level(s) and the level of his presenting issues, one can choose which of the ten functions can use in order to help consumer change. The model also represents some concepts that are dependent variables, ie the decision balance (clients weighs the professionals and cons of adopting the new tendencies) and self-efficacy (self-confidence and enticement). Self-confidence refers to the thought like that he/she may be able to achieve behavioral changes. Finally, temptation is not cured as inability, but as an understanding that will help the client be advanced (Prochaska, & Norcross, 2010).
The transtheoretical style of change (TTM) has both strengths and limitations. To begin with I discuss the strengths of this way. Broad, wide open, and deep are some characteristics of TTM. Specifically, TTM is profound because it consists of a conceptual construction of how (procedures), when (levels), and what (levels) changes. It really is broad because it provides a selection of ideas and techniques. Also, it is open to changes in areas such as phases, levels, and procedures of change. Durability of this model is that TTM can be an integrative model which makes predictions about which of different approaches can achieve success in change, taking in brain the levels and the levels of change. This prediction is not anti-scientific but valid. In addition, TTM's research results can be generalized to the populace (Norcross & Newman, 1992). . Furthermore, TTM combines the periods and degrees of change, in this way, allows the interventions. These interventions aren't only focus on symptom relief, however they also are examined according with their efficacy. For example, Barolow and Wolfe's (1981) analysis showed that clients with phobias can be helped through the changes of the problem that creates his/her phobias. However, 50% of phobic patients drop out or neglect to improve at the situational level. Corresponding to Prochaska & Norcross (2010), that psychodynamic remedy is inadequate to pain relief people suffering with manic symptoms, but it can inspire clients with bipolar disorder, who are in the precontemplation stage, and additionally, it may motivate them consider of your psychopharmacotherapy treatment. Finally, the TTM can be an integrative and not eclecticism model. To be more specific, eclecticism is a cousellor who opt for a range of techniques from different approaches (Hollanders, 2007). However, the integration model challenges to surpass the thought of eclecticism bringing together elements from different approaches (includes theories and models) in to the transtheoretical model (Prochaska & Norcross, 2010)
On the other side, criticizers support that there surely is no many proof in order to establish that the trenstheoretical model is related to changes in health behaviours (Bridle, et al. , 2009). To become more specific, regarding to Riemsma's et al. (2009) organized review of the effectiveness of stage, there is limited evidence for the effectiveness of stage based interventions in changing smoking behavior (Aveyard et al. , 2006, Cahill, Green & Lancaster, 2011) and then for the prevention of pregnancy, sexually sent diseases (Horowitz, 2003), to dietary interventions for individuals with diabetes (Aveyard et al. , 2009) and help obese and heavy people lose weight (Tuach, et al. , 2011). However, a series of studies advised that the TTM's interventions acquired some significant influence on the change of the behaviours (Johnson et al. , 2006, 2008, Noar, Benac, & Haris, 2007). Furthermore, Prochaska (2006) and Spencer et al. (2002) recognized that the studies which found TTM inadequate are badly designed (they may have small sample sizes, poor recruitment rates, or high loss to follow-up).
Another criticism is from West (2005). West said that the dividing lines between your stages are subjectively decided and the TTM makes predictions that are incorrect. Prochaska (2006) responded by stating that the phases are adaptable and the dividing lines must help your client. Furthermore, Velicer's et al. (2007) review exhibited that the level of change is descriptive alternatively than predictive. Besides, Littell & Girvin (2002) argued that TTM represents the movement between your stages as linear without allowing the individual differences. But, in reality, the TTM will not claim that a customer moves through the stages is a linear way, but you have the probability for a client to go back in a earlier stage. Moreover, the likelihood of relapse is higher than the likelihood of two-stage development (Prochaska, 2006).
