No Lights, No Camera… ACTION:
The BTS of Change and Transformation
(Behind The Scenes)
And we’re back! In my last post, Is Validation Getting In The Way?, I left off with a question: “What do you truly believe about healing, change, and transformation?” I also promised to dive deeper into two points on the stages of change map that I only briefly referenced in that blog. Those points are Action and Maintenance.
Since change is an active and deliberate process, I want to use this space to examine how Action manifests in the different models I adhere to. My goal is to provide clear examples of the active nature of psychotherapy and the specific intentional Action required for change during therapy. The mental, emotional, and sometimes physical energy I see as crucial for real change and transformation may resemble what we think of as physical therapy.
Truth be told, I often wish people viewed counseling and talk therapy the same way they view physical therapy. No one attends physical therapy and expects that simply showing up for a session and providing their history will heal their injuries and improve their mobility. They expect an active process and, at times, discomfort. Keep this in mind as we progress through this blog.
RECAP: STAGES OF CHANGE
As a brief refresher, I view the 6 stages of change (Precontemplation, Contemplation, Preparation, Action, Maintenance, and Relapse) as a map, not a motor. Arriving at one point doesn’t automatically propel you to the next. However, specific Action and Maintenance within the following models of change can support inner development and transformational change. Several versions of the model include Relapse; the research portrays it as returning to an earlier stage rather than reverting to zero, and I agree with this interpretation.
As a clinician who values and celebrates the individual nuances of healing and transformation, I don't adhere to a single, universal model or approach. Although I draw wisdom and inspiration from various sources, the information, examples, and perspectives provided are not intended as personal or professional advice, guidance, care, or diagnosis. The examples of Action and Maintenance below are based on a hypothetical client profile.
CLIENT PROFILE
Name: Hippolyta* (pronounced huh·paa·luh·tuh)
Age: 36-46
Household / Family Comp: Spouse, in-laws, three children
Career / Work: Administration
MH Hx: low motivation, low energy, low self-efficacy
Expressed Concerns: Low confidence and self-esteem, social anxiety and isolation.
Expressed Goal / Desired Change: Feel good about self. Improve confidence and self-acceptance.
*Hippolyta is the legendary Amazon queen from Greek mythology and Wonder Woman's mother in DC Comics. My favorite Hippolyta is played by Aunjanue Ellis-Taylor in HBO’s Lovecraft Country. She’s an astronomer, mother, and wife who evolves from a constrained 1950s housewife into a cosmic, time-traveling warrior. (Sadly, Lovecraft Country was unfairly denied a second season, and HBO should answer for their crimes…. But anyway)
Neuroplasticity and Co-Regulation
Overview:
Hebb's 1949 principle, later called "cells that fire together wire together" by neuroscientist Carla Shatz, explains how the brain strengthens frequently used pathways. The adult brain can build new pathways through repetition, especially in calm states that support deliberate learning (Shatz). Stress also fosters learning, which explains the durability of painful patterns. The work promotes equal reinforcement for calmer pathways.
Action and Maintenance:
For our hypothetical client, Hippolyta, Action could be 5 minutes of breath work in a quiet corner of her home, three mornings a week, before others need her. This isn't because mornings are magic, but because her nervous system is calmest. Maintenance involves staying consistent with these 5 minutes on her schedule during times when she feels okay, and not viewing missed weeks as evidence that the practice was ineffective. The focus here is on simple, regular skill practice rather than complex, daily engagement. While daily practice may be an eventual goal, starting in a way that makes sense matters.
The key point: practice during moments of calm, not during activation, to train the nervous system proactively rather than reactively. This approach helps the nervous system learn the skill in a relaxed state so it can access it during stressful situations.
Maintenance means ongoing practice even after seeing improvements. It also involves expecting some setbacks or regressions and planning for them, rather than being caught off guard.
