Chapter 7 of Jeffrey Kottler’s “Change”, entitled “Changing in Psychotherapy”, would be where you might expect Kottler to say that change on your own doesn’t work and you really need a psychotherapist to help you. However, that expectation would be wrong, particularly as that would belie Kottler’s premise that basically we don’t know how change happens. Early on in the chapter, he dispels the “one true way” myth:
Psychotherapy is usually a last resort after all other options have been tried and failed…As we’ve already seen, most changes that people make in their lives take place in the outside world, as a result of circumstances, challenges, adventures, disappointments, conflicts, transitions, traumas, opportunities, and other critical incidents.
[snip]
Consistently (and incredibly) more recent studies have found that the therapist’s techniques account for only about 15% of a client’s improvement, compared with triple that figure (45%) for so-called “common factors” that are evident in almost all approaches. This includes things like the quality of the relationship, client expectations and characteristics, the opportunity to talk openly about their concerns, feeling supported, taking constructive risks, and developing new understanding of themselves and the source of their difficulties.
[snip]
Psychotherapy is often a significant part of [the change process], but one that represents only one piece of the puzzle. There are all kinds of other forces and extraneous events (improved economy, family support, new opportunities, spontaneous remission of symptoms, self-initiated actions, impulsive gestures, random conversations, films, and books) operating outside of sessions, and within the client, most of which we will never identify, much less understand.
And if that is all true, it leads to a question put succinctly by Kottler as why do paid psychotherapy if you can just do it yourself?
Some of the answers are speed of success, effectiveness and efficiency if you will. I crunched my psyche for 4 years on my own so to speak, and a trained professional could have perhaps stopped me from going down unproductive avenues. In some cases, picking up on an earlier point, I made myself feel worse about myself (or an aspect of myself) so that I could critically examine it, turn it around in my hands, and decide if it was something worth putting back in my psyche or if I should jettison it.
On page 158, Kottler has an incomplete list of 38 factors that can make a difference in promoting change in therapy. It’s a long list, but I think it could have been grouped and consolidated into a lot fewer headings:
Hopeful intent / willing to do the work — a positive mental outlook that you are capable of some change that the psychotherapy will help you get through, along with active engagement, willingness to model new behaviours, perhaps a public commitment to your change, and a willingness to consider new options, alternatives and solutions with adjustment over time.
Emotional honesty / know what you want — it doesn’t work if you’re not willing to be open and transparent, candid, emotionally true to yourself, trusting, disclosing and facing your past/present/future fears, challenging your old beliefs, having integrity and respect for your therapist and yourself, and accountability for the outcomes you generate.
Try new approaches / take action — even if you’re willing to do the work and know what you want, if you take no action to change, you’ll get the same outcomes you already get. The personal narrative has to change too, and it can be a chicken and egg situation if the story changes before the behaviour or the behaviour changes before the story, but you’ll need to face your fears, rehearse new skills, devote new resources to the effort, and take constructive risks.
There are certainly other factors around support, planning, etc., but for me, those three elements are the ones that resonate.
When I started to read Chapter 6 of Jeffrey Kottler’s “Change”, I expected it to mirror the previous chapter i.e. that instead of hitting rock-bottom through some sort of death spiral, you would hit rock-bottom as a result of some traumatic event. And while that is part of the chapter, the focus is on the reactions to the trauma, i.e. how “post-traumatic stress is not the universal consequence of tragedy or unfortunate events”.
In fact, in a table, Kottler outlines some of the potential benefits of post-traumatic growth:
Toughening up;
Staying in the moment;
Altered priorities and values;
Greater appreciation of relationships, etc.;
Higher self-esteem;
More tolerance for others/empathy, etc.
But what determines whether a traumatic event leads to negative or positive outcomes? As expected, the answer is always “it depends” but some of the ideas mentioned included:
Severity and kind of event;
Personality traits of the person (optimism, resilience);
Prior experience with adversity;
Pre-existing conditions;
Absence of blame and shame;
Drugs and alcohol;
Personal resources;
Support system;
Spiritual beliefs;
Meaning making.
So you stand a better chance of surviving and growing if low to moderate severity, you`re optimistic, you`ve overcome previous adversity, you don’t have a bunch of other factors you’re dealing with, you’re not to blame or shamed by the event, not relying on drugs and alcohol to get by, decent personal resources, strong support system, a spiritual belief system that puts things in perspective, and a way of interpreting what happened in a constructive fashion. Obviously, you may not have all of them, but it increases the likelihood of responding to an event with a more positive outcome.