The central idea of the thanstheoretical model of change is the changing stages and all the other principles run around it. The periods are six (precontemplation, contemplation, planning, action, maintenance, and termination). Individuals who are categorized in the precontemplation stage have no intent to change in the future (usually about within the next six months). Moreover, they may be at this stage because they either don't have any information or have incomplete information about the results of their habit. Another circumstance is the people who have tried often to change in the foreseeable future but didn't flourish in, thus, they don't believe they be capable of change (low self-confidence). Both communities have a tendency to avoid reading, communicating or considering their behavior and dangers. In other approaches, they usually characterized as resistant or as individuals who have no motivation to change, or unprepared for health advertising programs. The other level is named contemplation. At this time, the labeled people intend to change within half a year. In addition, they want to change, nonetheless they have not taken action yet. Furthermore, they are planning of the professionals and disadvantages of changing. This romantic relationship between pros and cons of change can cause high degrees of ambivalence that will keep the client caught up in this stage for lengthy periods. This sensation is often characterized as a chronic concern or chronic procrastination. The name of the next stage is planning. This is the stage in which they want to change in the near future, usually for the next month. They often had taken some significant action in the past, and make an effort to make an idea of action. They realize that they need to do something in order to improve. Thus, they collect information to find available strategies and resources to help them in their try out. Usually, when clients skip this stage to be able to change straight, they are unsuccessful because they have got not sufficiently accepted that they are going to improve their lifestyle. The next stage is called action. At this stage, folks have made significant adjustments in their lifestyle of days gone by six months. The change which often occurs at this time is referred to other solutions as behavioral change, as it is observable change. However, according to the transtheoretical model this change refers to only one part of the entire process. Furthermore, they make an effort to change their behaviour by using a variety of different techniques. Also, clients at this time tend to receive support and help by others. Besides, another feature of this stage is that people depend most on their own willpower. In addition, they develop ideas to cope with both exterior and personal conditions that make them feel pressure. Here it is worth mentioning that for a customer to pass the stage of action, it is important the action which can be used to meet one criterion commonly accepted by the counsellors and it should be sufficient to reduce risks. However, now, as a criterion change is considered only the complete abstinence from smoking. At this stage it is vital to the lookout to all the relapse (DiClemente et al. , 1993). Another stage is called maintenance. People in this stage are still working to avoid relapse by expanding new skills and formulate the guidelines of the lives, nonetheless they do not apply change operations as frequently as those in the stage of action. People usually reach this level after six months. Their enticement to relapse is less, and the self-confidence that they can continue steadily to change constantly improved. The main goal of this stage is to maintenance the desired conduct. Another characteristic of this stage is that they assume that their change is significant and useful. Here it is worth mentioning the concept of relapse and recycling. Relapse is a second stage of change. Relapse happens when folks have didn't maintain a kind of behaviour, thus, they go back to any other previous stage of change. In addition, the term recycling refers to people who believe these are ''recycling'' via the stages. In fact, that occurs before they established their desirable behavior. Unfortunately, both of these tend to be the norm for almost all of the situations. The last but not least stage is named termination. Termination occurs when the clients have not went back to previous action. Furthermore, they have absolute confidence in the ability to maintain the new behaviour permanently in any situation. In fact, often psychotherapy ends before clients terminate totally. Thus, people have a tendency to come back for booster period when they believe that they may get back into the problematic behaviour (Cassidy, 1997).
In my circumstance, a client with most of his presenting issues reaches the contemplation level. To be more specific, he's not at the precontemplation stage because he desires to change. Furthermore, he is not at the planning stage because he hasn't any ways of change and he is not ready to try changing his difficult behaviour. Moreover, he is not at the action, maintenance or termination stage because he hasn't tried to improve something yet. He is at the contemplation stage because he desires to improve, but he has never tried to change his behavior and he has not any strategies to face his problems. However, he did not negotiate the professionals and negative aspects of the change (Prochaska, & Norcross, 2010).
Thus considerably, TTM appears to classify people into categories and choose some specific procedures in order to displace the difficult with the appealing behaviour. However, the procedure of change is not so simple. Thus, it is vital the third key aspect of the transtheoretical model, which is the amount of change, to be discussed. The degrees of change are consisted of five different, but linked with one another levels of emotional issues that are dealt with in psychotherapy. Therefore, a changing in a specific level can result in a change at other level. These levels are a) symptom/situational problem, b) maladaptive cognitions, c) current interpersonal conflicts, d) family/systems conflicts, and lastly, intrapersonal issues. To be more specific, the first level refers to the client's symptoms and the problem which the symptoms support. Here it will probably be worth mentioning the follow example. Symptoms may be advocated by maladaptive cognitions (counter-productive cognitions), which create social conflicts that are experienced in childhood in the construction of family conflicts, which come in the proper execution of intrapersonal issues. Furthermore, it is an important point in treatment when both therapist and consumer agree on the particular level (or levels) where they assign the trouble. Besides, the further down of the scale is someone's level, a lot more unconscious and historical the turmoil is. Therefore, a lot more historical is a client's problem, the greater resistance for some change your client will have. Thus, the further down is the level that has to be transformed, the longer and more technical the psychotherapy would be (Prochaska, & Norcross, 2010).
There are three strategies you can use to intervene at multiple degrees of change. The first one is called shifting. Initially, psychotherapists tend to give attention to symptoms and situations that create the client's symptoms. If your client effectively completes each stage, then your psychotherapy could be finished without another level of change being examined by the counsellor. If the treatment could not be effectively, the psychotherapist shifts his/her concentrate on the very next degree of change. The second category that focuses on the key levels is the certain notion of the next category. In a few certain circumstances if the available evidence is clear and points to 1 key level of causality, then your psychotherapist can first work in this degree of change with the corresponding processes. The last but not least category is the utmost impact strategy. In some instances, there is a specific level of change which appears as cause, consequence, or a maintainer of the client's problems. In this case, counsellors intervene in a manner that engage the patient at every single degree of change. This creates a chain one of the interventions (Prochaska, & Norcross, 2010).
