GIVE A SHIFT –Changing for the better
Navigating Waves of Change –
May 6, 2017
“The only one who likes change is a wet baby.”
From our own observations – perhaps even our own struggles, we recognize that change can be difficult. People fall into yo-yo dieting, go through repeated attempts to stop smoking or to become alcohol /chemical free. In their book Changing For Good, Prochaska, Norcross, and DiClemente break down the process of change into manageable steps. Since change is not merely a cognitive process, psychodrama offers powerful tools integrating cognitive, emotional and somatic aspects of self; this helps support these six stages and strengthens the potential for sustained change.
Our primary goals in this workshop are to introduce participants to the stages of change and to identify some applications of psychodrama to the stages of change.
The stages of change are: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, and Recycling. These stages are not a one-way street. We prefer to imagine these as a treasure map. At times, we might find we have circled around, or need to go back to pick up a few more clues before finding our treasure – consistent, positive changes in our lives. Let’s start by exploring each of these stages:
PRE-CONTEMPLATION: At this stage, there is no movement towards change. An individual might be oblivious or in active denial about an area worthy of change. They might have attempted change several times, and have given up any hope that change can occur. The person at this stage will frequently be defensive. Rationalizing or externalizing blame & responsibility are typical reactions. The problem areas are often be evident to others, but do not register with the individual. The individual may be caught up in the safety of the familiar; there is therefore minimal motivation to step off known pathways into the unknown.
Due to the strong defenses at this stage, direct confrontation or challenge tends to be less effective. Due to this lack of awareness, it is unlikely that motivation for change will develop in an individual functioning in isolation. The task for this stage is to raise consciousness, to let a person know there is a treasure map within their reach. From a psychodrama perspective, there are several useful tools for increasing awareness of problematic behaviors. Since direct confrontation risks increased defensiveness, using a psychodramatic mirror can be a gentler means to expand an individual’s perspective. One important set of questions weaves throughout the process of change. This is to reflect on what a behavior does for me and what that behavior does to me. What are the benefits, protections, purpose of maintaining a behavior? What are the costs, consequences, impact of these behaviors? These might become clearer to an individual through use of role reversal. Having clients develop their social atom is another doorway into considering alternative perspectives. Role reversal opens questions regarding how others might experience the current dynamics.
As an individual begins the shift to the contemplation stage, some questions to bring into any psychodramatic intervention could include:
- Who/what helps you observe your current behavior compassionately?
- Who/what helps you believe change is possible?
- Who in your social atom – living or dead- might sabotage potential changes?
- Who/what helps you see what you can change and what is outside your control?
- Who/what helps you focus on yourself, not on changing the world around you?
- What are your strengths – internal and interpersonal – that you can draw on during this stage of change?
CONTEMPLATION: As an individual breaks through denial, he or she moves into the contemplation stage. You might observe wishful thinking, yet at this point the individual is not yet sufficiently warmed up for change. Evidence of this shift can include growing acceptance or ownership for the issue. An individual may now be willing to talk about difficulties. Defenses are not gone, yet they are lowered. Some of the residual defenses can include being problem-focused rather than goal-focused. Sometimes a person expresses new enthusiasm or energy – think of our hopes when making New Year’s Resolutions. This stage can also hold fear, as an individual recognizes there are options beyond the previous scripts. This is a point of actually looking at our treasure map, and recognizing its worth. There are lands beyond our familiar borders that hold pitfalls and rewards. This is often a time of gathering accurate information regarding problems and solutions. This can also be a period of strong ambivalence. Imagine Bilbo Baggins, torn between his comfortable hobbit home and the adventure of seeking treasure. From a person’s social atom, the task at this stage is eliciting empathy and support, rather than criticism. This can therefore also be a time to help people role train assertively and clearly asking for their needs as well as how they prefer this support is offered.
This is often a time when cognitions shift. Possibly the individual is open to an intervention. Sometimes an external event becomes motivation for change: the alcohol-related accident or near accident, the friend who was hospitalized or died from poor health choices. Therefore, this can be a time to effectively activate and incorporate emotional responses.
