This application of therapy is called the precursors approach. It utilizes the precursors model of change, and is specifically designed for use with difficult clients. The model and its corresponding techniques have been published in articles and in the book, Therapy with Difficult Clients: Using the Precursors Model to Awaken Change, published by the American Psychological Association. Since adolescents are among the most difficult populations, the model seems to fit well in such settings.
The model is based on seven empirically validated client variables, functions, qualities, or change factors that can be considered to be therapeutic change mechanisms or processes. The precursors can be considered to be prerequisites of change.
The essential idea behind the model is that if a person is not manifesting the precursors, change will not occur regardless of the therapeutic approach taken by the therapist. Conversely, if a person has the precursors to an ample degree, any reasonable approach to therapy will be effective. Thus, a client is difficult simply because the precursors of change are missing or absent in that person. The model suggests that if the missing precursors are established, then the client can, to that degree, begin to respond to conventional therapy approaches.
The precursors approach includes a host of techniques and strategies designed to initiate and expedite the therapeutic change process by helping to establish the precursors in a client for whom change is not, or has not been, forthcoming. There is a set of techniques and strategies corresponding to each of the seven precursors. A precursors assessment form is an intrinsic part of the model, used to determine which precursors are most in need of attention in a difficult client. The approach is specifically intended to be used with difficult clients and has been used widely with difficult adolescents.
The seven precursors of change are:
- a sense of necessity for change
- the willingness to experience anxiety or difficulty
- awareness of the problem
- confronting the problem
- effort toward change
- hope for change
- social support for change
The purpose of the approach is to help establish the precursors to clear the way for the more established theories and approaches, so that they can be more focused and more effective. Part of the precursors approach involves motivating adolescents to work in therapy through aligning their own desires and values with therapeutic goals such as abstaining from drugs or alcohol, improving school performance, and/or satisfying the simple desire to be happy. The approach is also designed to help them tolerate and experience anxiety rather than shunning it at all costs. It is an extremely supportive model, relying on high empathy and intense techniques, with the goal of producing an initial breakthrough with a client.
The initial breakthrough converts the client from being unwilling to engage in therapy, to being motivated and involved in the therapy process. The precursors approach applies to such adolescent behaviors and issues as stealing, lying, blaming, drug and alcohol abuse, cutting, eating disorders, anger, violence, and many others. There are many, many precursor specific strategies utilized in bringing about that initial breakthrough such as admiring negative behaviors and attitudes, courtesy and permission, the subpersonality approach, addressing the hurt, the freedom challenge, the life circles technique, real self vs. fake self, the attention remedy, therapeutic button pushing, the use of metaphors, in vivo confronting, the use of metaphors, and many more.
The precursors model can also be used in supervision, due to the interesting notion that therapists have precursors ratings toward clients, and that a therapist's level of precursors varies with each client with whom he or she works. A supervisor can thus address the precursor levels in a therapist who is having difficulty with a particular client, and explore the possibility that the therapist's low precursor ratings may be in part responsible for the client's lack of change in therapy.
With regard to adolescents, oppositional defiant, angry adolescents are quite appropriate for this approach, as well as violent, manipulative, and drug abusing adolescents as well. It is also appropriate for teens with attention seeking, power struggles, eating disorders, and those who are not forthcoming with self-disclosure. It would be appropriate, but challenging, to use this approach for teens who are bipolar.
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