It can sometimes seem very overwhelming to people who desire to make changes in their lives that are more healthy and boosts happiness.  Of course, the unhealthy practices and thoughts that have served to hinder progress and maintain unhealthy behaviors are first to stand in the way.  The intent and motivation may be present but environmental and internal conditions stand in the way like the great wall of China.  

But, just as the Great Wall of China looks daunting and impassable and was ultimately breached by the Mongols so too are the negative internal thoughts and beliefs we have when wanting to achieve personal goals of better mental and physical health.  They seem daunting but with the correct perspective they can be easily overcome.  Seeing a counselor for help in making the desired changes in life and to achieve the desired goals in life is the best thing a person can do.  

Most people in the United States believe that the only reason anyone seeks out counseling or psychotherapy is mental illness.  However, most people who seek counseling are not mentally ill or even remotely diagnosable as being mentally ill.  These people come to counseling to help them overcome issues of self-esteem (self-value) and self-efficacy (sense of being able to accomplish things) that hinders their ability to succeed in life as they define success.  Self-confidence building is another reason they go to counseling.  In other words, they go to counseling to learn skill sets that allow them to break free of their personal hindrances and achieve their personal life goals and develop more healthy ways of perceiving the world around.

Years of research in clinical counseling and psychology has revealed that there is a continuum of change that people go through before committing to and taking action to achieve those changes that are desired and more healthy.  This continuum is most commonly recognized as stages of change and was originally observed in persons struggling with addiction behaviors.  But, over time it has been observed to be applicable in a number of settings and circumstances. 

 So, what exactly are these, Stages of Change?  First, it is important to note that the word, stages, infers a linear progression from one point to another through established and predictive steps or stages.  But it is more accurate to see them as being on a continuum that allows for both forward and backward movement along the scale.  So, the Stages of Change is a continuum of states that a person goes through leading to commitment to and action towards personal positive change in behavior and cognition.  

There are five stages that make-up the continuum.  These are: Pre-Contemplative, Contemplative, Determination, Action, and Maintenance.  These cover the range of denial or change consideration resistance to making a determination to accomplish positive change and on to Maintaining the changes after initially making the change.  Of course, a person’s journey towards change is never that smooth or cut-n-dry.  There are roadblocks and set-backs that occur and this is where a person working toward personal positive change can regress to an earlier stage.  This is why it is best to see the process of change as a fluid continuum of states rather than a linear process of set stages.  Progression and regression is a normal part of the process toward change and counselors assist the person in staying the course and re-engaging in their desire for change and goal accomplishment.

The first state in the continuum is the point where many people enter but some enter at other points such as contemplation.  In this state the person possesses a desire to make changes that make life better but isn’t sure about what changes to make or how to go about it.  There are also hindering conditions of negative auto-thoughts like catastrophising and fortune telling that are combined with negative self-esteem and self-efficacy.  However, those elements are more prominent in the next state of contemplation.  But in this stage there is a minimal if non-existent awareness of a need to change or of a means for effective change.  Feelings of hopelessness and helplessness, indigenous to depression, prevail.

The next phase/state is the Contemplative Stage where the person begins to become more aware of a need to change and of means for change.  The person considers, or contemplates, the need for change, what changes are needed, and Both their ability and resources for change.  The challenges presented by negative auto-cognitions and low self-esteem and self-efficacy become most prominent in this stage as the person battles internally to overcome the hindrances and transition into a determined state for change.

The contemplative state is where counseling is most visible as the person learns new ways of seeing the world and how to challenge and re-frame negative auto-thoughts.  The counselor also assists the person in boosting a sense of self-esteem, confidence, and self-efficacy regarding an effort to achieve positive change and life quality improvement.  Once the persons sees the true value of him/herself and the true inner strength and worldview he/she has then there is readiness to make a determination to achieve his/her changes and goals.

At some point during the contemplative stage the person will make a determination that he/she has the ability, strength, and means to effectively achieve positive change that improves their quality of life.  When this realization occurs the person becomes determined and committed to changing things.  The determination stage is where the person sees personal value, strength, and ability to achieve his/her goals in life.  Additionally, this is where the person and the counselor work together to identify clear and achievable goals and the steps needed to achieve those goals.  Once a goal is selected and the steps are established in accomplishing that goal transition to the action state comes quite easily.  

