Written by: Gary McFarlane, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
I never take it for granted when I get to come alongside a new client when offering counselling. (I call it Therapy, but may use the term interchangeably). For everyone of them, there is a journey that I won’t know about, as to how they find me and arrive in Therapy. This poem by John T Wood, encapsulates it really well:
“Poem for Every Person
From: John T. Wood, How do you feel? (A guide to your emotions, 1974)
I will present you parts of myself slowly, if you are patient and tender. I will open drawers that mostly stay closed and bring out places and people and things, sounds and smells, loves and frustrations, hopes and sadnesses. Bits and pieces of three decades of life that have been grabbed offin chunks and found lying in my hands.
They have eaten their way into my memory, carved their way into my heart.
Altogether ... you or I will never see them ... They are me. If you regard them lightly, deny they are important
or worse, judge them, I will quietly, slowly, begin to wrap them up, in small pieces of velvet,
like worn silver and gold jewelry,
tuck them away in a small wooden chest of drawers and close”.
Skilled Therapists know that as a very least “Do no harm”. Yet, unwittingly perhaps, some clients emerge with a wariness of future Therapy and it may be many years before they go back into such a process.
As a Relationship Therapist who has worked with hundreds and hundreds of individuals and couples, I find the adage to be entirely true – “Marriage/Partneredship commitment is the place of our healing. Don’t leave it to quickly”. Why? Because we are destined to encounter the very same issues at some point in our future; so, consider working them through in that relationship and then be in a better place to make an informed decision about leaving or staying. (I am not of course advocating remaining in an abusive relationship).
So often the experience for many is reflected in the truth of: “Going Home Again: but love don’t live here anymore…”. When the work-life balance is challenged and all is not well at home, it affects life in the workplace. We must either change or change will happen to us.
We were made to be in relationships and strive to be and remain in relationships. If there is any doubt, consider the impact on mental health toll of Covid-19 restrictions and isolation. Consider the increase in single occupancy dwellings. Also the increase in the mobile phone market, as we use them to nurture relationships. The full extent of the impact on mental health well-being from Covid-19 restrictions to interaction, is still manifesting.
Only for so long can we keep up appearances, using defences to hide the inner turmoil that breakdown in our close relationships can have upon us. Stuff happens! Life stages can throw some unconscious behaviours at us. Love and affection are challenged. Our stability in relationships can be tested and shaken. Increased hours in the office, workplace stress, alcohol, porn viewing and drugs are some of the precipitating factors, but which can also become the camouflage that provides a temporary false sense of well-being and security.
Counselling is one such therapy that has the potential to help individuals and couples change their mindset and change their lives. If you change your mind, you can change your life; effectively change the trajectory in which it is heading, with predictable and inevitable outcomes in the future.
Ambivalence that sets in at home, will sooner or later play itself out in the workplace. Transference of our feelings onto other people or projection of own issues, gives the Therapist a clue about possible inner conflicts.
So often our families of origin hold some clues about our later experiences that we go through at given points in our lives. There may be family scripts (as a way of behaving) that we have sought to cast off, which mould us and cause us to follow particular patterns of behaviour. After all, the child learns to be a parent from their parents. Unwittingly, batons get passed on; addictions get past on; compulsions get passed on – until there is a resolve that “it stops with me and it won’t pass on to the next generation of my family – the children”.
Re-editing or trying to correct our script, so as to avoid passing it on to our newly created family, is not always successful. Our choice of partner may even have been a part of our attempt at reshaping that script, but we end up re-enforcing it. Trying to blot out the past, cause us to repeat it unwittingly.
Learning and understanding more about our family heritage can free us to positively affect our future. Maybe, the more we know about our families, the better we are at trying to avoid repetitive behaviours.
“You are just like your…”, is rarely greeted as an endearment. Acknowledging an element of truth in the statement can be punishingly painful. Through the backdoor, some of those traits that we sought to reshape, have gained a firm footing.
Hope and history starts to rhyme as we begin a work of understanding self and reconnecting with a lost part of us. Our house can again start to become home – not just a room with a view. Life can start to take on colour again.
