6 Approaches to Change
On advice-giving, psychotherapies, rewards, drugs, and motivational messages.
Posted May 08, 2019
He can’t stop pigging out. She can’t stop worrying. He can’t stop his substance abuse.
Even good psychotherapists (and advertisers) have a hard time getting people to change—It’s been said that it takes six to nine exposures to an ad to get someone to change their brand of toilet paper!
So there are no magic pills yet. Best we can do, in our own lives and in trying to shepherd others to change, is to have a toolkit of interventions to draw from. Here are six widely used ones:
Advice-offering. Counselors and therapists are often trained to think three times before giving advice. I wouldn’t be so dismissive. First, note that I didn’t say advice-giving, I said advice-offering. Often key to advice-offering being effective is to suggest it as a mere possibility and ending with, “But what do you think?”
When to give advice? The more of these that are true in a situation, the more you should consider offering advice: 1) You’ve asked the person to generate his or her own idea but couldn’t, and you believe you have a good idea. 2) Your previous offers of advice have been well-received and, better, were implemented and the person was pleased with the result. 3) From previous experience with the person, you judge that if you try to get him or her to come up with an idea, nothing will be forthcoming thereby frustrating or embarrassing the person, and be more likely to waste time than to generate something useful.
Cognitive-behavioral therapy (CBT) and its variant, Rational Emotive Behavior Therapy (REBT.) Today, that is often the first line of defense against mild-to moderate depression, anxiety, or addiction. Such therapy often involves guiding the person to realize that their catastrophizing, so-called “awfulizing” is unwarranted: that the worst case is unlikely and is survivable. The REBT flavor of CBT replaces “musts” and “shoulds” with “likes” and “wishes.” For example, replace “I must get that job” with “I’d really like to get the job but if I don’t get it, I’ll find something better.” Replace “S/he should be more responsible” with “I wish s/he were more responsible.” That may dissipate much of the anger and sadness associated with life’s travails. Finally, cognitive-behavioral therapy teaches people to avoid secondary disturbance—worrying about being worried, which of course, yields no benefit and merely magnifies the malaise.
Rewards and punishments. Behaviorism asserts the obvious: We tend to do more of what we're rewarded for, less of what we're punished for, especially if the rewards and punishments are important to you. Short-term rewards and punishments for goals that are moderately difficult but doable tend to be most effective.
For example, parents trying to get their child to work harder at school might offer a short-term reward and punishment—a dollar added to his allowance for every night he does his homework well and a dollar subtracted for every night he doesn't. Sometimes, long-term rewards can also be effective. So, If the aforementioned teen craves getting a car, it could be agreed that if, by the end of the semester, his grade-point average rises from a C+ to a B, he gets the car.
Sometimes rewards and punishment can be less overt. Let's say a person wants to lose weight and cares deeply what other people think of her. She might daily post her weight on her social media. Thus, every day she loses weight, she gets the reward of telling her friends that and if she gains weight, she gets the punishment of their knowing that.
Psychodynamic therapy. This is rooted in the belief that much of who we are is caused, at least in part, by what happened in the past, especially in our family of origin. Psychodynamic therapies hold, for example, that if your parent called you stupid—even if it occurred only once—it can linger and diminish one’s self-efficacy today. If you were raped as a teen, it could impede your ability to have good romantic relationships long after. Psychodynamic theory argues that unless a person fully processes earlier traumas, s/he'll be less likely to move forward, that to suppress thoughts of the trauma will likely cause it to pop up in other contexts, a bit like if you press down on one side of a balloon, the other side will inflate.
Motivational messages. Some people are inspired by motivational speakers, affirmations, inspirational quotes, and friends' self-esteem-building statements. Motivational messages are most likely to be effective if truly believed and made to stay top-of-mind: writing a key word on the palm or on a Post-it on the computer monitor’s frame, or frequently writing a paraphrase of a motivational message that resonates, for example, “I deserve to love myself enough to stop smoking.”
Some people are helped to change with a drug. For example, a person suffering from depression may be better able to use the above strategies if they're accompanied by taking an drug such as Prozac or other SSRI.
Of course, none of these approaches to encouraging change are sure-fire. The best we can do, in our own lives or as a practitioner helping others to change, is to recognize that these six approaches are like an artist’s toolkit. Effective use requires the artfulness to sense which tool to choose first, and, if and when it’s right to replace it with another tool.
I want to thank fellow Psychology Today blogger Dr. Michael Edelstein for suggesting I write this post.