Abracadabra: The Magical Process behind Second-Order Change
Living things grow and growing things change ~ unknown
Change can appear to be a magical event when we are unaware of the underlying processes that encourage and influence change. What is change? For the presenting client, change is the desire to be/do something different (Miller & Rollnick, 2002). In the field of Marriage and Family therapy, there exists two types of change; first-order change (Nichols & Schwartz, 2008) and second-order change (Nichols & Schwartz, 2008). First order change is “change that occurs within a system that itself remains invariant” (Nichols & Schwartz, 2008). Second order change “occurs when a change occurs in the system itself” (Nichols & Schwartz, 2008). For the student-therapist second order change (Nichols & Schwartz, 2008) signals a change that is significant to the system (the client) and sustainable (Nichols & Schwartz, 2008).
Change that requires little to no client effort and reinforces the idea that there exists a magical formula for change creates false starts and unhelpful dependency. The elements of client motivation (ready, willing and able), the presence of a warm, accepting and supportive (safe, non-threatening) environment while producing the appropriate level of tension (discrepancy) are significant elements in initiating, progressing and sustaining the process of (second-order) change (Nichols & Schwartz, 2008).
First, change happens when the client is motivated (ready, willing and able) (Miller & Rollnick, 2002). Clients present in therapy when “internal and/or external motivation (crisis) or need (events) prompts them to do something different to get something different (change)” (Nelson J., 2009). This “motivation or need” (Nelson J., 2009) is primary to the process of initiating change. This readiness is characterized by the client’s subsequent actions (willingness and ability) (Miller & Rollnick, 2002). Webster’s dictionary defines readiness as an “availability” (attendance) and willingness as a deliberate “action or “choice” (engagement) and ability as the “capacity” (participation). When the client chooses to be different or do something different (Nichols & Schwartz, 2008) and becomes available through attendance, engagement and participation in the process of change (ready, willing and able) those efforts then initiate the process of sustainable change.
The initial and tangible signal that a client is motivated (ready) to change is during the first contact when the client first (willingly) calls to schedule an appointment (Duncan, Miller & Sparks, 2000). The therapist must acknowledge how the client’s attendance and engagement, signals their readiness and willingness and is a main indicator of their desire. This initiates their ability to “do and be” different (change). Attendance and engagement paired with the client’s ability (participation) (Duncan, Miller & Sparks, 2000) in the “process” of therapy furthers the progression towards sustainable change.
The client not only must be present physically but also must be available mentally and emotionally for change to happen. They must “show-up” in the room. The client’s are then empowered (able) (Miller & Rollnick, 2002) to continue the process of change. Research finds the value and the quality of the client’s active participation to be “the most important determinant of outcome” (Duncan, Miller & Sparks 2000). The therapist’s offering a variety of activities and experiences in session provides the client with continued opportunities to develop and strengthen their abilities (participation) thus strengthening the progression towards second-order change.
This initiating process towards change must be supported through the creation of a warm, accepting, supportive (safe, non-threatening) environment which includes the therapeutic relationship to continue the progression towards change. Since change does not occur in isolation but in the client’s relationship (Miller & Rollnick, 2002) to his/her environment including his/her relationship to his/her therapist this is a crucial assumption to the progression of change.
