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Chapter OneHow You Change
If one system of psychotherapy had ever demonstrated clear superiority over the others in helping humans shed undesirable behavior, the name of that system would be a household word by now. But until recently, change has remained enigmatic, and none of the several hundred different existing therapies can effectively explain just how it occurs. Furthermore, no therapy is any more successful than the change strategies that determined, persistent, and hardworking individuals develop for themselves.
My colleagues and I have made it our life's work to investigatehow people change on their own, without the benefit of psychotherapy. This is work that began, for me, with a terrific frustration at my inability to help a certain man overcome the depression and alcoholism that were killing him. Because this man distrusted psychotherapy, and denied that his depression and addiction were problems, it fell to his loved ones to help him. And although we tried to help, nothing worked.
The man was my father. After he died, in my junior year college, I began to study psychology in earnest in an effort to make sense of what had happened. I wondered if there wasn't some better way to help people like my father change themselves. Too few people with addictions or other self-destructive problems either can or will seek out professional help. I wanted to find some way to bring the wonderful insights of psychology to the mass of people who don't ordinarily benefit from them, those people who are self-changers. As I studied, I was confronted--just as the layperson seeking therapy is confronted today--with a bewildering array ofpsychotherapeutic systems from which to choose.
Therapy is a complex topic: Think of the range of possibilities you confront when you combine an individual client, with one or more complicated problems, with a therapist schooled in a particular theory. A relationship develops between the two, unlike any other relationship even this therapist has with other clients. He or she may employ one of any number of treatment techniques, and must continually decide what to do and when and how to do it. No single system of therapy adequately addresses all of these variables.
As often happens when a complex subject remains inadequately explained, new theories are developed. When my colleagues and I began our work, the field of psychotherapy was becoming fragmented. In the 1950s, it was estimated that there were some thirty-six distinct systems of psychotherapy; today, there are more than four hundred! Many of these approaches are narrow. Each has its own dogma, with its own saints and heretics along with its more or less faithful followers. Too often these followers are blind to the considerable affinities between their own theories and the theories that issue from other systems. They see only the differences. These differences command, it seems to me, far too much attention.
As I continued my studies, I became terrifically frustrated again. Now the frustration came from the feeling that I was spending all my time doing other people's research. And why was so much of this research aimed at bolstering one theory at the expense of another? I had to remember my basic reason for studying psychology in the first place--I wanted to learn what kinds of ways there were to help people change themselves. Could it be, I wondered, that the hundreds of extant theories reflected the existence of hundreds of unique processes of change, some more valuable than others?
It seemed more likely that no single approach could be clinically adequate for all problems, patients, and situations. And in 1975, Lester Luborsky, a psychologist from the University of Pennsylvania, declared the grand psychotherapy sweepstakes a tie, citing the Dodo's verdict in Alice in Wonderland. "Everyone has won and all must have prizes!" Subsequent studies have supported Luborsky's conclusion that all legitimate psychological therapies produce favorable and nearly equivalent outcomes.
Psychotherapy works. When they have finished with a course of therapy, clients are better off than 80 percent of people with the same problems who are on a waiting list for therapy. However, no one has ever demonstrated that one therapeutic approach is consistently superior to another.
The Transtheoretical ApproachThe lack of an overall guiding theory, the search for the underlying principles, the growing acknowledgment that no single therapy is more "correct" than any other, the proliferation of new therapies, and a general dissatisfaction with their often limited approaches, led many thoughtful psychologists to call for an integrated approach to therapy. Struck by Luborsky's findings, and finally out of school and practicing, I decided to pursue my own research. Was there, I wondered, a way to combine the profound insights of psychoanalysis, the powerful techniques of behaviorism, the experiential methods of cognitive therapies, the liberating philosophy of existential analysis, and the humane relationships of humanism? Was there a way to exploit fully the essential forces of psychotherapy? Naturally, a few theorists insisted that such integration was philosophically impossible.
Still, it seemed intolerable that no one understood the process of human change. As the psychotherapist Paul Watzlawick put it, "If that little green man from Mars arrived and asked us to explain our techniques for effecting human change, and if we then told him, would he not scratch his head (or its equivalent) in disbelief and ask us why we have arrived at such complicated, abstruse, and far-fetched theories, rather than first of all investigating how human change comes about naturally, spontaneously, and on an everyday basis?" Rather than shaping the therapy to the needs of the individual client, most therapists assume that the client's issues will fit into a particular mold-that, for example, all his or her problems will eventually lead to conflicts over sex, or aggression, or whatever.
I set out to find the common components of the major therapies. The first step was to master the masters . . .
Changing for Good. Copyright © by James Prochaska. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
