Change Work: Moving Beyond Surface Behaviors to Deep Transformation

By Kevin Brough, MFT

Introduction

In my years of practice, I’ve come to understand a fundamental truth about human change: You can’t change what you’re not aware of. This simple yet profound statement encapsulates the essence of meaningful therapeutic work and personal transformation. Too often, we focus on behavioral modifications—what I call first-order changes—without addressing the deeper cognitive and emotional systems that drive these behaviors. True, sustainable change requires a systems-based approach that recognizes the interconnected nature of our thoughts, emotions, and actions.

The field of cognitive-behavioral therapy has evolved significantly from its early focus on symptom reduction to a more comprehensive understanding of human change processes. Systems-based CBT recognizes that lasting behavioral change is only possible when we address the underlying cognitive and emotional patterns that maintain problematic behaviors (Mahoney, 1991). This approach acknowledges that human beings are complex systems where changes at one level inevitably impact other levels of functioning.

First-Order vs. Second-Order Change: Understanding the Hierarchy of Transformation

The distinction between first-order and second-order change is crucial for understanding why many therapeutic interventions fail to produce lasting results. First-order changes are surface-level behavioral modifications, such as stopping a habit, following a new routine, or implementing coping strategies. While these changes may provide immediate relief or improvement, they often lack the depth necessary for long-term sustainability.

Second-order change, in contrast, involves fundamental shifts in our cognitive schemas, emotional regulation patterns, and core belief systems (Watzlawick et al., 1974). These more profound changes create the foundation upon which sustainable behavioral modifications can be built. When we address the emotional and cognitive roots of behavior, we create systemic change that naturally supports new ways of being.

Consider, for example, a client struggling with chronic anxiety who learns relaxation techniques. This first-order change may provide temporary relief, but without addressing the underlying cognitive patterns of catastrophic thinking and the emotional dysregulation that fuels the anxiety, the symptoms are likely to return. However, when we help the client develop awareness of their thought patterns, process underlying emotional wounds, and restructure their core beliefs about safety and control, we create second-order change that naturally reduces anxiety at its source.

The Foundation of Change: Awareness, Consciousness, and Mindfulness

The journey toward meaningful change begins with awareness. As I often tell my clients, transformation is impossible without first developing a clear understanding of what needs to be transformed. This awareness operates on multiple levels: cognitive awareness of our thought patterns, emotional awareness of our feeling states, and somatic awareness of our bodily responses to stress and triggers.

Prochaska and DiClemente’s Stages of Change model offers a practical framework for understanding how awareness evolves into action (Prochaska & DiClemente, 1983). The model identifies six stages that individuals progress through when making lasting changes:

Precontemplation

At this stage, individuals are often unaware that a problem exists or that change is necessary. They may be in denial about the impact of their behaviors on themselves and others. The therapeutic work here focuses on raising awareness and helping clients begin to see patterns they previously couldn’t recognize.

Contemplation

Awareness begins to emerge, and individuals start to recognize that change may be beneficial. However, they remain ambivalent, weighing the costs and benefits of change. This stage is characterized by increased self-reflection and exploration of the problem.

Preparation

The decision to change has been made, and individuals begin to take small steps toward transformation. They may start gathering information, seeking support, or making preliminary changes to their environment.

Action

This stage involves implementing specific strategies and behaviors to create change. It requires significant commitment and energy as individuals work to establish new patterns while resisting the pull of old habits.

Maintenance

The focus shifts to sustaining the changes that have been made and preventing relapse. This stage requires ongoing vigilance and the continued use of coping strategies.

Termination

The new behaviors become so integrated that the individual no longer feels tempted to return to old patterns. The change has become an integral part of their identity, rather than something they must actively maintain.

This model illustrates how awareness naturally progresses to ownership and action. Each stage requires specific interventions and support to facilitate movement to the next level of change.

Extending Awareness to Relational Systems

Just as individual change requires awareness of internal patterns, relationship transformation—whether in couples or families—demands an expanded awareness that encompasses the interactive patterns and systemic dynamics between individuals. In my work with couples and families, I’ve observed that sustainable relationship change cannot occur through individual efforts alone; it requires each person to develop awareness of how their individual patterns intersect with and influence the relational system as a whole. This includes recognizing communication patterns, power dynamics, emotional triangles, and the unspoken rules that govern family interactions. For instance, a couple may each work individually on their anger management and communication skills, but without awareness of their cyclical pattern of pursuit and withdrawal, or how their family-of-origin experiences create complementary dysfunctions, their individual changes may actually make more tension in the relationship. True relational transformation occurs when partners or family members can simultaneously hold awareness of their own internal processes while also observing and taking responsibility for their contribution to systemic patterns. This dual awareness—of self and system—allows for coordinated change efforts where individual growth supports rather than threatens the relationship, creating space for authentic intimacy and healthier family functioning.

