Client Perceptions of Pretreatment Change

Questions surrounding the concept of change have been considered for a long time. The pre-Socratic philosopher Heraclitus was among the first to argue that change is an omnipresent condition of life, a view that was exemplified by his famous decree regarding the impossibility of stepping into the same river twice (Mahoney, 2000). The notion that change is possible, and even inevitable, is perhaps one of the central ideas inherent in the assumptions that inform mental health disciplines. Thus, questions pertaining to the nature of therapeutic change, such as pretreatment change, are important to mental health because of their fundamental association with the counseling process. Counseling outcome research has indicated that common factors, such as client strengths and resources, the facilitation of the therapeutic alliance, and client hope, are important contributions to the change process (Asay & Lambert, 1999; Beutler, Castonguay, & Follette, 2006; Lambert, 1992; Wampold, 2001). Research has also indicated that therapeutic change is more likely to be long lasting when counseling clients attribute change to their own efforts (Lambert & Bergin, 1994). There is some evidence to suggest that clients may benefit from different therapeutic conversations at various points in counseling, as change progresses. This idea has been systematically described as a transtheoretical theory, which delineates the stages of change (Prochaska, 1999; Prochaska & DiClemente, 1982; Prochaska & Norcross, 2002). From this perspective, change consists of six stages through which clients pass as they engage in therapeutic change: precontemplation, contemplation, preparation, action, maintenance, and termination. These stages describe different client needs at different stages of change as they consider, prepare for, enact, and maintain therapeutic change. Thus, therapeutic conversations designed to facilitate, and capitalize on, the therapeutic alliance, client hope, and client strengths and resources may need to be altered to match client needs as they progress through different stages of change. Counseling approaches that prioritize identifying and incorporating client strengths and resources and that are tailored to client needs at different points in counseling warrant further consideration. Research pertaining to client change has suggested that counselor understanding of client perceptions of pretreatment change could also help counselors meet their clients' needs. * Considering Pretreatment Change One of the first studies to appear in the literature on the topic of change without treatment was conducted by Schorer, Lowinger, Sullivan, and Hartlaub (1968). The authors examined pretreatment change with clients assigned to counseling waiting lists. Of the 55 wait-listed clients who received no additional services, 36 (65%) experienced significant clinical improvement without treatment. Weiner-Davis, de Shazer, and Gingerich (1987) interviewed 30 families seeking counseling at a community-based facility regarding pretreatment change. Specifically, the authors asked clients if desired changes related to their reasons for seeking counseling had occurred between the time of initial contact with the counselor and the first counseling appointment. The researchers found that 66% of the participants initially reported that desired pretreatment changes had occurred. In addition to reporting the prevalence of pretreatment change, some studies have investigated the impact or uses that pretreatment changes can have during the counseling process. Beyebach, Morejon, Palenzuela, and Rodriguez-Arias (1996) found that clients reporting pretreatment changes were 4 times more likely to successfully complete counseling than were clients who did not experience pretreatment change. These results indicate that it may be especially useful to focus on pretreatment changes in the first session of counseling. …