The Alcoholics Anonymous serenity prayer is:
“May I have the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference”.
The question posed by Charles Dickens “Shall I turn out to be the hero of my own life…”, can start to be answered in the affirmative, with a little help from a third person – a Therapist.
It Starts with the stages of change and motivation to change
Change interventions are sometimes necessary in life to address lifestyle modifications, aimed at preventing further unhealthy patterns of behaviours, such as compulsions and addictions (whatever they may be). Motivation often focuses on the person’s failure and why they failed the last time. Understanding a person’s readiness to make change; appreciating the barriers to change and helping individuals anticipate relapse, can better improve outcomes and reduce frustrations.
Sometimes we just have to “just do it”. Just go for it and let go of intellectual reasoning. (As Therapists, “We can lead the horse to water, but we cannot make it drink”. Forgive me, I wasn’t calling you a horse! I introduce humour into my work with clients, not seeking to undermine the seriousness of the work; rather to recognise that if we don’t laugh, we will cry).
Promised improved outcomes does not guarantee long term motivation to change. Relapse during any programme, can be viewed as failure. The feeling of failure (especially repeated failure) increases the desire to give up and avoid any future attempts. Labels can stick and create major barriers and blocks to trying again.
Those labels feed into other character traits that may predispose or act as a precipitant to future attempts at change. It is remiss of us to ignore the complexities of behaviour change processes.
Behaviour change is about the measurable modification of behaviour. Some theoretical assumptions about behaviour modification include:
behavioural repertoire is learned
even behaviours assessed as being abnormal are learned in exactly the same way as good behaviour is learned. (We can be predisposed to learning certain types of behaviours)
genetic and other physiological factors influence behaviour and are not neutral. They cannot be ignored
there are processes which cause us to acquire and maintain certain behaviours. They include classical, respondent conditioning, operand or instrumental conditioning
behaviour modification skills can have a direct and tangible effect on problematic behaviour.
One size does not fit all. There are different interventions. Behaviour change has come to be understood as a process of identifiable changes. Understanding the process provides additional tools.
The stages of change in behaviour occurs gradually. A person moves from being uninterested, unaware or unwilling to make a change (pre-contemplation), to considering change (contemplation), to deciding and preparing to make a change.
Genuine determined action then follows. Endeavours to Maintain the new behaviour occur, as well as the potential for Relapse snapping at its heel, to upset the journey towards life-long change.
Let’s look at those Stages of Change in more detail, then the concept of Motivational Interviewing.
Stages of change
Before an individual can even begin the process of change, they should identify the stage where they are at – genuinely at. Only when they know the stage they are at, can they ensure the correct work is undertaken at that particular stage. Work attempted in the wrong stage, is potentially doomed to failure at some point. The right skills must be used at the right stage. This is of paramount importance.
The first one in the Stages of Change cycle is Pre-contemplation. Individuals in this stage are not even thinking about changing the problem behaviour. They may not even see the behaviour as a problem or believe that it is problematic (even if others think it is a problem). They may be so familiar with the behaviour that there is resistance or a block towards change. They may be in denial. The four R’s of Reluctance, Rebellion, Resignation and Rationalisation are present.
The Reluctant pre-contemplators may lack knowledge or inertia to do what they want to do. Information about the problem and its impact has not be weighed up adequately. The Rebellious pre-contemplators have a vested interest in maintaining the problematic behaviour. They are resistant to being told what to do. Coercing, preaching or nagging may hit a rebellious wall. The rebellion may be a resistance arising from childhood insecurities and fears.
The rebellious pre-contemplators may appear hostile and quite resistant to change. It can be quite easy to spot the rebels. They are set in their ways. They argue with even the questions. They make it clear that they will only participate as long as they are not going to be forced to try to change. They use a lot of energy maintaining the problem by resisting any attempts at being told what to do.
The Resigned pre-contemplators are the opposite. Apathy and Lacking energy, means they have given up on the potential for change. The issues are too overwhelming and the number of past attempts and failures have taken a toll. Hopelessness has set in and become encrusted. They believe it is too late for them.
