Friday, March 16, 2012

Change in psychotherapy.

I had a good one the other day. It’s good for the therapist when this sort of thing happens.
Goal setting or contracting for change in psychotherapy is big business. Much has been written about it over the years. One can attend entire workshops on how to set goals or make effective contracts with the client. In many different approaches this is considered a most important part of the therapy process. The client and therapist must both be clear and in agreement about what the contract for change is or the goals of therapy.

Contract process

For example in Transactional Analysis it is called contracting. At the beginning of the session the client states what their contract for change is for that session. This is either accepted by the therapist or if not it is negotiated between the two until an acceptable contract is arrived at. An example of how this is done is shown in the diagram above. It shows seven different aspects of a contract that must be clarified in order to make an effective contract for change.
Sometimes clients change in response to therapy without any contract or therapy being done on the area of the change. The other day I was discussing with a client who can suffer episodes of depression and dissociation how she felt the therapy was progressing. I had seen her about 10 times. Initially I thought the therapy may not go so well or last very long. She began by talking in a very medical way about her difficulties such as about her serotonin and depression. It’s not that I disagree with it, it’s just not what I do when I treat depression. If she wants to do that then she needs to see a psychiatrist not a psychologist.


However she continued and kept making and attending appointments and then we had this discussion. As we talked about how her therapy was going at one point she stated:
“I feel like I have got my hope back and also my diet is much better than it has been before”.

Neither of these had ever been raised by her nor discussed in any of the sessions. I had no idea she even thought of these as possible contracts for change. Indeed she may not have been aware she wanted those until they happened. For example she may not have been aware that she had lost hope. 
These are called spontaneous changes and as has been described sometimes occur in therapy. I have always felt these are a good sign. The Child ego state is sitting by watching the therapy proceed, starts to feel a bit better about self so these spontaneous changes occur.
Also in this instance we have two things that are completely unrelated - hope and diet. If it had been something like hope and trust or hope and closeness then that is a bit more understandable. She was of average weight and neither fat nor thin, it was just her eating habits had changed spontaneously such that she was eating healthier. This indicates the kind of random nature of such changes and that she had never raised either of these in therapy before.

Giving digit

It’s good for the therapist when this sort of thing happens.

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