Planting Seeds of Change for Kids in Crisis
by ANNE MELFI
anneamaz108@cs.com

A kid comes to Southwest Mental Health Center in San Antonio, Texas, in a state of crisis and may stay only a few days to a couple of weeks. That's not enough time for radical transformation, but it is enough time for planting seeds for change.

"We have an understanding of how the change process works here," says Geoff Gentry, the center's Director of Clinical Services. "It's a step-wise process, and you can't skip any steps. The first is education, especially where the family is concerned. It's a slow process and can be very frustrating but in most cases it has to be done."

Gentry draws inspiration from the Stages of Change model, which James O. Prochaska, John Norcross and Carlo Di Clemente evolved by studying how more than 1,000 self-changers changed for good without therapy. They focused on smoking cessation and other health issues. Here's how it works at Southwest Mental Health Center.

• Stage One: Pre-contemplation and lack of awareness or under-awareness. The facilitator wants to move the client to awareness of the problem and solutions. The client holds on to the status quo like a security blanket.

"A key factor is that many patients and families are more receptive to information during crisis than they are at other times," says Gentry. "Crisis presents an opportunity."

Two catalysts for change at this level are: consciousness-raising about the problem; and providing new sources of support.

"Directing families to support groups when they have had little or no treatment experience can be very powerful," he says. They may come thinking, 'How can I get my kid to change,' but realize alternatives, like behaving differently with my kid. Someone in the support group may say, 'I had so much trouble with my kid until I started to listen to the child.' Gentry explains, "It's a new and supportive setting in which the family is provided a way to discover information for themselves. This is a model of intentional self-change."

• Stage Two: Contemplation. "The more emotional connection to the problem, the more successful the change," says Gentry. "Part of the contemplation stage is to rein in the urge to plunge into change prematurely and balance it with stability. This bears emphasis in an acute setting. Once a person becomes aware of a problem, there may be a tendency to move ahead to action too fast. You can't skip from the awareness stage to action until there's an emotional investment in changing."

"One way the agents of change develop depth is through films and dramatic portrayals to raise emotional meaning and give fuel to the work that must be done in the later stages. Then the work will have deeper impact," says Gentry. "You can persuade intellectually, but we're talking about change, which requires emotional investment," says Gentry.

• Stage Three: Preparation. "I'm going to change," says the client, who now sees benefits looming larger than the costs of change. "The change model is not a form of therapy, and it doesn't tell you what kind of tools or interventions to use," says Gentry. "You get to the point where you are motivated, and then you find ways." How empowering.
  
  
• Stage Four: Action. We use three basic change techniques - countering, environmental control, and rewards. "We rarely move past stage four here," says Gentry. The therapists write reports for subsequent caregivers to use after the patient's short stay at the Center. They will be the facilitators for the Maintenance, and Termination Stages.

"The applications are broad," says Gentry. He used it to improve clinical training. One seminar wasn't working, but for a while no one was willing to say the emperor has no clothes.

"Because of the people involved, we accelerated the change process. It came out in 2001, and by 2002 we were maintaining. We had everyone in the training group read Prochaska, Norcross and Di Clemente's book, Changing for Good (1955). It's very exciting stuff."