Psychodrama offers a number of tools for reinforcing transition to the contemplation stage of change. Rather than waiting for a ‘near miss’ event, potential consequences can be brought into psychodrama enactments. The ambivalence of this stage can be explored through spectrograms or split screen dramas – sculpting the two forks of choosing inertia or change. Another tool for exploring ambivalence is the Diamond of Opposites. This can be done in action or as a paper and pencil exploration of ambivalence. This stage has its own applications for using a social atom. As a person approaches a personal, internal decision to change, social atoms can raise awareness of how others might support or sabotage. This is a time to examine self-sabotaging behaviors. Perfectionism, waiting for the perfect moment to initiate change, or other defensive patterns can undermine the likelihood of change. Psychodramatic encounters allow an individual to compassionately explore his or her defenses. Understanding defenses can help a person assess the benefits and costs of remaining the same and the benefits and costs of changing. One psychodrama option would be to explore these four points through a locogram. This could be done by marking each zone on the floor and allowing the protagonist to speak from each quadrant. Psychodrama may help the person develop his or her imagination regarding what might occur through the process of change, or to try on the role of a new self-image.
As an individual works in the contemplation stage, there are areas to attend to during psychodrama interventions:
- What is the impact on you and on your social atom if you change? If you remain as you are?
- What are the cost and gains of remaining the same?
- What are the costs of changing? The gains of changing?
- Do you have the facts, the data you need to make a thoughtful decision?
PREPARATION: This is a pivotal step in changing. Sometimes, in the enthusiasm of the contemplation stage, a person works past ambivalence and leaps into action without adequate warm-up or preparation. As we leave what is familiar to journey on our treasure hunt, we need to be sure we have a coherent map and sufficient supplies. We will likely not have our familiar road signs to guide us, yet we fear returning to old patterns. This is a time for recognizing resources, internal and interpersonal. Identifying specific clues or road markers in our treasure map is an important step in making and sustaining change. There is potential to increase a person’s warm-up to the change; this can often occur during the enactment of a psychodrama.
“None of us suddenly becomes something overnight. The preparations have been in the making for a lifetime.” Gail Goodwin
It is important to help the individual create manageable steps and goals. This process can include trials and explorations as we reassess what is meaningful and effective in promoting change. It is a time when commitment increases. A person is choosing to change and accept his or her responsibility for this decision. This is a time of acknowledging ‘If you’re not part of the problem, there is no solution.’ Typically, at this stage, individuals will set a goal date within the next several weeks. Comments like “I’ll be ready next year”, when it’s only May, suggest someone is likely still in the contemplations stage or struggling with ambivalence. Sometimes people don’t share their goal, out of fear of public failure. “What if I tell my family I’m seeking fortune and come back empty-handed?” However, creating accountability is actually a strong indication that the person has resolved ambivalence and is committed to change.
There are a number of psychodrama interventions appropriate to this stage of change. Preparation is strongly connected to Moreno’s principles of warm-up. An important part of your journey with an individual at this time is fostering healthy warm-up. This can be reinforced through future projections to increase hope and enthusiasm. If there is fear over sharing their plans, they can practice telling significant others through role training. Again, the social atom can be a template for considering who to engage in the planned changes. It is also important to role train these individuals how to support you. For example, some people engage an exercise program modeled as ‘boot camp’; for others this would mark their first and only visit to the gym. How can key individuals reinforce your goals in a way that is valid for you?
Part of preparation is to consider alternatives to the old behaviors. It is critical for the individual to create specific concrete plans that can be managed in small steps. Trial and error is typically not an effective strategy. However, psychodrama allows a person to explore new behaviors or roles in a safe environment. Action explorations can be a powerful way to identify when goals are too general or large and to create more realistic, detailed plan for change. It offers a safe stage for trying out potential steps. Metaphor can be a useful psychodramatic tool. For example, individuals can imagine a set of stairs, and identify a goal on each step. Consider who might walk up these stairs with them. Utilize the image of the treasure hunt. Are there dangers on the path? Where are there caches of supplies? Is there a safe harbor or an oasis to rest? Help them identify any self-sabotaging beliefs and any positive reinforcements and work at balancing these through sculpting and role reversals, using auxiliaries and objects.
