St. John's Counselling Service

Individual, Couple and Family Services

Our Understanding of Change in Counselling
If there is anything consistent about life irregardless of your social, economic, gender and racial-ethnic status, it is the forever human experience of change. Change comes in many sizes and colors; understandable or confusing, believable or with doubt, planned and unplanned, evolutionary (slowly over time) or revolutionary (quickly), sad or happy, for the many or for the few, with open arms or with defiance. Concurrently, the advances we have seen in our lifetime with media, technology, education, entertainment, medicine, science, travel, telecommunications, global economics, politics, and lifestyles further remind us of another constant factor in life that remain central to change: lifelong learning. We can all agree that certain things in life we would like to remain the same (i.e. my favorite sofa for an afternoon nap comes to mind). Tradition, maintaining a sense of the status quo, and being (realistically) content with how most things are in our life are normal.  However, with today's ever changing world (and let's not forget the ever evolving human brain), what allowed us to get here today may not be enough to get us where we need to go tomorrow. Hence, as Robert C. Gallagher once said, "Change is inevitable . . . except from a vending machine."

Which leads us to the processes of change in therapy and counselling. In general, any given time a person decides to modify his thinking ("maybe I will try spicy food for once tonight"), feeling ("I never liked the Beatles before but now they're ok"), or behavior ("I'll give it a try with salsa dancing") are all basically a change process. In other words, whether we recognize it or not, we actually do change on a regular basis throughout our life. Some changes are significant, others less so (the sizes and colors of change as shared above). Thus, even with change being a normal and regular aspect of life, why do we often hear the following comments when we ask a loved one, a friend or work colleague to consider counselling: "people can't change," "I've tried stop smoking before, nothing works" or "change is way too difficult," and "you can't teach an old dog new tricks?"

We believe the answer lies in the following quote: "the first step towards change is awareness. The second step with change is acceptance." Regarding awareness, most people are unaware that change is actually an everyday reality for all of us. Therefore, irregardless of why a person comes to counselling (by choice or by nudge), we enhance our clients' sense of awareness with not only what type of change options are available to increase their health and happiness (new ways of thinking, new ways of behaving), but we also ensure the client is aware of what change stage they are in throughout the counselling process. With respect to acceptance, once a person is aware of the dynamics (the desire as well as the fear) of change, we then collaborate with our clients on accepting what areas of life they desire to change: if you will, their map of orientation (who am I?) and their map of direction (where do I want to go and how?).

Change in a perfect world may not always be a smooth journey. As a Buddhist monk once said to a young student, "if the road you are on is with no obstacles, then you are clearly on the wrong road." We accept that change we desire or change that we must (sometimes with resentment) enact upon is not always an easy process, but our 33 years of counselling experience also reminds us that with a bit more awareness of how the brain denies, resists, fears or desires change, getting a person to accept he or she needs to change becomes a greater reality.

The Change Processes in Counselling
We understand that for counselling to be successful, both the client and the counsellor need to understand what change stage they are in. There are six (6) stages of change in counselling, each one having an importance in allowing each and every one of us to move from the unpleasant to the pleasant state of living (the happy life). In an almost perfect world these six stages of change proceed in a linear manner, other times stages may need to be repeated due to various nature/nurture factors that are discovered in the learning and growth dynamics of counselling.

Stage 1: Precontemplation
This stage is characterized by two distinct elements: a) the person not being able to see or understand what the problem is, and/or b) the client wanting some other person to change (the problem is them, not me). Precontemplators usually come to counselling because of some form of pressure from another person (spouse, employer, the courts, school, friends). Concurrently, precontemplators also resist change and therefore employ denial-minimization tactics to disown any responsibility for their contribution to the issue(s) at hand. Thus, one of the initial goals in counselling is to determine how much denial or minimization the client is experiencing that prevents change.

Stage 2: Contemplation
This stage is characterized by the client wanting to better understand what the "bump in the road" is, to see the causes and as well to explore what options are available to resolve the demise. The key point to remember here is that even though a person may know what is the issue and what needs to be changed, contemplators are not quite yet ready to make a commitment to action (fourth stage of change). The second stage is a critical time for those in counselling to better understand two (2) key themes before action is undertaken: who am I (their map of orientation) and what strengths and resources do I have to support my journey (map of direction)? Hence, in counselling the client and counsellor will know when the time for action arises when the language and thoughts in counselling focus around the "solution versus the problem" and a "view more about today and the future than the past."

Stage 3: Preparation
This stage is characterized by the client going through additional areas of learning and growth. Sometimes the client needs to improve their communication skills, career goals, parenting behaviors, intimacy practices, and further strengthening their self-esteem. In particular, we use this stage as an opportunity to identify the client's values and supporting behaviors in four key areas of life: defining the self, self-development, work and relationships. The primary goal here is to actualize individual awareness so that a sense of self-control, comfort and security are present when the client goes from preparation to action.