Very different to the resigned pre-contemplator, the Rationalising pre-contemplator believe that they have all the answers. Having weighed up all the risks and odds, they have resolved to stay put; the issues are not that problematic, in the stream of things. (That is what they have told themselves during a conversation with self!). Any conversation with them will become point scoring, placarding and a healthy debate. An example – about giving up smoking? “My grandad was 84 before he died and he smoked 10 cigarettes a day for most of his adult life. What do you say to that”!
(Personality type indicator assessment tests are worthwhile undertaking by all of these individuals, to better understand own propensity. Personality type indicators (as you well know) is not about right or wrong, but gaining greater understanding and insight about own propensity towards a way of working, functioning and doing life).
There is a difference between a risk and rationalising. Some people may genuinely know what the risks are and accept those risks and are not rationalising. They may be seen as unreasonable, but they have assessed the risks. They have exercised their freedom to choose the particular behaviour. They can still be helped towards contemplating change, but the limit of any motivational strategies must be acknowledged. Once individuals have used informed choice, then (for the present) they may not want to even contemplate change; but there is hope for them for a future occasion, where they move from pre-contemplation to contemplation. The work done at this pre-contemplation stage may have been enough to get them ready for some movement later on.
The second of the Stages of Change (moving clockwise) is Contemplation. It is a stage with paradoxes. Just because a person is there, does not mean they will ever move beyond that stage – for many, many years! There is a willingness to consider the possibility of change and hope which change offers, but…
Ambivalence stops them in their track. The contradiction is that change is desired, but something else is awaited. What? An additional incentive; push (off the ledge!); a piece of information; just something. Anything! What? “Just tell me” – “I don’t know what?”
Remember to not minimise the fact that the behaviour does and is serving a purpose! It may not be best choice, but it is serving a purpose nonetheless. It did get the individual through some tough spots in life. Don’t beat up the behaviour too quickly!
The main obstacle underpinning the block to progressing beyond Contemplation, is Ambivalence. It is the main enemy to commitment to change and a prime reason for remaining stuck at the contemplation stage.
Our third in the Stages of Change is Determination. It is easy to think that after Contemplation, the obvious next step is “do it”. In other words, “Action”. No, it isn’t Action; it is what I prefer to call it – Preparation. That more aptly describes what is in the tin!
There is a definite resolve to achieve the shifts and overcome the problem behaviour. It is a practical stage. In order to have a fighting chance of beginning, there is a need to take some practical steps to ensure Action can begin! That might entail putting preliminary things in place, such as setting a date to start; making the appointment to acquire the support – from a General Practitioner; from a Therapist or someone else. Acquire the resources that may be needed; research and obtain literature.
This stage is practical and represents a preparation and not just a determination. Commitment is great, but without appropriate other complimentary skills, progress will be tenuous.
Recognise that even a strong resolve or commitment alone does not guarantee commencing change or achieving change. Enthusiasm is good, but will not necessarily (on its own) achieve “lift off”. Neither can Willpower alone. It can temporarily underpin the resolve, but not create sufficient traction and glue to get to the finish line. I call Willpower, the white-knuckling. It will become an energy drain.
The fourth in the Stages of Change is that of Action. The plan and strategy are in place, ready to implement. The Preparation stage is done and there is an exit strategy in place; even if “no quick fixes”. Hamster wheel patterns of behaviours (otherwise known as Neural pathways), take a while to breakdown, deconstruct and new ones created and constructed). Let go of quick fixes. You can’t have them!
The next stages are Maintenance, Relapse and (Recycling back on the change cycle after a Relapse). Don’t believe the lie. You can change. You can do this; but be realistic as to how long it takes to break down past Hamster wheel behaviours and create those new neutral pathway behaviours.
The action stage might take between 3 – 6 months; even longer for other compulsions and addictions. Remember, you are reclaiming your life, for the rest of your life. The behaviours often have had a few decades start on you. They won’t give up their hold in your life rent free, without a fight, in a matter of just weeks. Get help to stay in there – to Maintain the gain. Often that will involve the support of a Therapist and also a 12 Steps Group.