In my case, my client feels some fear due to his idea that he is going to reduce his job because he does not have the abilities to keep it. Thus, he believes that he is worthless. He activities this maladaptive cognition during his workplace, also in other conditions too, like in his family system. In addition, he seems loneliness. He has also experienced this feeling earlier in his life when his daddy forgotten him. Therefore, his mother must do two careers in order to improve him. Because of this he was not seeing her many times. So he noticed lonesome again. Summarizing, both client's presenting issues are a) fear of dropping his job and b) his dad has discontinued him, both these issues have their root base in his years as a child. Hence, taking in my brain the three ways of treatment, I find the second one (focus on key levels). In this way, I can work with the fourth degree of change ''family/systems conflicts'' because I believe it's the cause of his problems (Prochaska, & Norcross, 2010).
Thranstheoretical model includes a number of concepts which work as independent parameters; they called change techniques (which cause the change, ie the movements from one stage to some other). Additionally, these concepts are derived from a number of psychotheraputic models. To become more specific, there are five experiential and five behavioral operations that help the change. The experiential procedures are used mostly for the sooner level of change and the behavioral functions for the later level of change. The five experiential techniques are the followings: a) awareness raising, b) dramatic relief, c) environmental re-evaluation, d) home re-evaluation, and e) self applied liberation. Alternatively, the five behavioural operations are: a) public liberation, b) stimulus control, c) aiding marriage, d) counter-conditioning, and finally, e) contingency management. In the next paragraphs, the interrelation between your stages and operations of change is shown. Additionally, it is mentioned which one of the functions is appropriate for my client according to his stage and level of change (Patten et al. , 2000).
The first of the experiential process is the awareness raising and it can be attained by increasing client's awareness of the causes, repercussions and solutions for a particular problem behaviour, finding and learning new facts and information which helps the change. It is vital for a counsellor (who use this process) to start by exposing client's defenses before they become more conscious to him/her. Client's understanding can be increased through responses, education, confrontation, interpretation, bibliotherapy, and marketing campaigns. Second, through the second processes remarkable comfort (or catharsis), your client initially experiences and expresses negative emotions for the problem, such as anxiety and fear which are accompanied by the reduced amount of their emotions if the counsellor can take an appropriate action. Psychodrama, role performing, grieving, personal testimonies, and press campaigns are examples of techniques that can stimulate the client emotionally. Moreover, both of these processes can be employed at the pre-contemplation stage and help clients move at the next stage. However, consciousness raising methods (psychodrama etc. ) can be applied easier to people in the contemplation stage. People at the precontemplation stage have a tendency to use change processes less frequently than at any other level (Prochaska, & Velicer 1997).
When clients are more aware of themselves and their unhealthy behaviour, they need to reevaluate both their environment and themselves. This reevaluation can be achieved through from both environment and personal re-evaluation process. First of all, the process of environmental re-evaluation combines an emotional and a behavioral assessment of the way the existence or the lack of a person's behavior affects his/her cultural environment. Particularly, it offers the knowledge that he/she can work as a negative or positive model for others. Furthermore, if the problematic behaviour is a result of their core ideals, client and counsellor have to work on themselves. Empathy training, documentaries, value clarification and interventions in the family can lead a client to the re-evaluation of his/her environment. Additionally, the self re-evaluation process combines cognitive and affective assessments of the individual's image of his/her self-image, with and without this difficult behaviour. The value clarification, health role model, and imagery are techniques that can inspire people re-identify themselves. Both of these two techniques above are used by the counsellors when their client is in the contemplation level (Rodgers, Courneya, & Bayduza, 2001).
As clients are in the preparation stage, counsellors may use stimulus control and counterconditioning to reduce client's undesirable behaviour. The characteristics of the stimulus control process are the taking away stimuli that lead to problem action and adding stimuli that cause the suitable behavior. In addition, counsellor's involvement includes avoidance, environmental re-engineering, and self-help categories can be set up to provide stimuli that support change and reduce the threat of relapse. Furthermore, counterconditioning process includes learning healthy manners that can replace the problematic habits. A counsellor can intervene using desensitization and relaxation techniques to reduce the client's stress, cognitive counters to irrational thinking or assertion training can counter peer pressure. Self liberation includes the fact that a person can change, but also the commitment and re-commitment to do something on that opinion. When the individual sets an objective and he/she has multiple options rather than a single choice, then this may improve self-liberation or what people call willpower. Research related to motivation suggests that when people have two options, have better commitment from those who have a choice. People who have three options are even greater commitment, while people that have four or more options have significant strengthening of perseverence. Here it is worth mentioning that prior to the clients move from prep to action stage, they have to focus on their self applied liberation. This process requires an increase in interpersonal opportunities or options especially for people who are deprived or oppressed. The central concept of self-liberation is that the client's attempts play an important role in succeeding in the deal of hard situations, in other words, the thought of self-efficacy. Besides, during this process counsellor must help your client find strategies to change his life. Defend, performance power types of procedures, and appropriate guidelines can result in the increase of the opportunities for health promoting minorities and minority categories and categories with special characteristics, health promotion for people with low socioeconomic position, etc. A similar types of procedures can be applied to help all people change, eg creating non-smoking places, offering balanced diet in schools (eg salad pubs), quick access to condoms and other contraceptives (Velicer et al. , 1998).