Stage 4: Action
Probably the most misunderstood and misapplied stage of all in counselling. The common problem here is that most clients and counsellors believe that change means action, and action now. However, if the first three stages of change are not properly addressed in counselling, failure in counselling and/or after counselling can occur (in fact, over 45% of all clients stop counselling before the third session as they feel their therapist or family want action before they are actually ready for action). This stage is characterized by the basic premise in positive psychology and cognitive behavioral sciences that before we can "change" a behavior, we must first change or reframe our thought patterns (our mental tapes we play if you will).While most of us want to "see" some form of change, often times the more important change must occur in the way we think where we often don't see that change until some future point and time. Once the action stage in counselling has allowed us to change our thoughts (reframing), then and only then can we commence with the more visible desired actions outside of counselling.

Stage 5: Maintenance
This stage is characterized by the counsellor and client (and in most cases his or her social support network) to identify what possible trigger points or other conflictual issues exist in the work and social/family setting that could cause a relapse. Whether a client is coming in to quit smoking or improve his communications at work or in the marriage, the counsellor and client in this stage shall develop a strong commitment to establishing positive reinforcement activities (validation, cheerleading, acknowledgement, praise, rewards) to sustain the change made in the action stage. In other words, change never ends in the action stage, it merely takes a new form and presence in our life.

Stage 6: Termination
There are some thoughts, behaviors or feelings we wish never return  (the former smoker who doesn't take up smoking again when he gets stressed). However, some healthcare professionals believe there are certain behaviors, thoughts or feelings we never completely remove (traditional 12 step programs for example propose that alcoholics will always remain "an addict in recovery"). This stage is characterized by determining what types of behaviors, thoughts or feelings can realistically be terminated, and equally as well, what types require a lifetime of support and maintenance. The ultimate goal though in the termination stage is to ensure that the client understands that by embracing lifelong learning he or she increases the chances for a more healthier and happier life.

Overall, by using the above mentioned six stage model of how we go through learning and change, our counsellors are able to work in a more understandable and believable way with each and every one of our clients. Our counselling model then ensures each change stage has its own correlating counselling process(es) that allow two short-term goals to be continually experienced in counselling: i) a greater sense of awareness and b) shift from focusing on problems to thinking about solutions.

For example, in the precontemplation stage (stage 1), the counsellor may need to work with the client over a period of time with cognitive, gestalt or psychoanalysis to replace the denial mindset with an ownership mindset. Stage 2, contemplation stage, the counsellor may focus more on traditional psychoanalytical and existential processes to allow suppressed feelings and thoughts that often times makes us feel "stuck" in unpleasant moods be identified and understood in counselling. In stage 3 (preparation stage), the counsellor may then shift to a rational-emotive or cognitive-behavioral model (CBT) to challenge non-effective thinking patterns that often times causes non-action or procrastination that often times prevents stage 4, the action stage, from being experienced. Stage 4, action stage, focuses on three areas for movement and change: thoughts, emotions and behaviors. Hence, this stage will require a focus on growth in our thinking patterns as well as modifying behaviors and replacing unpleasant emotions with pleasant feelings. The most effective process used in stage 4 is CBT (cognitive behavioral therapy). Maintenance, stage 5, is a key stage where we ensure the progress made is sustained for a lifetime. We also focus on not only maintaining the change, but also how to ensure the client continues to use the change processes. The processes of rewarding positive behaviors and developing nurturing relationships are key here. Stage 6, termination, utilizes similar processes like that of stage 5 whereby the temptation or threat of returning to old behaviors/thoughts are removed. Reinforcing the happy life model is key here to ensure the spiraling cycle of change is absent for most of life's "bumps in the road."

Next Step
If desiring a positive, caring, effective, professional and confidential opportunity to improve your health and happiness, please contact us by email ( info@sjcshk.com ) or by telephone on (852) 2525 7207 or 2525 7208. All inquiries are strictly private and confidential, and all efforts in our counselling centre are geared towards growth and happiness.

Our Affiliations
As an Organizational Member of BACP (British Association of Counselling and Psychotherapy) we are bound by its Ethical Framework for Good Practice in Counselling and Psychotherapy, the Ethical Guidelines for Researching Counselling and Psychotherapy (where organizations undertake research) and subject to the Professional Conduct Procedure for the time being in force.

As a professional member of the American School Counselor Association (ASCA), St. John's Counselling Service is able to collaborate with one of the largest counselling associations worldwide in working with students, schools and their families in addressing academic, personal/social and career development issues. This collaboration also allows us to remain current with counselling tools and strategies for Hong Kong's schools and families to ensure our children and teens can seek a healthy balance between learning and fun.

St. John's Counselling Service is also in partnership with Hong Kong University HKU Family Institute, City University (Hong Kong), Hong Kong Polytechnic University, University of New England (Australia), and Monash University (Australia) master's degree counselling and psychology programs as an internship placement centre for their students to acquire advanced counselling skills and knowledge as so provided by our positive psychology counselling model and 33 years of experience in counselling.

Email: info@sjcshk.com