Maintain the gain for just weeks and after a “cold turkey” effect (that may be mood related and you have apologised for biting people’s heads off just because they asked you if you want a cup of tea or coffee!) – you will see hints of the benefits of a changed life; but there is so much more to come.
Relapse is hounding at the heel of Action. In other words, as soon as Action begins, you then have to Maintain the gain and Relapse wants to take you down. Don’t let it. Don’t yield to the pervasive voice that wants you to return to the comforts of a past life. The old is going, going, gone. In with the new.
Let me do brain surgery would you? I do it on every one of my sex, porn, love addiction client! Multi-talented Therapist that I am. I am going to cut round your skull; lift it off; remove your brain and put your brain on the chair next to you. (Don’t forget to take it when you leave!)
Why do I do something so bizzare? Because I want you to know that your brain (we also call them “Parts”), is not your best friend all of the time. It is well intended. It is seeking to look after and protect you; but it does not always make right or best decisions for you in the moment.
There are times when it will work against you. It will sabotage. That is why I encourage all of my clients to build in “Treats & Rewards” into their programme of change. Over time of the brain experiencing treats & rewards for small incremental good outcomes, I hope (eventually) to entice the parts of the brain to Start to work with you. It likes treats & rewards for good outcomes. Make sense?
There is another reason for doing brain surgery. I want to have a conversation with my clients, but I don’t want their brain to hear. I need to tell them something, but if their brain hears it, the brain may receive it as permission to Relapse. I don’t want to unwittingly give them that message.
The problem is, however, if I don’t give them this message, there are some who do not get up after a Relapse. They write themselves off as not having the Resiliency skills to succeed. Not true. Don’t believe the lie. Yep, you are believing the lie. Stop it.
Here is the message – for you only – not for your brain to hear. All the statistics tell us that very few people achieve the change outcome that they want, from first attempts at change – such as giving up a compulsion or addiction. You are not worse than others. It isn’t true. Get, up, dust off and get back in.
Do you know the story of the Donkey in the well? How did he get back out from the bottom of the well? When copious dirt was thrown down the well on top of him, intended to bury him, he did a jig, by wiggling his body to shake it all off. He did this repeatedly and trampled the dirt under foot, until it built up under foot and elevated him back to the top! Do the same. Yes, you can.
Is it better illustrated by this Poem? There’s a hole in my sidewalk:
Autobiography in 5 Short Chapters
A poem by Portia Nelson, published in her book
Verse I
I walk down the street. There is a deep hole in the sidewalk I fall in. I am lost ... I am helpless. It isn't my fault. It takes forever to find a way out.
Verse II
I walk down the same street. There is a deep hole in the sidewalk. I pretend I don't see it. I fall in again. I can't believe I am in the same place. But, it isn't my fault. It still takes a long time to get out.
Verse III
I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in ... it's a habit ... but, my eyes are open. I know where I am. It is my fault. I get out immediately.
Verse IV
I walk down the same street. There is a deep hole in the sidewalk. I walk around it.
Verse V
I walk down another street.
Do you get it – from this poem?
It is in this Relapse stage that this thing called Motivational Interviewing also becomes a useful process to challenge a pervasive “all or nothing” perspective towards the Change process. In other words, a slip-up spells the end and is doom and gloom, that dictates giving up. No, it isn’t and No, it shouldn’t. Don’t throw in the towel. Don’t throw the baby out of the window with the bath water. Re-assess what you have achieved – even the smallest incremental shift.
Motivational Interviewing (MI) is a concept. What a strange name to call it. The concept evolved from experience with the treatment of alcoholics. Here is a definition of MI: “it is a directive client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence”.
All about coming alongside clients to help them move through the stages of Change. It is not about cajoling, nagging, coercing, pushing or any such attempts. That is not in the spirit of MI. It is focused and goal-directed. Motivation to change comes from the client only. It is work to assist clients get to the Action stage.
Don’t try to do Action stage work if a client is not at Action. They will get indigestion, since they will not be able to use effectively, the tools that are being offered to them. Eventually, they will become overwhelmed and drop out.
MI work therefore, requires an examination of the stages of Change and coming alongside clients at the stage where there are at – to help them. The aim is to identify and mobilise a person’s own values and goals, in order to stimulate an attitude towards behavioural change. It is the person’s task (not anyone else’s) to articulate and resolve their own ambivalence, but there is a coming along side.