Taking action to accomplish an identified goal is where the real work begins.  This is where the person uses skills learned and continues to learn skills that promote a healthy accomplishment of the goal.  This is were regression and a true test of the person occurs.  It is perfectly normal in this stage for a person to feel overwhelmed and to experience a number of external pressures to quit the effort.  This is especially so for a person trying to leave a dysfunctional family role where the family members, seeking homeostasis, will pressure the person to abandon their efforts towards the goal they have.  And, it is here that the client-counselor working alliance is needed the most.  Coaching, support, teaching, are all elements provided to the person through the therapeutic alliance.  

Making the changes happen is never an easy process and almost always requires the person to step outside of his/her comfort zone.  This is because the persons unhealthy ways have become comfortable and behaving, interacting, and thinking differently is new and uncomfortable.  However, with commitment to change and perseverance the uncomfortable becomes comfortable and normal to the person while the dysfunctional and formally comfortable status wains.  That is where the achieved goal is manifested - new and healthy becomes comfortable and normal to the person while the unhealthy becomes uncomfortable and abnormal to the person.  Boom!  Goal achieved.  All that remains is to maintain the accomplished state.

The Maintenance Stage is where the person, having achieved his/her goal, uses the skills learned and modifies some skills to strengthen the new behavior(s) and cognition(s) achieved during the Action Stage.  There will be moments where life may provoke a regression or a challenge to the skills for overcoming life obstacles and the more automatic the person’s use of healthy coping skills and tools the easier it is to overcome challenges and pressures to return to unhealthy practices in life.  Counselors continue to work with the client during the early part of the maintenance state until the client has thoroughly incorporated the changes and overcomes challenges without a need for assistance.

These are the states/stages that comprise the continuum of change.  This process was originally identified when working with people who were struggling with addiction behaviors but was soon discovered to be applicable in a number of human behavior and thought settings.  The stages of change, though quite applicable to the substance addiction recovery process/model, has been modified a bit to allow for its application in other clinical and non-clinical helping relationships between clients and counselors.  While reading this article you, the reader, may have seen some of your own experiences described in one or more states along the continuum.  That is perfectly fine because we all make changes in one place or another or at one time or another and find ourselves flowing through these states more easily sometimes while not so easily on others.  

Instead of blaming yourself for not achieving your life goals and not being in a more healthy position in life think about the challenges you have faced and remember that counseling isn’t just for the mentally ill but for all people seeking self-improvement through changed conditions, thoughts, beliefs, worldview, and behaviors.

In my some odd six years of experience in clinical counseling I have encountered many troubled people. Most experience chronic bouts of depression while others experience anxiety. It is more common to see people experiencing both depression and anxiety.
In every case of depression I see that the person seems trapped in a fixation on memories of moments and events in the past. The seem stuck in a repeating cycle of re-living sad, disappointing, and/or traumatic moments. It plays over and over like a song stuck in one’s head and the result is the consumption of time for the here and now of the person’s life. Feelings of hopelessness and helplessness grow and entrench themselves in the persons thoughts, beliefs, and worldview. They become withdrawn and lose interest in things they used to find enjoyable.

In each case of anxiety I see the anticipation of some or other catastrophe. It doesn’t matter if the foreseen catastrophe is rational or not or if it can even by concretely identified or not. Every desired activity or plan for the future is met with a wall of things going wrong - not just wrong but catastrophically wrong. A fear of doing develops in the face of expected catastrophe. This is known as a pattern of Catastrophizing.
In these cases there is an awareness of a sad, disappointing, and perhaps even traumatic past. There is present an obsessive dwelling on the negative events while past positive events are set aside or ignored altogether. From this obsessive focus on negative past events comes the

anticipation of an equally negative, if not worse, future for the person. The Self-fulfilling Prophecy ensures self-sabotage in nearly every event thereby creating additional negative memories to be fixated upon and thereby concrete the anxiety side of the person’s problems.

