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Change maintenance after therapeutic enactment : a critical incident study The show must go on Fotheringham, Jodi Lee


Peoples' efforts to change, grow, and heal take place under a variety of conditions. The goal of any therapeutic intervention is to provide exceptional conditions of safety and skill to strategically promote change. The majority of psychotherapeutic investigation has focused on its own outcome effectiveness to the detriment of a broader understanding of change (Karoly & Wheeler Anderson, 2000; Meichenbaum, 1997; Prochaska, 1999). The purpose of this study is to contribute to an understanding of how people continue their own change process after participating in therapy. The present study uses Flanagan's (1954) Critical Incident Method to investigate what factors facilitated participants' efforts to maintain the change they achieved through therapeutic enactment. Co-researchers in this study were individuals who reported significant change as a result of their experience as leads in their own enactments. These co-researchers were asked to engage in self-reflection, and to articulate their experience of critical incidents which helped or hindered them in the consolidation of their changes. They were interviewed once to collect the data, and again a second time in order to validate the data. Five additional procedures were used to establish validity and reliability of the data: independent raters, expert raters, exhaustiveness check, participation rate, and theoretical agreement. A total of 125 critical incidents were reported by eight co-researchers. Six facilitative action categories were developed from this data: (a) connecting with others, (b) practicing, (c) remembering, (d) connecting with emotional and physical aspects of self, (e) resolving, (f) contemplating. Strong theoretical agreement was established between these helpful activities and nine of the ten processes of change determined through the studies of Prochaska and colleagues (Prochaska, Johnson, & Lee, 1998). The source or contexts of the incidents also proved to be significant in facilitating change maintenance. A taxonomy of action categories and context sub-categories was developed to provide some ideas to promote change maintenance. The taxonomy is based on a compilation of the results from this study and relevant literature. Special attention was paid to two of the most commonly and frequently used facilitative activities: connecting with others and practicing. Theoretical, practical, and research implications are discussed related to these facilitative action categories.

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