In the action level, clients can be helped by behavioural techniques such as counterconditionis, stimulus control, aiding relationships, and contingency management. Contingency management provides effects for the steps that lead to one specific direction. This process may include the use of consequence, but research data demonstrates those changes are centered more on rewards alternatively than punishments. Furthermore, it emphasizes on aid as the school of thought of the model is to work in tranquility with how people change naturally. The increasing of the aid procedures and the likelihood that positive changes will be repeated again include contingency contracts, reinforcements, positive self applied claims and group recognition that facilitate the change. In addition, helping relationships refer to a mixture of care and attention, trust, openness, acceptance and support for the new healthy behaviour. Rapport building, restorative alliance, counsellor telephone calls the consultant, and sets of friends or family can be resources of interpersonal support that help build the desirable behavior. During this stage, therapists can provide skills trained in behavioural operations to facilitate the client's change and decrease the possibility of relapse (Velicer et al. , 1998).
Finally, a successfully maintenance is a consequence of the previous techniques that the client has experienced and of knowing under of which conditions your client is likely to relapse. Also, clients measure the alternative options they have in order never to relapse. On this stage, an extremely encouraging common idea that clients have is that they are more of what they would like to be. Therapists can use techniques such as counterconditioning, stimulus control, aiding interactions, and contingency management to determine the change. Here it is worth noting that these processes are far better when clients strong have confidence in their value and in what they think they are really and not in what the top others see or think about them (Velicer et al. , 1998).
According to the level and the stage of change, the therapist has to decide which one of the therapeutic approaches has to follow. Generally, psychoanalytic functions are most useful in pre-contemplation and contemplation stage. Moreover, cognitive behavioural therapy is most readily useful at preparation, action, and maintenance levels. Furthermore, Roger's person-centered therapy is employed as basis for an effective therapeutic relationship. In this way, this process reduces the distance between stage and degree of change facilitating the client's change.
In my circumstance, the client's presenting issues are both at the contemplation stage; therefore, it would be used psychoanalytic operations such as consciousness increasing (methods), environment and personal re-evaluation. Furthermore, as it was discussed earlier, it is vital both two showing issues at the fourth degree of change to be worked well (family/systems discord). It's important to use psychoanalytic techniques because in the forth degree of change psychoanalytic and family/systems remedy is commonly far better than the others. For instance, behaviour therapists give attention to the symptoms and situational problems, cognitive therapists give attention to maladaptive cognitions and psychoanalytic therapists give attention to intrapersonal issues. To be more specific, to begin with, how aware is this client about his poor behaviour and exactly how this behavior is interrelated along with his family system has been inspected, because the knowing of his problem had not been very clear at the prior session. Then, functions such as environment and personal re-evaluation as they were discussed in the aforementioned text can be used (Prochaska, & Norcross, 2010).
To summarize, the present essay is a critical discuss about how the processes, phases and levels are related with my client's profile. Here it will probably be worth noting the data that was received utilizing the TTM as a framework for integrative practice. First, it is vital for both customer and therapist to just work at the same level. For instance, if a counsellor tries to utilize his/her consumer at the action stage but, your client is precontemplator then, the client may assume that the counselor is insensitive and coercive. Second, the meaning of the levels is the main organizational idea of theory. Stages symbolize the dimension of the time, not by dealing with the change as a single event but as a process that does take time. Third, your choice of the change originates from your client. Finally, if a therapist matches the client's level and level of change, he/she is able to use the correct process(es) of change. Moreover, the transtheoretical model has both strengths and restrictions. Thus, there's a need for further research (Prochaska, & Norcross, 2010).
More theoretical parameters should have a part in future studies, such as operations of resistance, framing, and problem severity in order to see if such variables connect with the predict process of the stage. Finally, it should be important to look at the framework or intergration of techniques and periods of change through a range of bevaviours (like exercise) and extinction behaviours (like smoking cessation) (Glanz, Rimer, & Viswanath, 2008).
Na balw sto dior8omeno arxeio thn paraktw protash: Na grapsw gt to transtheoretical legetai diaewritiko, dld oti sundiazei tis alles prosegkiseis k. a. To allazw se intrapersonal.