Applied Improvisation and The Stages of Change - workshop handout

The Transtheoretical – or “stages ofchange” – Model developed by researchers James Prochaska, John Norcross, andCarlo DiClemente at the Cancer Research Center in Providence, Rhode Island — reveals a powerful insight into a core dilemma in the fields of counseling and psychotherapy. The studies of behavior change that led to this approach found that 80% of people who show up for treatment are pre-contemplative – which means they have

Workshop design and facilitation by Jude Treder-Wolff, LCSW, CGP, MT

consequences and problems related to a behavior pattern they are not thinking about nor open to changing - but that nearly 100% of treatment approaches are geared to people who are in the contemplative or action stage. This means that as a whole our training and our thinking as mental health and addiction professionals prepares us to meet the needs of 20% of the people who present themselves for help. Also this leads clinicians to label clients “resistant” and “help-rejecting” when the reality is that our methods simply were not matched to their needs and degree of openness. The ability to assess a person’s degree of readiness to deal with a proposed change can significantly impact the effectiveness of treatment. 

The 5 stages of change identified by the Prochaska-DiClemente Transtheoretical Model are:

"People in the Precontemplation stage do not intend to take action in the foreseeable future, usually measured as the next six months. Being uninformed or under informed about the consequences of one’s behavior may cause a person to be in the Precontemplation stage. Multiple unsuccessful attempts at change can lead to demoralization about the ability to change. Precontemplators are often characterized in other theories as resistant, unmotivated, or unready for help. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs.
Contemplation (Getting Ready) Contemplation is the stage in which people intend to change in the next six months. They are more aware of the pros of changing, but are also acutely aware of the cons. In a meta-analysis across 48 health risk behaviors, the pros and cons of changing were equal (Hall & Rossi, 2008). This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately.

Preparation (Ready) Preparation is the stage in which people intend to take action in the immediate future, usually measured as the next month. Typically, they have already taken some significant action in the past year. These individuals have a plan of action, such as joining a gym, consulting a counselor, talking to their physician, or relying on a self-change approach. These are the people who should be recruited for action-oriented programs.

Action. Action is the stage in which people have made specific overt modifications in their lifestyles within the past six months. Because action is observable, the overall process of behavior change often has been equated with action. But in the TTM, Action is only one of five stages. Typically, not all modifications of behavior count as Action in this Model. In most applications, people have to attain a criterion that scientists and professionals agree is sufficient to reduce risk of disease. For example, reduction in the number of cigarettes or switching to low-tar and low-nicotine cigarettes were formerly considered acceptable actions. Now the consensus is clear—only total abstinence counts.

Maintenance. Maintenance is the stage in which people have made specific overt modifications in their lifestyles and are working to prevent relapse; however, they do not apply change processes as frequently as do people in Action. While in the Maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes. Based on self-efficacy data, researchers have estimated that Maintenance lasts from six months to about five years. While this estimate may seem somewhat pessimistic, longitudinal data in the 1990 Surgeon General’s report support this temporal estimate. After 12 months of continuous abstinence, 43% of individuals returned to regular smoking. It was not until 5 years of continuous abstinence that the risk for relapse dropped to 7%." ****

A person's mindset determines his/her ability to take in facts, suggestions or even make a positive connection to us in our clinical role. The stress that drives a person to seek help, or has produced a health problem that leads a medical professional to recommend a behavior change, has the effect of slowing down the ability to cognitively process emotionally-loaded information. A mindset can be an invisible roadblock on psychological road to recovery. While it can seem counter-intuitive for a clinician to seemingly accept or condone behavior that is self-destructive, the evidence shows that timing interventions to an individuals stage of readiness is most effective. 

Applied Improvisation deals with moment-to-moment shifts in live interaction between individuals or people in a group and is an ideal training ground for examining the often subtle ways that readiness-or lack thereof-to receive and consider an idea is communication. This workshop explored some of the subtle ways that emotional states and mind set are communicated, through vocal inflection, attitude and movement. 

APPLIED IMPROVISATION is grounded in 3 fundamental principles- beautifully explored in a blog post by the wonderful San Diego-based improviser Amy Lisewski - that are extremely useful for adapting in the moment to whatever other people present, and for accepting others exactly where they are psychologically and emotionally:

• Let Go
• Notice More
• Use Everything

EXERCISES:
THE STAGES OF CHANGE ENACTMENT

Objectives:

• Provide a visual and experiential view of the stages of change
• Explore a fictional change through a realistic lense

Using improv rules, the group develops an imaginary group to which belonging would mean a significant change (mainly because the group is imaginary and "out there" and the more "out there" the better for this exercise). In this workshop, the group developed the idea of converting to "The Church Of George Clooney." What was involved with belonging to this church was getting a gold tooth right in front that everyone could see, and the opportunity to have lunch with George Clooney, who we endowed with magical power to have lunch with millions of people simultaneously. 

Group members are handed a card that has one stage of change written on it, then line up in the order of the stages. The group explores what is happening at each stage of converting to The Church Of George Clooney, e.g. 

Pre-contemplation: the person at this stage cannot envision being part of this church or even wanting to be part of it. It seems impossible and irrelevant. At the same time, there is something about his/her present life that seems lacking, or something that is not working as a result of loneliness, isolation, or social disconnection. The concept of precontemplation is that there is a problem of some sort, but a change in behavior or trying something new is not under consideration. 