If people have these “conditions” in place before the event happens, then Kotler argues that “such individuals already have solid skills to manage and bounce back from adversity, [and] they often take such challenges in stride, returning to their previous level of functioning but not necessarily spring-boarding to higher levels.”
By contrast, I was interested in how he talks about avoidance in both positive terms (buying time until the person is ready) and negative terms (denial or extreme procrastination). Overall though, Kottler notes that “responses to crises are often guided by how you conceptualize them”. I was also interested in how he views “secondary trauma” i.e. the impact of witnessing trauma happening to others.
In the end, though, I was a bit disappointed with the chapter. While there are some tips on how to recover, mostly obvious things (“take care of yourself”, “get help”), I thought there should be more about how people respond who DIDN’T have the ideal factors in place before the event. Without it, it reads to me almost like “if you’re strong enough to get through it, you’ll get through it easier than those who aren’t”.
Chapter 5 of Jeffrey Kottler’s “Change” is a challenging chapter in terms of how universally applicable it is. The premise of the chapter, entitled The Benefits of Hitting Bottom, is that some therapists believe that true change will only happen once you hit rock bottom, and you have nowhere to go but up.
It’s a common theme in the narratives of lots of people who turned their lives around and became “success” stories that are shared, repeated for others as inspiration, the “if she/he was down so low and crawled back up, I can do it too”. It is almost de rigeur it seems for addiction stories, and certainly so in pop culture. The arc almost writes itself:
Average Joe/Jane goes through life;
An EVENT happens and they start taking painkillers;
They get addicted;
They lose everything, including their spouse and kids;
They have an epiphany while lying on the bathroom floor of a dive bar in SoHo;
They quit cold turkey and start getting their shit together;
They claw their way back into a semblance of normalcy;
They`re journey encourages them to help others find their way out too.
The media and the internet loves these kinds of stories, and I confess, I think most of them are complete and utter horseshit. Partly because the narrative is too perfect — “something happened TO them” that started the spiral i.e., there is nothing negative about them, it could happen to anyone. Except often when you poke the surface of the story, you find out that they were a recreational drug user already. But, you know, THAT was under control, no issues. Then, because of the DRUGS, they lost everything, but the story omits the fact that they were already heavily in debt to begin with, and had never held a steady job for more than a couple of months. Or the bathroom floor was just them stopping in while passing by, and they slipped and fell. They weren`t passed out high. But the arc says they bottomed out.
Really? Because there are LOTS of stories out there of people who have bottomed out way lower than that. I`ll come back to that in a moment. But then, by the grace of God (who by the way wasn`t involved in the story up until now apparently), they manage to crawl their way out on their own and are now independent. So, without any training other than they dragged themselves out, they now want to help others, despite the fact that their self-help was partly what gives them their new life, i.e., doing it on their own gave them a boatload of confidence that will now be denied the person they`re helping because they`re not doing the same thing on their own, they`re getting helped. Not that being helped is a bad thing, but if the whole idea is “do what I did”, well, they’re not doing what they did.
Now, separate from my BS detector going off every time I see someone claiming they`ve ascended spiritually or intellectually on their own and now want to become evangelical about the ONE TRUE WAY to change, I am strongly critical of what “bottoming out” even means to them or the universality of approach. As I said above, lots of people bottom out at different places…some might bottom out if there child doesn’t get into their preferred middle school. Others bottom out when they have debt collectors calling. Other bottom out when they’re selling their body for foodstamps and living on the street. Everyone has a different threshold for when the price of whatever they`re doing gets too high for them, and they say, “Okay, I’m out.” They’re fine up until that point, vaguely dissatisfied perhaps or the addiction is too strong, and they hit a point where they say, “here, and no further”. The proverbial and mental line in the sand that once they cross it, they’re suddenly motivated to change.
But I hate the term bottoming out because it suggests someone has nothing left to lose and hence the reason they are willing to change. Except they can always lose something else, even if Dante’s view of hell only had 9 rings.
Part of the reason I don’t like the term is often, as I mentioned above, the therapy community considers bottoming out as a pre-requisite for change. Often in addiction treatments, for example, a tough love view of “they’ll change when they lose everything”. Almost where some people have thought, “Great, I want to change, now I just need to accelerate my bottoming out to get to that point faster.” Not necessarily consciously, but there are those who have told stories of doing exactly that, and partly under a therapist’s care. Including spiritual scammers who convince them material possessions are the devil’s playground and they need to lose it all to experience rebirth, so why not donate it to the scammer’s very helpful associates.
