the 7 things you need to create meaningful change – precursors of change

Quick summary: Dr. Fred Hanna did some excellent work on identifying the variables which must be in place in order for a person to experience change. He not only studied these 7 variables he also came up with specific techniques to encourage those variables into existence. According to him, the seven precursors of change are:  a sense of necessity  –  a willingness or readiness to experience anxiety  –   awareness  –   confronting the problem  –   effort of will towards change  –   hope for change  –   and social support for change.
Dr. Hanna Currently works at the University of Northern Colorado you can find out more about him and his publications at http://www.unco.edu/cebs/counsed/faculty/hanna.html
He wrote an excellent book which I believe is a must read for anyone working in the mental health profession –

Hanna, F. J. (2002). Therapy with difficult clients: Using the precursors model to awaken change. Washington, DC: American Psychological Association. 

I learned about Fred’s model as I was lucky enough to have him as a professor and I have read his book and most of his research – his philosophically themed investigations are awesome… He exposed me to some super facinating literatureon subjects like phenomenology.
The 7 Precursors of Change
The seven precursors of change are those qualities that must be at least partially present in a client for a client to change.
Clients must have:
A sense of necessity  –  a willingness or readiness to experience anxiety  –   awareness  –   confronting the problem  –   effort of will towards change  –   hope for change  –   social support for change
The Precursors
(These are not linear and they are all interconnected)
I will provide a definition, one example (using a person with alcoholism to be consistent), one technique to develop the precursor, and one common belief held by people lacking the precursor.  Note: Dr. Hanna has over ten techniques for every precursor. Many techniques can be used with more than one precursor. (if you life this basic summary – you will love his book)
A sense of necessity:  the client must feel that a change in circumstances must take place. The client essentially needs to have a reason to change. The goal is to create anxiety in the client so that they feel a sense of necessity. 

• Example: If a man doesn’t quite drinking his wife (whom he enjoys) will divorce him. 
• Subpersonality technique:the therapist asks the client if there is a small percentage of him/her that wishes things were different. The therapist asks what percentage of the client holds that belief. The therapist then asks permission to talk with that part of the person’s personality. The goal is to increase the subpersonality’s influences so that the majority of the client feels a need to change. 
• Belief without the Precursor: “I am just fine the way I am.” 

A willingness or readiness to experience anxiety or difficulty: The client must be willing to deal with the inevitable discomfort which arises naturally with the onset of change. Often the maladaptive thought or behavior etc is in place to reduce anxiety.

• Example: The alcoholic man must be willing to face the hardships of temptation and the anxiety surrounding the process of finding new ways to cope without alcohol. This often means that one must accept that new environments and new habits must be found.
• Educational metaphors technique: metaphors are used to teach the client that things will get better once they face the anxiety.  The intention is to use a metaphor that the client can relate with to display that very little is accomplished without effort. The workout metaphor, ‘no pain no gain’, is used to display the idea that if you do not let your muscles feel tension they will not in fact grow.
•  Belief without the Precursor: “if I have no feelings I have no pain.”

Awareness: This is simply knowing that a problem exists and then being able to isolate what thoughts behaviors and feelings are connected to the problem. This is closely related to accurately perceiving your environment.

• Example: an alcoholic must be aware that he drinks too much and he must be aware of what thoughts feeling and behaviors occur within him and around him when he drinks too much. 
• Role plays of others technique: the client is asked to role play someone whom he/she trusts very much. This is essentially an empathy building exercise where the client is asked to perceive him/her self from the vantage point of a trusted companion.
• Belief without the Precursor: “If I am not aware of something it can’t hurt me.”

Confronting the problem: This is when the client is willing to focus his/her attention on the problem so that they can fully understand all of its’ attributes. Essentially this is knowing and accepting all the effects of the problem and admitting the truth to yourself.

• Example: the alcoholic man might know that he drinks too much but he has not focused on the problem enough to find that his drinking is inhibiting him from spending quality time with his family 
• Representational or concretized confronting technique: this technique is used to make a tangle object (such as a pen or a paper weight) symbolize the problem. As the clients acknowledges the problem, but then quickly changes the subject the therapist can hand them the concrete object and tell her/him that it represent the elusive problem. This forces the client to stay with the problem so they can investigate its’ nature 
• Belief without the Precursor: “if I ignore a problem it will go away. I can deny the negative repercussions of my problem.”

Effort or will towards change: this is when a client takes action to solve the presenting problem. This is the actual effort.

• Example: the alcoholic man will actually make effort to stop his drinking. This would likely manifest itself in actually attending AA and/or actually stop ingesting alcoholic substances.
• Assigning graduated tasks technique: First it is important that any goal is both reasonable and is something that the client wants to do. This is a behavioral technique which focuses on getting the client to start small so they are reinforced by success. If a person wanted to start eating better for example you would have them eat a healthy meal just one time a week to start. Gradually the goal would be to eat healthy meals 80% of the time etc.
• Belief without the Precursor: “I know that if I try I will fail.”

Hope for change: this is having the belief that change will occur. This is a realistic expectation based on ration. Hope in this sense is not synonymous with wish. Hope involves seeing how things will change and believing you can accomplish and overcome all you need to. 

• Example: hope for the alcoholic man would be that he actually believes that he will succeed in controlling his drinking and that his life will in fact improve as the result of his efforts.
• Reframing negative behaviors as skills technique: a great way to instill hope is to reframe negative behaviors to shed light on the usable and positive aspects of such a behavior. For example the same skills that are needed to manipulate someone can be used to help someone in that manipulation necessitates a firm awareness of the person in front of you. If you are great at manipulating situations for yourself, it would not be a huge stretch to manipulate situations for the better of everyone.
• Belief without the Precursor: “no matter what I do, things will never really get better.”

Social support for change: this is having people in the client’s life that are supportive of the relevant change to be made by the client. The relationships help the development of the other precursors. This obviously does not encompass those people who inhibit the development of the other precursors. 

• Example: for the alcoholic man this would be having relationships with people who believe that his life will be better when he controls his alcohol. Those people might also being willing to help.
• Concentric circles technique: the therapist draws five circles each representing a level of intimacy. The counselor tells the client that the outer most circle is for people who simply know surface level stuff, and the inner most circle is for people who know or have known the client’s most intimate and personal secrets. The two then discuss which people are instrumental towards the desired change and which people are hindrances. This could bring up past relations that were dissolved do to the problem.
• Belief without the Precursor: “people really only care about themselves.”