Relational Frame Theory
Overview:
RFT is a behavioral theory of language’s role and relation to cognition. Its science is foundational to Acceptance and Commitment Therapy (contextualscience.org). In ACT, it recognizes that language can tether pain with identity. Change involves easing struggle with thoughts and engaging in actions aligned with personal values, known as committed action and psychological flexibility (A-Tjak et al., 2015 meta-analysis).
Action and Maintenance:
Action here requires a neutral, nonjudgmental awareness of the internal language and dialogue that often goes unnoticed or is accepted as unequivocal truth. Yet what comes after noticing, even during one’s thought, is key. It’s important to pause here and not immediately jump to “fixing” or replacing what we perceive as a negative or undesired thought. The following activity is a cornerstone of ACT and helps people practice cognitive defusion. When practiced intentionally, daily or several times a week, it is ACTION. Chronicling one’s observations and insights from the activity can have a greater impact.
I'm Having the Thought: A Defusion Practice.
Ex: Fat-phobic inner critic scenario
The internal thoughts below could very well belong to our client Hippolyta: the reunion is on the calendar, the dress is hanging in the closet, and the Automatic Identity Defining Dialogue is already active.
OG Thought (Automatic Initial Thought):
“I’ve gained so much weight.”
Automatic Identity Defining Dialogue: “I’ve gained so much weight. Everyone at my class reunion is going to think I’ve let myself go. I only have 3 weeks to get into this dress. I’m always putting things off. I’m so lazy. I knew I should have started that class last when the kids got out of school. I never have time for myself… I could have gotten up earlier. I need to get my “ish” together. Maybe I shouldn’t even go. No one is going to miss me anyway… what’s the point?”
PRACTICING DEFUSION
Step 1. PAUSE.
Take a full inhale and exhale
Step 2. IDENTIFY The One / primary OG THOUGHT. (Note: DO NOT REFRAME IT… AUDIBLY AND INTERNALLY).
“I’ve gained so much weight”
Step 3. IDENTIFY the Thought AS A THOUGHT. (Out loud or in your mind)
I am having the thought, “I’ve gained so much weight”.
Step 4. PAUSE AND NOTICE.
Observe the words as words in a neutral, nonjudgmental manner. DON’T GET CAUGHT UP IN THE VALIDITY OF THE THOUGHT. Ex: Maybe it’s not that much weight. Simply notice the thought. You don’t have to agree or disagree.
This activity aims to reduce the emotional intensity and urgency of painful or intrusive thoughts, preventing you from wasting energy fighting or trying to eliminate them. It introduces a brief pause between the thought and your next action, allowing you to select a more helpful response instead of reacting automatically.
While weight gain definitely has social and cultural connotations, the words themselves are neutral. You don’t have to act on them. You don’t have to continue down a self-deprecating thought path. While this activity can be used as a doorway into exploring where one’s beliefs about weight, size, worth, and value come from and evaluating if those beliefs are congruent and helpful, just realizing your thoughts as thoughts (mental images, words, etc) and not inherently your true identity is powerful.
Maintenance may look like expanding this activity and practicing observation and curiosity as a way of life. Gently and compassionately investigating your own thoughts and assumptions, even when they aren’t distressing, helps maintain and hone this skill when challenges arise.
Social Constructionism and Post-Structuralism
Overview:
Narrative therapy, created by Michael White and David Epston, operates on the idea that the person is not the problem; the problem is the problem. (Narrative Approaches, externalizing conversations). Since much of what we deem problems exists, at least partially, within the stories we have internalized about society, our environment, and ourselves, shifting involves re-authoring: stepping outside the conflicting story and reconstructing identity based on strengths.
Action and Maintenance:
Action in this context can involve deliberately re-authoring one's personal narrative, or at minimum, a segment thereof, through the active and intentional practice of narrative therapy. The narratives that reside within our minds can assume a life of their own and, either consciously or unconsciously, influence our lives.