We see in these people an awareness of the past albeit limited to negative outcomes and we also see an awareness of the future that is clouded in exaggerated risk for failure. A wave of seemingly endless “What if” scenarios of catastrophe overcome the person at the mere thought of participating in an event or planning for something as simple as a vacation. The past, the future - what is missing?
The Moment of Now is what is missing from this equation. There is so much regret and remorse from the past mixed with worry for the future that the Here and Now is smothered. There is little to no awareness of the here and now for those experiencing depression and anxiety. But, it is in the moment of now that we all live. Here and now is where the future comes to fruition and memories are made. What we do now constitutes our memories tomorrow and the achieved goals that were planned yesterday. Without now, there is no past and no future and yet in cases of depression and anxiety, the moment of now is ignored and passed over without ever really having experienced it. Being mindful of what is going on around you, to the smallest detail and sensation, is the key to success, positive outlook, and healthy memories.
“Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment.” - Gautama Sidharta, 3000yrs ago

“Anxiety is an illness of the future while depression an illness of the past. Their cure lies in the moment of now” - John M. Duffey, Sr., 2017
Mindfulness is an exercise of the mind that grounds the person in the moment of now. It is a means by which the control of breathing and the focus on the rhythm of breathing allows for the person to escape the regret of yesterday and the worry about tomorrow - you experience right here, right now. This exercise allows for the person to focus only on the sensations of what is happening around him/her - to feel the reality of the environment around the person. The smells in the air, the sounds heard right now, the rhythm of breathing, heart beat, and the pressure of the ground or seat upon the legs and buttocks of the person experiencing the here and now moment.
Through this exercise, the brain becomes better supplied with oxygen, muscles relax, and norepinephrine is released to calm the anxiety symptoms supported by high levels of epinephrine in the brain. Blood pressure also comes down and all of this is experienced throughout the mindfulness exercise. When the exercise ends the person is left with calm and clarity of mind to critically examine and challenge the assumption of the self and the future.
This has been proven in numerous research studies to be highly effective in assisting people in reducing their depression and anxiety symptoms that it has now become an integrated part of psychotherapy. It is most effective in cases of Generalized Anxiety Disorder (GAD), PTSD, mild to severe chronic depression, and even stage fright/phobia.

The Biopsychosocial assessment is a tool used by mental health professionals to assess where a client is at the present moment.  It is a three-part examination that includes the biological, psychological, and social elements of a persons functioning as an individual, a part of a family system, and in society at-large.  Much of the concerns raised by the client can be better understood through a review of these areas of influence and personal functioning. 

BIOLOGICAL

The biological element deals with issues that affect the client physically like illnesses, disease, medication, diet, drug use, etc.  This is the body-behavior element of the assessment.  Some medications will influence mood, sleep, and levels of lethargy that contribute to conditions such as depression and anxiety.  Other areas such as Hyper-/hypothyroidism can impact cognition, perception, mood, and behavior.  Hyperthyroidism is a contributor to feelings of anxiety and in severe cases may contribute to the development of psychotic episodes.  A client may encounter questions concerning topics such as:

1. Medical Diagnoses
2. Physical challenges and disorders
3. Medications being taken
4. Alcohol consumption habits/abuse/addiction
5. Illicit drug use/abuse/addiction

The biological category allows for the identification of medical or physiological conditions that contribute to the concerns of the client that may need to be addressed by a medical doctor.  In treating any conditions or possible medication interactions a person's distressing behaviors and/or cognitions may resolve.  In other cases, a discovery of a need for psychiatric teaming may occur that will lead to a joint treatment effort that assists the client.  Conditions such as hypothyroidism or hyperthyroidism are examples of hormone imbalances that contribute to cognitive and behavioral problems.  Other endocrinological conditions also impact thought, perception, and behavior.  

PSYCHOLOGICAL

The psychological element, as would be expected, assesses the psychological factors that impact a person's feelings, emotions, etc.  In this section there are going to be questions regarding:

1. Self-esteem (Self-Value)
2. Self-Efficacy (How well the client believes he/she can accomplish goals in life)
3. depressive symptoms
4. Anxiety Symptoms
5. Mood patterns
6. History of Trauma
7. Developmental status/assessment
8. History of Psychiatric diagnoses and treatment
9. Outlook
10. Cognitive functioning
11. Suicide ideation/history of attempts

These eleven are not the only areas that will be assessed during the intake interview and periodically throughout the counseling process.  Additionally, informal and formal assessment questionnaires may also be completed in order for the therapist to get a full picture of the client's psychological state as of the time of the assessment.

  SOCIAL

This section deals with the social factors that impact the client.  Here the therapist will ask questions concerning the client's community involvement, family and friend support, community support and resources, employment and employability, and hindrances to social participation.  Support and resources are very important to a person's ability to cope and overcome adversity.  We are all inherently social beings and isolation has a profoundly negative impact on us.