In navigating this stage of change, be conscious of the principles of warm-up:
- What awakens your anticipation?
- What helps you clarify your awareness of what can be accomplished?
- Are these goals reasonable, manageable, and measurable?
- Who in your social atom are your strongest advocates in this change?
- Who might undermine or sabotage your goals?
ACTION: The transition from preparation to action takes time, energy and commitment. Actually embarking on change not only impacts the individual but his or her social atom. It creates demands that others also change; this might trigger resistance. Just as one psychodrama is unlikely to fully resolve a complex issue, action requires several steps. The act of change demands multiple skills, internal commitment & courage, and negotiating interpersonal dynamics. Sometimes an individual only shifts from one self-medicating behavior to another. Moreno differentiated between the catharsis of abreaction – (the sudden release of emotion, which can offer brief respite) and the catharsis of integration – (when we make the internal shifts that support long-term equilibrium and a healthier self.) This understanding can serve as a template for assessing changing for good rather than simply shifting to a different problematic pattern.
Part of this stage includes facing your shadow. The archetypal treasure hunt always holds obstacles or pitfalls. What might undermine our new behavior or entice us to return to the familiar patterns of old? These can include an internalized critic, perfectionism, pressure from others, or backing down after realizing how change creates ripples throughout your social world.
“And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.” Anais Nin
Psychodramatically, we can offer role training and safe places to try out these changes and help them become more familiar. We can help an individual assess his or her social atom, examine the impact of change, and develop options for addressing these. Interventions include concretizing both internal and interpersonal strengths and resources. An individual can use role training to explore healthy, active diversions from the old behavior. These could include warming him or her up to exercise, relaxation, new hobbies as positive alternatives to the old patterns. After an individual is well connected to resources, you can facilitate an encounter with the negative introjects or the sabotaging individuals. This is when future projections can be useful; helping someone concretize and image the end treasure can reinforce and reward the energy investment in change.
“You may be disappointed if you fail, but you are doomed if you don’t try.” Beverly Sills
In working with psychodrama, some areas to keep in our awareness are:
- Who/what helps you to commit to this change?
- What thoughts, attitudes or individuals could sabotage your goals of change?
- Who/what helps you distinguish mere action from authentic change?
- Who/what keep you in perceptive – this is neither the first nor final stage of change?
- What are your strengths – internal and interpersonal- that you can draw on during this stage of change?
“You may never know what results come of your action, but if you do nothing there will be no result.” Mahatma Gandhi
MAINTENANCE: Maintenance is far from a static stage. It embodies Moreno’s concept of catharsis of integration. On a difficult journey, an individual can become homesick for the familiar places. Likewise, we can have euphoric recall regarding old behavior patterns. One task of maintenance is facing these thoughts and feelings directly. 12 step groups refer to ‘keeping the memory green.’ It is helpful to remember the cost of these old behaviors, yet also acknowledge what purpose they served. This can help identify potential areas of relapse and encourage an individual to continue developing tools that promote better choices. Was care-taking a way to mask poor self-esteem? Maintaining greater self-care and healthy boundaries offers another means of building a positive self-esteem. Was smoking, binge eating or alcohol a way to manage stress? New behavior means not only stopping these behaviors but finding healthier choices.
Identifying potential or early small lapses supports the stage of maintenance. Once a person is highly warmed up to old behaviors, it will be harder to choose an alternative path. One task in maintenance is to identify high risk situations, and develop early interventions for addressing these. This can include internal steps, or thoughtful decisions regarding our environment: attending alcohol-free events, choosing heart-healthy items on the menu, clearing out addictive substances from the home. It might include renegotiating relationships.
Sometimes people avoid talking about changes they have made, out of fear they might relapse. However, letting others know your progress will likely support your maintenance stage. You both elicit support from your social atom and include those who can keep the memory green regarding past unmanageability.