Developing Emotional Intelligence Through Awareness

Emotional intelligence—the ability to recognize, understand, and regulate our emotions while empathizing with others—is a crucial component of second-order change (Goleman, 1995). Many of the behavioral patterns we seek to change are driven by emotional reactions that occur below the threshold of consciousness. By developing emotional awareness and regulation skills, we gain access to the emotional drivers of our behavior.

The process of developing emotional intelligence begins with what I call “emotional mapping”—learning to identify and name our emotional experiences with precision. Many clients come to therapy with limited emotional vocabulary, describing complex feeling states with simple terms like “stressed” or “upset.” Through mindfulness practices and focused attention, we can cultivate the ability to recognize subtle emotional states and their corresponding cognitive and somatic markers.

This awareness then extends to understanding emotional triggers and patterns. Clients learn to recognize the early warning signs of emotional dysregulation and develop strategies for intervention before reactive patterns take over. This represents a shift from being controlled by emotions to creating a collaborative relationship with our emotional life.

Transformational Skills: The Tools for Change

Once awareness has been established, the next phase involves developing what I term “transformational skills”—the specific abilities needed to create and maintain change. These skills can be broadly categorized into several domains:

Cognitive Restructuring Skills

The ability to identify distorted thought patterns, challenge unhelpful beliefs, and develop more balanced and realistic cognitive frameworks. This includes skills such as thought monitoring, cognitive reframing, and the development of adaptive self-talk (Beck, 1976).

Emotional Regulation Skills

Techniques for managing intense emotions, including distress tolerance, emotion surfing, and developing self-soothing strategies. These skills help individuals remain functional during emotional storms and prevent impulsive reactions (Linehan, 1993).

Interpersonal Skills

The capacity to communicate effectively, set boundaries, and navigate relationships in ways that support rather than undermine change efforts. Many behavioral patterns are maintained by dysfunctional relationship dynamics that must be addressed for lasting change to occur.

Mindfulness and Present-Moment Awareness

The cultivation of non-judgmental awareness of present-moment experience, including thoughts, emotions, sensations, and environmental factors. This skill forms the foundation for all other transformational abilities (Kabat-Zinn, 1994).

Behavioral Activation and Goal-Setting

The ability to identify values-based goals and take consistent action toward their achievement, even in the presence of obstacles or setbacks.

Like any skill set, transformational skills improve with practice and application. Initially, clients may find these skills awkward or challenging to implement. However, with consistent use, they become more natural and automatic, eventually requiring less conscious effort to maintain.

The Neurobiological Foundation of Change

Understanding the brain science behind change can be empowering for both therapists and clients. Neuroplasticity—the brain’s ability to reorganize and form new neural connections throughout life—provides the biological foundation for all psychological change (Doidge, 2007). When we engage in new ways of thinking, feeling, and behaving, we literally rewire our brains.

Chronic stress and trauma can create rigid neural pathways that maintain problematic patterns of thinking and behaving. The amygdala, which is responsible for threat detection, can become hyperactive, while the prefrontal cortex, which is responsible for executive functioning and emotional regulation, may become less active. This neurobiological state makes change more difficult but not impossible.

Therapeutic interventions that promote mindfulness, emotional regulation, and cognitive flexibility help strengthen prefrontal cortex functioning while calming amygdala reactivity. Through repeated practice of new skills and behaviors, we create new neural pathways that support healthier patterns of functioning. Over time, these new pathways can become the brain’s preferred routes, making positive changes feel more natural and automatic.

The process of neuroplasticity also explains why change takes time and why consistent practice is essential. Each time we choose a new response over an old pattern, we strengthen the neural pathways associated with the new behavior while weakening those associated with the old pattern. This is why I often tell clients that change is not a destination but a practice—a daily commitment to choosing new responses over familiar ones.

Trauma-Informed Change Work

No discussion of change work would be complete without addressing trauma’s impact on our capacity for transformation. Trauma, whether acute or developmental, creates disruptions in our nervous system that can significantly impact our ability to engage in change processes (van der Kolk, 2014).

Traumatic experiences often overwhelm our natural coping resources, leading to the development of survival strategies that may have been adaptive in dangerous situations but become problematic in current contexts. Many of the behaviors clients want to change—addiction, relationship difficulties, emotional dysregulation—can be understood as trauma responses that have outlived their usefulness.

Trauma-informed change work recognizes that healing must address both the psychological and physiological impacts of traumatic experiences. This often requires a combination of top-down approaches (cognitive interventions that help make sense of experiences) and bottom-up approaches (body-based interventions that help regulate the nervous system).

Top-Down Processing for Change

Top-down approaches work through the neocortex to influence lower brain regions. These interventions include:

Cognitive restructuring to address trauma-related beliefs about safety, trust, and self-worth
Narrative therapy techniques that help clients develop coherent stories about their experiences
Psychoeducation about trauma’s impact on the brain and nervous system
Mindfulness practices that strengthen prefrontal cortex functioning

Bottom-Up Processing for Change

Bottom-up approaches work directly with the body and nervous system to promote regulation and healing:

Somatic experiencing techniques that help discharge trapped trauma energy
Breathwork and other nervous-system regulation practices
Movement and dance therapies that help restore natural rhythms
EMDR and other therapies that work directly with traumatic memories stored in the body

The most effective trauma-informed change work integrates both approaches, recognizing that healing occurs through multiple pathways and that different clients may respond better to various interventions.