For me, a great question is not only the typical “what is your break-even point where your benefits equal your costs” but rather “how can we change your perception so that the break-even point is higher than you think”. We already have tons of research on positive goal-setting where we are told to chunk large goals into smaller goals and thus you can achieve the smaller ones to start with (assuming they’re realistic) and moving up and on from that early success. But negative goal-setting could work the same way — chunk out a larger fear (i.e. “I never want to weigh more than 300 pounds”) into smaller fears (i.e. “I never want to weigh more than 275, 285, 295”) until the 295 becomes the new 300, or the 275 becomes the new 295. Raising the threshold of what they feel is their break-point before they get to it. Kottler words this as raising the “negative feelings” about the current state of affairs in order to increase motivation/impetus to change, although I’m not sure I like the idea of “feeling worse to get better”, a little too simplistic and too close to hurting yourself to get better.
The chapter struggles with the concept, much in the same way I do, namely that “addiction specialists have a name for the level of desperation it takes to overcome resistance — hitting rock bottom” while researchers call it “someone’s relative degree of impairment”, although I don’t think “bottoming-out” is a prerequisite and what “bottoming-out” means depends on a case-by-base basis. For me, I think the key element is that it isn’t the bottoming-out that matters so much as an open confrontation by a person of what the problem is and what the costs and benefits are that are keeping the situation “as is”. The bottoming-out, so to speak, is just a manifestation that causes the person to confront their costs. Until that happens, the change won’t occur. Kottler talks about how often change won’t happen until there is no alternative, but I am not so certain. As I said, there is always the alternative of death or descending lower to another ring of hell. Instead, they choose to try and rise, a conscious and cognitive-based choice. I do like the recognition however that if the outcome seems uncertain, people will tend to drag their feet on the commitment/implementation until they are more certain their “solution” will work.
Near the end of the chapter, there is a small phrase that jumps out at me, and I’m not sure how I feel about it. While everyone wants to know about preconditions for change, most of the answers are “it depends”. However, Kottler says:
The single best predictor of a successful change effort is the degree of support you receive from others.
I get the theory — you can’t do it alone — but the word that bothers me in that sentence is “degree”. I agree that support is required, but I think it is more about the presence of support, friends or family, or professionals, not the extent of the support as an universal benefit for everyone going through change. I have reflected a great deal on the change I went through between ages 29 and 33. I stripped my psyche down to the component parts, I tweaked and rearranged them, and I put them back together. Did I put them back in the best order possible? I have no idea. But I liked the result. Could I have done it more effectively or efficiently with professional help? Absolutely. Except I wasn’t in the headspace to get professional help at that point, I wouldn’t have accepted it.
Yet I did have support through friends. Three friends in particular, Sebastien, Sara, and Aliza, were privy to my thoughts [perhaps under the hashtag #TMI!], and frequently served as sounding boards as I worked through some of my mental rebuild and tested out my latest theory. And while I don’t want to dismiss some of the EXTREMELY long conversations some of those sessions lasted (Yes, Aliza, I’m talking about you and one particular 12-hour marathon!), there also times where I would sequester myself for 4-6 weeks while I did my homework on myself. So I don’t know if it is about degrees of support so much as (a) having support at all; (b) having support available when needed; and (c) quality of support targeted to the issue being addressed. For example, I knew I had friends. And they were open to conversations about personal things, not just chatting about the weather. But much of what I was trying to figure out what I wanted out of life, and if that life was to be shared with someone else, what I was looking for in a partner.
In retrospect, one of the things I got “right” in my approach is that I did it while single, and remaining so through the process. There is a fair amount of research on addiction treatments and the challenges posed not only for the person in recovery (i.e., anchoring themselves to people who might have enabled their previous behaviour or who harbor resentments for past behaviour) but also for the partner (i.e., the massive changes going on in the other person, often leading to unpredictable behaviour, inconsistent mood management, etc.). I can’t imagine what I would have done to someone else if they were “with” me during that time. Take for instance a serious relationship scenario, where not surprisingly, one of the key questions might be if both people want kids. And during that four years, I didn’t know the answer to that question because I didn’t even know who I was, let alone who else I wanted in my life or what I had to offer. Imagine doing the work while a relationship clock ticks alongside you asking, “So, you got your shit together yet?”.