Name it. Select a personal story that has had or still has significant impact on your life. Give it a distinctive name that reflects its influence on you. For example, Hyppolyta might call her story the “Not-Enough Novella.” It appears whenever her in-laws comment on her house, when a coworker gets her desired project, or when she removes herself from a group photo. Its publication date is decades old, and when she checks the byline, her name isn’t there. Other personal narratives might have titles like “Body-Shame Bulletin” or “Always-Behind Bestseller.” Moving forward, you can refer to this story directly, without needing to label it as “me,” “my ____,” or “I.”
Observe it. Exactly where does the B-S Bulletin show up? In a Ross dressing room, when you’re scrolling on TikTok, when you cancel a much-needed night out with friends, when the camera comes out at the work retreat. Count the costs: what toll has this tale taken: community connection, missed opportunities, memories you didn’t create? Check that publication information. Stories have creation, if not publication, dates. The story may predate you, but it’s not you.
Interrogate it (and its author(s)). Look it square in its references and ask, Bully-Ton, who paid you? Who benefits from my subscription? Which structures establish the standards and guidelines you espouse (capitalism, misogyny, white supremacy)? If your bulletin is just an op-ed, how do I even know if this is empirical journalism?
Seek Suppressed Evidence. Each biased story relies on omitting important facts. Remember moments when you challenged manipulated data. For instance, think of a time you appreciated something about yourself that wasn't influenced by others, such as wearing something or showing up despite doubts. What did those moments demand from you? And what do they reveal about your genuine values?
Now you take the pen. Using the moments and values from step 4, write a brief account of yourself, something the old story would never have written. It could be a letter, a declaration, or just half a page. Then, share it with one trusted person, whether by reading or hearing. A story truly begins to hold when someone else witnesses you telling it.
Maintenance applies the same approach outwardly: observing the company you keep without judgment, noticing how they build narratives, and understanding how these affect interactions. Emphasizing nonjudgment and neutral language is crucial, particularly during times when positive and optimistic expressions may seem insincere. Striving for neutrality is genuine; insisting on forced positivity is not.
Decolonized and Liberation Therapy
Overview:
Rooted in Ignacio Martín-Baró's work, liberation psychology sees psychological suffering as connected to social and historical conditions. Healing involves concientización, or critical awareness of the systems shaping one's life, a concept Martín-Baró adapted from Paulo Freire (Martín-Baró, Writings for a Liberation Psychology; Freire, conscientization).
Action and Maintenance:
Action within this model is predicated on an individual’s awareness of their positionality within broader social, cultural, historical, and structural contexts, as well as a genuine curiosity about aspects of these contexts they are not yet aware of. The individualistic culture in which I live tends to focus mental health and well-being primarily, if not solely, on the individual. In some instances, the family or primary relationships are given consideration, but by and large, the current dominant systems of psychological and mental health care models don’t investigate or address the external factors that complicate, if not outright cause, psychological distress.
I firmly believe that bibliotherapy plays a crucial role in this approach. Collaborating with a culturally sensitive and historically knowledgeable clinician, along with utilizing texts that examine history, social structures, and norms from perspectives relevant to the client’s lived and identity experiences, provides healing insights and empowerment. Research on critical consciousness underscores this; understanding history is seen as a key component of the critical awareness necessary before taking action (Watts, Diemer, and Voight, critical consciousness research).
Here, Hippolyta may practice Action by exploring how the ideal worker and endlessly capable caretaker standards were created and whose labor underpins them. It might be participating in a community group where she isn't the administrator, caretaker, or fixer, but simply a member. Maintenance involves recognizing when she begins judging herself again by standards she has already examined.
If literature isn’t an accessible or preferred avenue to explore liberation psychology, scholarly documentaries, diverse sources read with media literacy (asking whose interests each narrative serves), and classes are viable alternatives (or additions to bibliotherapy). Beyond gaining knowledge, actively participating in community groups and volunteering for causes that matter can support the client’s wellbeing. These channels ignite curiosity, which sparks deeper understanding. The real work involves recognizing oneself as part of a larger system, rather than perceiving oneself as isolated and defined solely by personal will, habits, thoughts, or individual actions. This perspective fosters connection and belonging, encouraging continuous learning and personal growth.