The Therapist’s task is to give expression to both sides of the ambivalence and guide the person towards their own acceptable solution that might get them to a place where they decide on change. Remember, MI is about motivating the person towards a decision to change and not necessarily starting the change itself. Here are some further qualities and also ineffective endeavours:
Direct persuasion, aggressive confrontation, preaching, debating, arguing and justifying, are all opposite to MI techniques. Pushing clients to make changes for which they are not ready, can be quite counter-productive.
Direct persuasion and advice giving, aimed at effecting change, is not MI.
Direct persuasion is not an effective method for resolving ambivalence. It is tempting, but it is not the best way. The client needs to own the desire to move to the next stage.
The skills used are much more guiding and showing, so that the client examines and resolve ambivalence.
Readiness to change is not a trait of the person, but is a fluctuating process coming out of the interpersonal interaction. The person’s resistance and denial of the problem are not seen as problem traits, but as indicators of where the person is at.
The therapeutic alliance (which should come out of the Therapeutic relationship) is more of a partnership or companionship; rather than the Therapist taking an expert stance. Therapists respect the client’s own autonomy and freedom of choice (as well as the consequences) for their own behaviour.
They may be wanting to change drinking habits, alcoholism, eating habits (excessive eating or addiction to a particular food), smoking, poor marital or other relational issues; poor communication, parenting, problem with self-esteem, failure to apply Spiritual standards such as in the arena of sex, anger, temper, greed, hording, lack of consistent giving, gossiping, quick tempered, inability to retain others confidences, inability to maintain relationships, addiction to drugs, sex, masturbation, pornography, shopping, food stuff, are all amenable to change.
Individuals move from being unaware or unwilling to consider the possibility of change, to becoming determined, prepared to make the change and actually actioning, sustaining and maintaining the change over time.
Self-help courses are available, but otherwise the skilful help of a Therapist is significantly beneficial. Certainly, we will all need another person to help us, but one that is knowledgeable, since otherwise they can become a block or hindrance – particularly those that are close to us such as a partner. Relapse has to be handled well and with care, to avoid long periods before individuals “Recycle” back onto the Action stage in the process of change.
Motivational Interviewing skills in more detail: A more comprehensive viewing through the lens of MI, will reveal these traits:
Motives as well as motivation are needed to transition from one stage of Change to the next. It isn’t only a matter of moving through all the stages, to get to Action. Resistance, ambivalence and commitment must be understood at each of the stages.
Reluctance to change may mean giving consistent feedback in a sensitive empathetic manner over quite a period of time. (Not quite ”Coaching”, but gets close to it).
The strategy includes highlighting choices. When a choice is made, then ensure they own the choice, as well as (hopefully) good (even if small incremental) outcomes. (That represents the horse drinking – that was led to the water!)
Highlight the inherent skills that they have, including more energy and tenacity and resilience that they actually do possess. Those skills just need to be re-harnessed and re-directed in a more positive and healthy manner – to maximise repeat and consistently good outcomes. Consistent and repeat good outcomes (alongside consistent and repeat Treats & Rewards) act as a glue. The Rebellious attitude is being overpowered and overcome. Get it!
Instil hope by exploring the barriers to change. Our processes are often black & white/all or nothing ways of thinking. Therapists introduce a middle ground, so that we see a continuum on a Timeline of options and possibilities; a challenging of closed mindsets, to increase possibilities, where previously there was none – at least, none visible to the client.
Empathy and Advanced Empathy are skills that can be adopted in the midst of ambivalence and “stuckness”. Empathy skills might involve reflecting back to the client what they are saying; which in turn, causes them to reflect and consider the stance they are taking – as they hear their own words.
Psychoeducation plays an important role. That involves imparting knowledge. Keep an eye out for chasing your tail! When a key piece of information is given, things may shift to needing something else and the journey toward change is a moving feast and even more elusive. Clients already know a lot of what you are going to tell them; but they need to know what they know, that they know what they know, so they know it. Get it!