Massive change over 4 years as I figured out who I was. But my bottoming out, so to speak, didn’t look like most people’s. For me, there was some financial stuff involved, but not life-ending. My father had passed away, and I was in grief. Sure, that was going on, but that’s part of life. But the real “bottoming-out” was simply the end of a relationship where neither of us were “in love” with the other person anymore, but I was still pursuing it. And in my head, I still saw it going towards marriage. Three thoughts were existing in my head simultaneously — a) I wasn’t in love; b) she wasn’t in love with me; and c) we weren’t “right” for each other long-term, and yet I was still bopping along thinking naïvely about the future. And it shocked me. Could I really be so messed up mentally that I would marry someone who was nice and we were friends, rather than holding out for “true love”?
And once I started poking the surface, I realized that I was drifting. Letting the winds of fate blow me wherever life took me, there was no real control in place of asking myself what I wanted, I just let life guide me. Yet that’s not who I wanted to be. I’m more analytical, rational than that…I didn’t think exactly in these terms, but I was more of a planner. A directed life. Yet it wasn’t how I was choosing to live.
Overall, I come down to believing that bottoming-out is the wrong focus — it should be more about figuring out in advance what you think your break-point is, and trying to slow your descent before you hit it, while also potentially raising the threshold through confronting your situation openly and consciously. Bottoming out is just one way to trigger such a confrontation, but my change was triggered not by a flame-out so much as a general malaise with where my life was going and a cognitive confrontation of my need to change to get what I wanted.
I read Jeffrey Kottler’s “Change” last year, and was blogging about it, but I got distracted with my “50 things before 50” theme, and kind of forgot about getting back to the book. I wouldn’t say Chapter 4 was particularly compelling for me, or at least most of it wasn’t. It was about how people attempting to change can create narratives to help or hinder themselves. It seems pretty obvious to me, so the various headings of different types of stories didn’t really resonate with me. I did like a couple of quotes, including stories that promote change (as opposed to other stages in the process):
Through the use of metaphors, they have the advantage of operating indirectly and bypassing resistance; they engage in active imagination and require listeners / viewers / readers to personalize the lessons in a meaningful way.
Some helpers (teachers, psychotherapists, health experts, leaders, etc.) often use stories to help instruct or heal:
Contemporary therapists often make frequent use of recommending particular books or films to their clients, even basing their treatments on what has been called bibliotherapy or cinematherapy. One practitioner has compiled a collection of movies that inspire people to overcome their problems, organizing them according to the issues they highlight…
There are some people who read through several self-help books or biographies and nothing resonates. Then they read THE ONE that does resonate with them, and they feel almost like they can model their behaviour after the person’s success. Books help for me, but movies not so much. I do however believe there is a great untapped role for music, but perhaps that is more short-term mood management than inspired change. However, those with specific issues have merged upbeat playlists to help them deal with depression over their love life or their weight or challenges staying motivated to work out. I guess it is similar in many ways to those who listen to sad songs after a break-up to help them process the experience and move them through it towards a healthier mental view of the end of a relationship.
Rarely, however, does a book inspire me so much as an idea or two within a book. I do like the power of stories, just not sure they are as strong when not self-created, so ideas often spark me to take them away, wrestle with them, unpack them, and decide if they work for me or not. But that process is more creative for me than a passive reading of other people’s stories.
I have pretty eclectic tastes when it comes to reading, although my fiction choices usually are mystery stories if I have a choice. However, for non-fiction, I am willing to consider a lot of different topics. One book that caught my eye was “100 Diagrams That Changed The World” by Scott Christianson.
The description was appealing — an idea or an idea represented by a picture, that the mere conception of it changed our understanding forever. Some of my interest is pedantic…I’ve often searched for ways to explain things simply to get the best explanation possible down in a format that can be grasped immediately by almost anyone. Some of my interest is more philosophical — how did the person come up with the idea, how was it they perceived something others didn’t?
Yet that’s not quite what the book is about. It is more “here’s an important image/drawing/graphic from an important part of history”. So cave drawings i.e. petroglyphs are amazing, but not quite what I’m looking for, nor is the Celtic triple spiral image that is dominant in Celtic culture.
I was gobsmacked though by a description of “Marshall Island Stick Navigation Charts” (pg. 19). According to the text, “as many as 4000 years ago, some human beings left Asia and voyaged in canoes over the vast Pacific Ocean to the islands of Micronesia”, and once there, they created primitive cartographic aides to help them navigate the new area.
Palm leaves, shells, and coconut fibre allowed them to map winds, variable water colours and the location of atolls. Pretty freaking cool. Learning about that was alone worth the price of the book, and I’m only on page 19. As I go, I’m going to point to some interesting other diagrams (in whatever form).