This second assumption of change through the creation and maintenance of a warm, accepting and supportive environment emphasizes the therapist’s ability to manage the level of anxiety (Nelson, T., 2008) in the room by creating a warm, accepting and supportive relationship (alliance) (Minuchin & Fishman, 1981) to allow space for the client’s viewpoints to emerge and be utilized and understood. In the same manner that a new client will “trigger” a level of anxiety for the therapist (Nelson, J., 2008) the client will experience a similar level of reactivity (threat) during presentation which creates a barrier to feelings of “warmth and acceptance.” Clients and therapists who are “flooded don’t think or hear well” (Nelson, J., 2008). If the environment impacted by the therapeutic relationship continues to lack a “sense of warmth and acceptance”(safety) it intensifies the client stress, and the client’s functioning and availability will be “impaired” (flooded) (Nelson, T., 2008). The flooded environment then causes both to be reactive instead of responsive (Nelson, J., 2008) to one another, resulting in the inability “to hear until they are heard” (Nelson, T., 2008). The client then regresses and/or loses the function to “be able” or to “be available” (Nelson, T., 2008). This impacts and interrupts, then slows the process of change and contributes to the client’s feeling of “being stuck.” This is particularly important because those feelings “influence our emotions, behaviors, or perception directly” (Siegel, 2001, p. 75). When an individual’s perception is impaired by anxious feelings (flooded) he/she can “exclude important contextual data” (Nelson J., 2008) which is also crucial to the continued progression of the desired change.
The research is clear. The client’s experience of the therapeutic relationship as the therapist works to create an alliance “is the greatest predictor of client success and change” (Duncan, B. & Miller, S., 2000). Allowing the client to maintain a sense “that the therapist understands them and is working with and for them” (Minuchin & Fishman, 1981, p. 31-32) creates a dynamic relationship and interaction with their clients which feels warm, accepting and supportive (safe, non-threatening). The therapist who is able to create a warm, accepting and supportive (safe, non-threatening) environment influenced by the therapeutic relationship by managing the anxiety in the room will greatly impact the successful progression towards change.
The creation of a warm, accepting and supportive (safe, non-threatening) environment for the client to present (Miller & Rollnick 2002) is essential to the progression of change because of its subsequent production of enough tension to allow the client space for the valuable process of moving from ambivalence to discrepancy (Miller & Rollnick 2002, p. 22). The third assumption of producing enough tension to increase discrepancy is significant for sustaining change. Discrepancy as defined by Webster’s dictionary is the “distinct difference between two things that should match or correspond.” A client’s ambivalence (Miller & Rollnick, 2002) or conflict (perception) between what they do and what they value is often not apparent.
Through “gentle, responsive and imaginative” leading (Miller & Rollnick, 2002), the therapist is able to elicit from the client their conflict (perception) between “the actual present and the desired future” (Miller & Rollnick, 2002). This type of leading is important because a client is more influenced “by what they hear themselves say than by what other people tell them” (Miller & Rollnick, 2002, p. 39). Once the therapist elicits from the client the discrepancy of their perception between what they do and what they truly value, “change will occur” (Miller & Rollnick, 2002, p. 22). The authors also note that the “larger the discrepancy, the greater the importance of change” (Miller & Rollnick, 2002, p. 22). The belief is that “when a behavior comes into conflict with a deeply held value, it is usually the behavior that changes” (Miller & Rollnick, 2002, p. 23). Moving the client from ambivalence towards discrepancy is a process that the client can internalize and sustain the process of second-order change. This internalization allows the client to continue the process long after the session cease.
In summary, the level of attendance, engagement and participation in the change process, the creation of a warm, accepting and supportive (safe, non-threatening) environment through the management of the anxiety (Nelson, T., 2008) in the room allows space for the client’s viewpoints to emerge and be utilized and understood and produce the appropriate level of tension to reveal discrepancies that inhibit change. The combination of these elements facilitate the initiation, progression and sustainment of second-order change.
Discussion of the Role of Core Assumptions in Therapy
This particular client I selected for my clinical demonstration has not only challenged and supported my therapeutic assumptions but has provided fertile training ground for me to grow as a student-therapist. Compiling this paper has provided an important opportunity to reflect on my own values and beliefs as an individual and on my resulting practices as a student-therapist.
The initial client struggles with the issue of trust in relationships. The week prior in session, I had the difficult task of informing my client about an incident that occurred two years between him and his teenage son was reportable. We made the necessary calls to SRS. He let me know then that he had a difficult time trusting the system and “the process” and left the session in a hard place. I was very conscious of my need to be present and join the client during the subsequent sessions. The client showed up for his next appointment. Although the client had a “big’ week and had several incidences to process, including the attempted suicide of his nephew, he chose to bring up a recent incident involving his son and ex-wife.