There are a number of ways that psychodrama supports maintenance. Obviously, encouraging a protagonist to enact celebration dramas is an opportunity to claim success within a group. Psychodramas can be used to help an individual remember the negative effects of the old behavior in action. As director, you might observe a protagonist appearing overly confident in a drama. Helping this person recognize potential risks can reinforce maintenance as a challenging stage- the work of change is ongoing. Psychodrama can provide a safe venue for practicing skills to address high risk behaviors. Moreno said “the body remembers what the mind forgets.” Using action to reinforce resources and skills can make them more available when needed. Helping an individual sculpt his or her relationship to the old behaviors and the new behaviors offers a three dimensional view that can consolidate positive change. As with other stages, creating future projections can reinforce an individual’s goals.
In directing psychodramas involving this stage of change, some areas worth keeping in your awareness or including in concretizations:
- Who/what helps you consolidate the positive effects of your change?
- Who/what nourishes your commitments to maintain change?
- What did your old behaviors do for you, internally or interpersonally?
- What are specific, healthy alternatives? How can others be part of sustaining these alternate choices? “Life itself is the proper binge” Julia Child
RECYCLING: Change is a gradual process and relapse into old behavior is one of the common symptoms. Some studies show that only 20% of individuals succeed with change on their initial attempt. When we find we’ve meandered back into familiar patterns, our response impacts our long-range goals for change. Do we respond to relapse with shame? Do we accept defeat and return to a pre-contemplation stage? (“See, I will never be able to change…”) Do we go back to considering the full impact of what change means, and identify areas that we might have missed during our earlier stage of contemplation? Did we simply substitute one problem for another, rather than seek out authentic change? Do we reassess our planning and preparation, and adjust these, based on additional knowledge or insight? Did we have a plan for change that we stopped using? What is needed to recommit to action?
“We transform our struggles into sweet moments by learning to explore rather than combat our circumstances.” Jeff Code
Using the perspective that we learn from our mistakes and integrate from our successes, recycling can become a discovery experience, rather than a shaming one. In this approach, mistakes will often lead to more detailed preparations and to new and more productive action steps.
“If you have made mistakes…there is always another chance for you. You may have a fresh start any moment you choose, for this thing we call ’failure’ is not the falling down, but the staying down.” Mary Pickford
There are a number of ways to explore recycling through psychodrama. An important focus is minimizing toxic shame. Helping an individual connect to his or her self-compassion allows someone to explore a lapse as an opportunity for growth. Replaying a lapse situation in psychodrama can help a person identify the stage of change that needs to be revisited. If an individual was not prepared for maintaining change, consider if he or she had sufficiently developed the roles needed for sustained change. Moreno described role development in three stages: role taking, role playing, and role creating. Psychodrama is useful to help develop and strengthen recovery roles.
“When we can begin to take our failures nonseriously, it means we are ceasing to be afraid of them. It is of immense importance to lean to laugh at ourselves.” Katherine Mansfield.
In working with an individual in the recycle stage, some themes to attend to include:
- Who is supporting you at this time? How can you strengthen this relationship?
- Who is likely to shame you? How might you set boundaries in this relationship?
- Where is self-compassion, as an individual explores a lapse?
- How can I renew my commitment to my goal? Is my future projection one of failure or hope?
In this workshop, we hope we’ve sparked enthusiasm & creativity regarding ways psychodrama integrates with the stages of change. As we frequently observed in this presentation, change involves not just the person but also his or her social system. We made several references to social atoms. There is information on social atoms available, including an article at www.dreamer2doer.com. Additional information/resources are available on topics such as the Diamond of Opposites, sculpting and psychodrama. www.asgpp.org and www.psychodramacertificatin.org identify resources for finding training in psychodrama and action methods in your region. The website: www.authentichappiness.com incudes a page of questionnaires. The VIA Survey of Character Strengths is a wonderful tool for helping people identify and honor their gifts and resources.
Estelle Fineberg, LCSW, LMFT, LMT, TEP
Stephen F Kopp, MS, TEP