Psychotherapy Key Terms: Transtheoretical model

Termination

A "stage" of change that occurs after maintenance, in which one remains at a healthy level of functioning and does not relapse. No real way to measure, other than death.

Dramatic relief

A catharsis process of change; watch or read an emotional movie/play/book and have an emotional reaction. Most often used in the precontemplation stage.

Consciousness raising

A change process characterized by education and feedback. In the transtheoretical model, considered most effective in moving clients from the precontemplation to the contemplation stage.

Self-reevaluation

A change process in which a person assesses which values she will try to actualize, act on, and make real, and which they will let die. May involve change in sense of self, if problems are central to a person's core values. Occurs after a client becomes more aware of herself and the nature of her problems. Most commonly used in moving a client from the contemplation stage to the preparation stage. Includes REBT, cognitive therapy, Adlerian therapy, and ACT.

Self-liberation

A change process in which an individual learns he possesses the autonomy and power to change his life in key ways. Must also accept that coercive forces play a part in life. Ideally results in a sense of self-efficacy, in which a person believes that his efforts play a critical role in succeeding in difficult situations. Most commonly used in moving people from the preparation stage to the action stage. Includes Adlerian therapy, existential therapy, motivational interviewing, behavior therapy, ACT, DBT, and more.

Stimulus control

A process of change in which an individual controls the presentation of certain stimuli. Includes sleep hygiene, keeping healthy snacks in the house, and keeping alcohol out of the house. Most often used in the action stage.

Relativism

A therapeutic developmental perspective that recognizes there are many right ways of doing things, and eclectically chooses whichever "works" for a given situation. This technique runs into problems when there isn't a single right answer for a given situation, or when the therapist is forced to know many perspectives.

Shifting levels

A treatment strategy in which the therapist begins working at the symptoms level, and then if treatment does not make progress, moves in order through deeper levels of analysis: maladaptive cognitions, current interpersonal conflicts, family/systems conflicts, intrapersonal conflicts.

Maximum impact strategy

A treatment strategy that engages complex case patients at every level of change

Key levels

A treatment strategy that identifies a primary area of conflict, and then focuses on the according level of analysis.

Processes of change

Covert or overt activities that people engage in to alter emotion, thinking, behavior, or relationships related to particular problems or patterns of living. Include consciousness raising (psychoeducation and feedback), catharsis (corrective emotional experience and dramatic relief), choosing (self-liberation and social liberation), conditional stimuli (counterconditioning and stimulus control), contingency control (self and environmental re-evaluation), contingency management, and the therapeutic relationship.

Transtheoretical, transtheoretical model

Describes a model of therapy that aims to draw from the entire spectrum of major theories. Respects fundamental diversity and essential unity of psychotherapy systems. Emphasizes empiricism. Accounts for change both within and without therapy. Approaches psychotherapy by assessing the client's stages and levels of change, and the implementation of according processes of change. Based on theoretical complementarity; aims to match level of change and stage of change with a targeted psychotherapy. PROBLEMS: • Comorbidities: you can be in multiple stages at once • CBT includes psychoeducation, which should affect earlier stages than preparation • How to move through stages of change? Switch treatments? No mechanism given • What even is intrapersonal conflict? The model has general support. Most researched and supported with respect to health behaviors (e.g., smoking). It may boil down to "when to use MI."

Dualism

In Perry's model of theoretical development, dualists see the world in terms of polar terms of right/wrong, true/false, good/bad. Dualistic students expect to learn the one right way of doing things [therapy] and reject that there may be multiple right ways or nuances to each way for different situations.

Preparation stage

Individuals intent to take action and report some small behavioral changes, e.g., smoking a few less cigarettes. Individuals have not reached a criterion for effective action (e.g., abstinence). High levels of contemplation and action. Example: a client has begun to cut back on drinking, but still drinks. Need to set goals and priorities, dedicate selves to change. Self-liberation is the key process of change.

Environmental reevaluation

Once a client has an idea of himself and the nature of his problems, he deeply considers the effects his behaviors exert on the environment (particularly loved ones). Most commonly used in moving a client from the contemplation stage to the preparation stage. Includes REBT, cognitive therapy, Adlerian therapy, and ACT.

Contingency management

Reinforce adaptive behaviors; very rarely punish maladaptive behaviors (aversive conditioning). Most effective in the action and maintenance stages.

Relapse and recycling

Sometimes, when people are in the maintenance stage, they experience symptoms again (relapse) and have to go through the stages of change again (recycling). Interventions include transtheoretical relapse prevention (self-management training to teach skills such as understanding relapse as a process, indentifying and coping with high-risk situations and cravings, reducing harm of relapse and learning from experiences, and achieving a balanced lifestyle of moderation) and MBCT.

Stages of change

Stages through which individuals progress when addressing problems. Include precontemplation, contemplation, preparation, action, maintenance, [relapse and recycling], and termination. Each stage benefits from different treatment methods.

Levels of change

The hierarchically organized, interrelated levels of human functioning, which can be targeted in psychotherapy. Include symptom/situational problems (behaviors and moods) maladaptive cognitions (negative thoughts), interpersonal conflicts (grief, role dispute, role transition, interpersonal deficits, and single-parent family in IPT), family/systems conflict (acculturation and discrimination), and intrapersonal conflicts (acting against oneself). Problems at higher levels are considered simpler to treat. Problems may exit at many levels. Different therapies target different levels.

Theoretical complementarity

The idea that different systems of therapy can be used to complement each other, as a client moves through different stages of change and addresses different levels of change.

Action Stage

The stage of change associated with the most overt behavioral changes and time and energy required. Defined as having successfully altered a problem for a period of 1 day to 6 months. Successfully altering a problem requires a completed criterion — complete absence from smoking, not simply cutting down (which would be considered preparation)

Maintenance stage

The stage of change following action, after the most dramatic gains have been made. In this stage, aim to prevent relapse and consolidate gains made during action. Defined as remaining free of a chronic problem and/or consistently engaging in a new incompatible behavior for more than 6 months.

Precontemplation stage

The stage of change in which a person is unaware of the problem, denies that a behavior is a problem, or is unaware of what behavior is causing associated problems. There is no intention to change the problem behavior. Example: a client seeks treatment for anxiety and insists that his constant drinking is fine. In order to move ahead, a precontemplator needs consciousness raising or dramatic relief — to become aware of the problem.

Relapse prevention

Treatment to reduce the likelihood of relapse and recycling, for individuals in the maintenance stage. Include transtheoretical relapse prevention (self-management and skills training focusing on: understanding relapse as a process, identifying high-risk situations, learning how to cope with cravings and urges to engage in addictive behavior, reducing the harm of relapse and learning from experience, and achieving a balanced lifestyle centered on moderation). Another example of a relapse prevention treatment is mindfulness based cognitive therapy.

Counterconditioning

Treatments that involve changing cognitive or behavioral responses to stimuli. Most effective in the action stage of change; continue with counterconditioned responses in maintenance. Include behavior therapy, Rational-emotive behavior therapy, cognitive therapy, EMDR, exposure therapy, feminist therapy, multimodal therapy, solution-focused therapy, ACT, and DBT.