Contemplation: there is an awareness that belonging to The Church Of George Clooney has some appealing features. Information about the benefits and requirements are received and under consideration.

Preparation: the person is now actively gathering information, seeking out resources and weighing what is involved with moving forward on it. 

Action: movement is happening. The person is engaged in signing up for the church, meeting the requirements, etc.

Maintenance: the person is now an active member of the Church Of George Clooney, and has internalized the new habits and relationships as part of his/her identity and life.

For this exercise, it is helpful to use an imaginary reality as the focus of change so that the rules and requirements can be invented in the moment, and because when we are working with great change the outcome can be seem as improbable and unrealistic to achieve as belonging to something like The Church Of George Clooney. 

When working through the stages of change, there are barriers that come up. We may be in the action stage of one change only to find that moving forward means facing another change about which we are pre-contemplative, e.g. a person who is in the action stage of leaving an unsatisfying job discovers that the process of seeking a new job feels threatening. The application and interview process brings up fear and anxiety - the person is precontemplative about going through this so has to work through those feelings.

One-word sentence
Objectives:

• To explore the physical, vocal and other nonverbal ways that emotion and intention are communicated;
• To explore the diverse meanings that a single word or idea can carry;
• To provide an experience for looking at subtle cues in communication and what they might signal;

The group calls out a variety of words that can be used as a complete sentence, e.g. No. Really. Oh. Wow. Well. Now. 
A word is chosen from the list. Each member in turn says the word with a different emotional tone or intensifying the emotional tone that someone else expressed. First rounds are just listening to each person's take on the word. Subsequent rounds can branch into discussion of what the listeners perceive when hearing the word. Different perceptions of the same emotional expression are common. Discuss what images come up hearing the word spoken in different ways, and the subconscious patterns that might be expressed through nonverbal cues. 

VARIATION: Have a conversation using 1-word sentences, e.g.
Now? (confused)
Yeah. (reassuring)
Well...(uncertain)
Here. (comforting)
Okay. (hopeful)
Good. (confident)
Thanks! (grateful)

3-Line Scenes
Objectives:
To explore how a story can be created with 3 just 3 lines being spoken;
To experience initiating a scene using one word and receiving a partner's interpretation of it without judgment;
To practice thinking on one's feet and working with the unexpected in relating to others;

In pairs, particiapnt A starts a scene using a 1-word sentence. Partner B responds with a complete sentence. Partner A completes the scene with a 1-word sentence, e.g.
Person A: Great (sighing)
Person B. It looks like we're going to be here awhile so lets order some food.
Person A. Okay (resigned)

Insult - Compliment - Threat
Objectives:
Explore how the same statement can be perceived as an insult, threat or compliment based on the receiver's mindset;
Explore the way it might feel to perceive information as a threat or insult that is not intended that way (which can happen with people struggling with change that challenges long-standing ideas or relationships);
Have fun with learning not to take other peoples' preconceptions personally;

Facilitator prepares index cards that have "Compliment" "Insult" or "Threat" written on it. These are handed out to participants. Participants pair up, one with a card and one without one. The person with no card says any random statement. The person with a card must respond from the mindset of the word on the card:

Person A: This place doesn't take reservations.
Person B: You must think I'm a real loser. (card says 'insult)
Person A: I'm pretty sure they don't take reservations from anyone, not just us.
or
Person A: This place doesn't take reservations.
Person B: Thank you!! You know I only go to places so high end you can't get a reservation.(card says "Compliment")
Person A: Well really its because they're not that fancy but I'm glad you're happy about it.

I AM A TREE - 
Objectives:

• Develop a story moment-to-moment;
• Replace over-thinking and planning with moment-to-moment responsiveness;
• Collaborate with others to create a story without planning or over-thinking;
• Focus awareness on emotions;

Player A stands in the center of the circle and says "I am a tree." Next player adds something to the tree, e.g. "I am a bird in the tree." Next player adds something to the bird, e.g. "I am a piece of birdseed in the bird's beak." Next player adds something to the birdseed, e.g. "I am the lady throwing birdseed on the ground." Next player adds something to the lady throwing birdseed, e.g. "I am the bench the lady is sitting on. And so on until everyone is in the story. The story can continue, starting with the last offer that was made: "I am the bench the lady is sitting on," followed by "I am a cell phone that's been left on the bench, " etc. 

RESOURCES FOR FURTHER INFORMATION:

Click here for a list of books by James Prochaska that deal with The Stages of Change model in psychotherapy and addictions work.

6 Reasons Why Improv Class Can Improve Your Confidence on Elite Man Magazine website

How Laughing Leads To Learning, website of the American Psychological Association.

Amy Lisewski's new book Relax! We're All Just Making This Stuff Up: Using The Tools of Improvisation To Cultivate More Courage and Joy In Your LIfe

Jude Treder-Wolff, LCSW, CGP, MT is a trainer/consultant and writer/performer. She designs and facilitates creative, experiential workshops and classes for personal and professional development, and is President of Lifestage, Inc, an approved provider of Continuing Education for social workers in NYS, Provider #0270. She is host/creator of (mostly) TRUE THINGS a storytelling show that features true stories - with a twist. Follow her on twitter