Watch out that good intentions do not switch over into becoming manipulation, during this work.
A Confrontational approach may be perceived as helpful, but rarely will it be so. The more intense the dialogue, discussion, information giving or debate becomes, the less likely there will be a positive outcome. There is a balance that needs to be achieved, to avoid those skills becoming counter-productive.
Avoid scare tactics, lecturing or nagging. Clients already know a lot of what you are going to tell them; but they need to know what they know, that they know what they know. Get it!
We have to be careful of assuming that the problem has the same meaning to the individual as it does to the Therapist. That would be to impose our script, our ethics, our morals, our way of doing life – upon the client. I call it “the danger of creating Gary clowns, doing life on the planet as I think they should do. That won’t be great for the planet”!
Simply creating space in the silence of a Therapy session is valuable. Don’t be intimidated by the silence. Therapist, don’t be intimidated by the silence. It is a valuable space. Clients get to use the silence to evaluate their own thoughts about the problem, as well as what others (more objectively) think about the problem.
Be reminded that the presence of Ambivalence (a conflict between two opposing choices) is revealing the fact that the behaviour actually served/serves a purpose. It won’t go quietly. There will be a sense of loss if it changes or goes, despite the perceived benefits. There is insight about the benefits of change, the need for change and the advantages of change; but there are definite disadvantages to change and therefore benefits to maintaining the old life style – to the Parts/brain.
Address past attempts at change. A reframing may be required. Rather than them being viewed as failures, clients can be encouraged to see learning outcomes. Just like in the Pothole holes poem above, each time they failed (fell in the pothole), they were actually learning about it, in readiness to utilise the learning to project them into future success. Failure is not failure, but a setting up for success; a lot like the donkey – you get up each time, dust off, recycle back in and continue the stages of Change.
Consider using this Four Square Diagram. (What a strange title – but it does properly describe what is in the tin!). When it is time for step 4 Action, just take first step. If you are at the bottom of the staircase on crotches and need to get to the top; those 21 stairs can seem like Mount Everett; very intimidating. Don’t look to the top; look at the very first stairs in front of you. Concentrate upon getting on the first step; nothing else matters right in that moment. You can do that. Break it down into bite size pieces. Instil a “can do” mentality. You got this.
We owe it to our children (the generation which will follow us), to be the best that we can be. That may involve us having to change so that some others benefit and not inherit our legacy, which gets passed on from generation to generation. Turn life into colour and make it more appetising.
Do it without increasing Shame. That is precisely what The Kairos Centre is about. Contact us. Begin your journey toward change and become the best that you can be and in so doing, leave a great legacy for your generation and not hand on the baton.
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Gary McFarlane, Executive Contributor Brainz Magazine
Gary was previously a Solicitor for many years and has undertaken a career change. He is a Relate trained and experienced Relationship counsellor, Mediator and undertakes Sex Therapy & Sex Addiction treatment all of which are undertaken by various secure online modes including webcam such as zoom and Bilateralbase, with clients from all parts of the country and abroad. Gary has been working Online for some 11 years and holds a certificate in Online Therapy. He is also a member of the National Counselling Society, the Association for the Treatment of Sexual Addiction & Compulsivity (ATSAC) and an Accredited member of the Association of Christian Counsellors and is a member of stopSO. He also practices EMDR (Eye movement desensitization and reprocessing). AI-EMDR, G-TEP, R-TEP and The Advanced Flash Technique, for Trauma/Complex Trauma and unprocessed issues from the past or current.
Gary has created what may be the world’s first comprehensive Online webinar Sex/porn/love addiction Video-on-Demand Recovery Programme, being used by many clients throughout the world.
In July 2023 he launched on his website, a comprehensive Video-on-Demand Online Course (for Singles Pre-Married prep, Partnerships, Couples, Marrieds, long, long time Marrieds/Partners) bringing together his experience with hundreds of Singles and couples over 19 years and a few books written on the subjects.
Additionally, he trains Therapists to work with Sex/Porn/Love Compulsivity/Addiction – which enables them to add that skill set to their tool kit and Counselling practice. Maybe consider Individual or Group Supervision with Gary.