Mastering Awareness: The First Phase of Transformation

The development of awareness is not a one-time achievement but an ongoing practice that deepens over time. I conceptualize this as the first significant phase of personal transformation—learning to observe ourselves with clarity, compassion, and accuracy.

This phase involves several key developments:

Meta-Cognitive Awareness

Learning to observe our thoughts without being controlled by them. This includes recognizing thought patterns, understanding the difference between thoughts and facts, and developing the ability to step back from our mental content.

Emotional Awareness

Developing the capacity to recognize, name, and track our emotional experiences throughout the day. This includes understanding emotional triggers, recognizing the physical sensations associated with various emotions, and learning to tolerate difficult emotional states without resorting to immediate action.

Somatic Awareness

Tuning into the wisdom of the body and recognizing how stress, trauma, and emotional states manifest in physical sensations. This includes learning to use the body as an early warning system for emotional dysregulation.

Relational Awareness

Understanding our patterns in relationships, including how we contribute to relationship dynamics and how our past experiences influence our current interactions.

Values Awareness

Clarifying what matters most to us and understanding when our actions align with or contradict our most deeply held values.

Mastering Transformation: The Second Phase

Once a solid foundation of awareness has been established, the focus shifts to mastering transformation—the skillful application of change strategies in real-world situations. This second phase is characterized by several key developments:

Flexible Response Repertoire

Rather than being limited to automatic reactions, individuals develop multiple options for responding to challenging situations. They can choose responses based on effectiveness rather than habit.

Emotional Regulation Mastery

The ability to remain centered and responsive even in highly charged emotional situations. This includes skills such as self-soothing, distress tolerance, and maintaining perspective during challenging times.

Interpersonal Effectiveness

The capacity to maintain relationships while also maintaining personal boundaries and values. This includes skills for communication, conflict resolution, and collaborative problem-solving.

Resilience and Recovery

The ability to bounce back from setbacks and maintain forward momentum even when progress is not linear. This includes skills for self-compassion, meaning-making, and adaptive coping.

Practical Applications and Interventions

The theoretical framework outlined above translates into specific therapeutic interventions and practices:

Mindfulness-Based Interventions

Regular mindfulness practice helps develop the awareness necessary for change while also strengthening the neural pathways associated with emotional regulation and cognitive flexibility.

Cognitive-Behavioral Techniques

Traditional CBT interventions remain valuable for helping clients identify and modify problematic thought patterns; however, they are most effective when integrated into a broader, systems-based approach.

Somatic Interventions

Body-based interventions help clients develop awareness of how emotions and stress manifest physically while also providing tools for nervous system regulation.

Interpersonal Skills Training

Many behavioral patterns are maintained by dysfunctional relationship dynamics. Teaching clients effective communication and boundary-setting skills often facilitates broader change.

Values Clarification Work

Helping clients identify their core values and align their actions with these values provides motivation and direction for change efforts.

Conclusion

Change work, at its essence, is about helping individuals move from unconscious reactivity to conscious responsivity. This transformation requires more than surface-level behavioral modifications—it demands fundamental shifts in how we think, feel, and relate to ourselves and others.

The journey begins with awareness. As I’ve emphasized throughout my practice, you cannot change what you are not aware of. This awareness must be cultivated patiently and compassionately, recognizing that many of our patterns developed as adaptive responses to earlier life circumstances.

Once awareness is established, the focus shifts to developing transformational skills—the specific abilities needed to create and maintain change. These skills, like any others, improve with practice and become more natural over time.

The integration of top-down and bottom-up approaches ensures that change work addresses both the cognitive and somatic dimensions of human experience. By working with both the mind and body, we create the conditions for profound, lasting transformation.

Perhaps most importantly, this approach recognizes that change is not a destination but a way of life. The skills we develop in therapy become lifelong tools for continued growth and adaptation. As we master awareness and transformation, we build the capacity to navigate life’s challenges with greater skill, resilience, and authenticity.

The work is not easy, but it is profoundly worthwhile. Each moment of increased awareness, each skillful response to a challenging situation, and each choice to act from values rather than habit contribute to the larger project of becoming who we are meant to be. In this way, change work becomes not just about solving problems but about discovering and expressing our fullest potential.

Love & Light

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – 435.688.1111 – kevin@ascendcw.com

References

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.

Goleman, D. (1995). Emotional intelligence: Why it matters more than IQ. Bantam Books.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Mahoney, M. J. (1991). Human change processes: The scientific foundations of psychotherapy. Basic Books.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. Norton.