There were issues of race that he brought up that would have normally triggered me to “come to the rescue,” however, in reflecting on my assumption that a warm, accepting and supportive environment (safe, non-threatening) environment includes managing the level of anxiety (Nelson, T., 2008) in the room, including my own, allowed me to be mindful that my client needed a safe place to process this incident in his own terms. My realization that this was “his” story allowed me to maintain a calming environment and allow space for the client’s viewpoints to emerge and be understood strengthening the warm, accepting and supportive environment.
For the second segment submitted it was my third session with this client, upon reflection of our previous interactions, I began to see that the client’s “desperate” efforts to tell her entire story was an expression of her passionate desire for change and that her scheduling another session within two days of each other signaled her “willingness” (Duncan, Miller & Sparks, 2000) to be available to the process. This awareness provides me with a new respect (and compassion) for the client and a fresh perspective. This passionate motivation and decision to change creates a readiness for change (Miller, & Rollnick, 2002). This also offers both the client and student-therapist a challenging opportunity to be and do different. I continue to listen for more opportunities to note the client’s strength and courage to highlight and support their ability to create this difference.
The client’s artistic talents creates a natural flair for details in the telling of her story. I attempt to create a warm, accepting and supporting environment by acknowledging her talents and utilized ner energy in creating her healing process. I attempt to tap into her creativity through “gentle, responsive and imaginative” (Miller & Rollnick, 2002) questioning to elicit a “different story” of her recovery of herself in the midst of her health-related issues. I attempt to tap into her creativity to assist her with creating a different story for herself (Nelson, J., 2009). To join (Minuchin & Fishman, 1981) the client in her efforts I look for opportunities to utilize her natural talents and creative flair in developing a collaborative partnership around her goals for herself and creating a common perspective.
The determination of my assumptions has made me mindful of my current practices with my clients. I have become mindful of the very conscious effort needed to be present with each client. I have also refocused the initial energy used to “assess the problem” more towards hearing and acknowledging the client’s motivation for change (Miller, & Rollnick, 2002).. This refocus allows me to mentally relax the “expert” stance I am accustomed to taking when presented with a “problem” to solve. I am training to not respond to every question immediately (although there is much work to do in this area). I am aware of the need to take a more curious stance and lean into my questions more to elicit the client’s curiousity. I am training to promote a sense of understanding and remind myself to ask questions for which I don’t have the answers. I have a strong desire to validate their story and continue to train in that area.
In creating a warm, accepting and supportive environment I continue my efforts to tolerate my anxiety and not absorb that of the client’s. When the client begins to tell me of a bad experience concerning a previous therapist, although I am triggered, I continue my effort to validate her story and listen for the meaning she has put on that experience. “What is it she needs me to hear” (Nelson, J., 2008)? This question creates for me a quiet curiousity to improve my listening. Eventually, I need to externalize this thought to allow the client to answer that question and provide a clearer picture on how I can be helpful to her process of change.
The paper has allowed me to think through and externalize my understanding of the process of change by reflecting on my own process. It has brought to surface my previous desire and hidden-agenda to problem-solve and rescue the client. The paper had me turned toward my wounds (Nelson, J., 2008) and begin to discover the triggers (Nelson, T., 2008) that have me anxious and not present for the client. Although the paper and the clinical demonstration addressed the significance of client motivation (Miller, & Rollnick, 2002) and of creating a warm, accepting and supportive (safe, non-threatening) environment while producing the appropriate level of tension (discrepancy), as significant elements in initiating, progressing and sustaining the process of (second-order) change (Nichols & Schwartz, 2008) for the client, it emphasized the need for training and internalizing this process in the heart of the therapist.
References
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Miller, W. R. & Rollnick, S. (2002). Motivational interviewing. New York: Guilford Press.
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