Maintenance is a balancing practice. Personalization has to be weighed against short- and long-term context. And autonomy must be actively maintained, especially when dealing with historical oppression, generational trauma, and real social challenges. A caution and a comfort in one: understanding may not create fixes, but it may offer context, compassion, courage, and connection.
Let’s Talk Physical….Therapy
As I mentioned earlier, I often wish psychotherapy were conceptualized like physical therapy. Active, repetitive, practical, and supplemental engagement are expected parts of physical therapy. A physical therapist wouldn’t be expected to “suggest” a client into healing. (Suggestion alone, no matter how skilled, can't rebuild muscle; the patient's own movement is what does. Strength isn't achieved by just talking about it, like expecting a hamstring to strengthen from words alone; it requires loading and movement.)Patients must engage their muscles and practice stretching and mobility to get the results they want.
But we, as a culture, tend to agree that we can train our bodies. Yet despite spending years in compulsory education, learning songs, jingles, movie lines, and TikToks, there is still debate about the ability to heal, change, and transform the mind.
While I don’t believe we can control our thoughts, as our subconscious generates them, we can direct our focus and attention. We can do the work of uncovering the unconscious, investigating what lies there, and integrating the various parts of our experience and identity. And this doesn’t take place in a utopia that doesn’t impact our existence. We can engage our environment intelligently and critically.
The same components of will, choice, and intention that are brought to PT can also be brought to talk therapy. Home practice, client and therapist collaboration, and safely navigating discomfort while avoiding pain and re-injury, managing it with care and caution if it occurs.
Talk therapy doesn't have an MRI, so there's no scan to show a fracture healing or range of motion returning. Instead, progress is assessed through collaboration and honest self-reporting, revisited intentionally. Unlike physical therapy, where injuries often improve before rehab begins, emotional issues like strained relationships, hostile workplaces, or systemic problems can persist. As a result, pain is interpreted differently; sharp pain in PT usually signals to stop, but in therapy, discomfort might indicate addressing underlying issues that have been previously avoided. Learning to tell harm from growth is essential, as it’s part of healing. Additionally, the therapeutic relationship itself is crucial for success; while home exercises can help, decades of research show that therapy is most effective when there is a strong connection between client and therapist. (Flückiger et al., 2018)
Next time, I'll share my personal insights on healing from my journey, including practices like yoga and meditation.
For a quick start, 'Open and Align,' an introduction to chakras, is available for free when you subscribe to the Nuanced NŪS letter.
References
Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648
Association for Contextual Behavioral Science. (n.d.-a). About ACT.https://contextualscience.org/act
Association for Contextual Behavioral Science. (n.d.-b). The six core processes of ACT.https://contextualscience.org/six_core_processes_act
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764
Beinart, N. A., Goodchild, C. E., Weinman, J. A., Ayis, S., & Godfrey, E. L. (2013). Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: A systematic review. The Spine Journal, 13(12), 1940–1950. https://www.sciencedirect.com/science/article/abs/pii/S1529943013014745
Dulwich Centre. (n.d.). Externalising [Lesson in What is narrative practice? A free course]. https://dulwichcentre.com.au/courses/what-is-narrative-practice-a-free-course/lessons/externalising/
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Freire, P. (1970). Pedagogy of the oppressed (M. B. Ramos, Trans.). Herder and Herder.
Hebb, D. O. (1949). The organization of behavior: A neuropsychological theory. Wiley.
Martín-Baró, I. (1994). Writings for a liberation psychology (A. Aron & S. Corne, Eds.). Harvard University Press.
Physiopedia. (n.d.). Adherence to home exercise programs.https://www.physio-pedia.com/Adherence_to_Home_Exercise_Programs
Shatz, C. J. (1992). The developing brain. Scientific American, 267(3), 60–67.
Watts, R. J., Diemer, M. A., & Voight, A. M. (2011). Critical consciousness: Current status and future directions. New Directions for Child and Adolescent Development, 2011(134), 43–57. https://doi.org/10.1002/cd.310
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W. W. Norton.
