Stages of Change

[LtlFirecracker]

This is purely educational for anyone who wants to learn about behavior and change, it helped me a lot, and maybe it will help a few of you.

So this is a model that is used to help professionals understand how people break bad habits. Understanding the process that a person goes though to make a major life change is important because you can figure out where they are at and deliver advice that they are ready to hear. If a person is not ready to change a behavior, and you are telling them to, they are going to shut you out, and even though you might feel good for telling them the “truth” you have not helped them at all. If anything, you have hurt things. So the first thing I am going to do is introduce the 5 states and than give some examples of effective and ineffective counseling based on these changes.

Disclaimer: I am not a mental health professional, so if someone here knows more than me and wants to chime in, please do so. To give credit, this model was proposed by James Prochaski and Carlo DeClemente.

Precontemplation - the person does not see their is a problem with their behavior and sees no reason to change it.
Contemplation - the person knows there is a problem, but is not ready to make a change
Preparation/Determination - the individual is planning to make a change
Action - the plan is initiated, and the person changes their behavior
Maintenance - maintaining the new behavior
Relapse - going back to their old ways

The diagram for this is a circle, often for a habit such as an addiction, relapse occurs more than once, but they more times someone goes through this, the better chance they have at stopping the behavior for good, which is called transcendence. The point where this habit is no longer a normal part of the person’s life.

This can be applied to anything from smoking, gambling, alcoholism, and toxic relationships (it is used for domestic violence counseling).

This will be over several posts, it is too long to do in one

 

[LtlFirecracker]

Example of ineffective counseling based on the changes of change

I am going to use smoking as an example, I will use a relationship example later as that is what this was created for. But I think it is best to start with something non-relationship.

Provider “do you use any tobacco products.”
Patient “well, yes.”
Provider “what do you use”
Patient “I smoke cigarettes”
Provider “how many a day”
Patient “1 pack”
Provider “and for how many years”
Patient “20 years, I know that I am at risk for lung cancer and many other health problems, I am already starting to feel like I can’t keep up with my kids the way I used to, but my spouse smokes, and I don’t think there is anyway I can realistically stop.”
Provider “yes, you are at high risk for lung cancer, COPD, heart disease, stomach cancer, bladder cancer, throat cancer, and those risks will continue to rise if you keep smoking. You know there are plenty of products to help you quit, I can help you get started if you want to do that now. Oh and your spouse really should quit too, it is bad for him, and the second hand smoke is bad for your whole family.”

So this patient is in the Contemplation stage of change and was counseled at the action stage. They know smoking is harmful, know they should quit, but see to many hurdles be being successful. By telling them to just quit without a plan, you a are not addressing all the hurdles they need to overcome to be successful, and the person thinks that you are not listening to them and gets frustrated at you.

 

[LtlFirecracker]

Here is a better response

“Well, it sounds like you are aware of the heath risks associated with smoking, and that you might be feeling some of them. Perhaps we can address your lung function and send you for testing to make sure any damage has not been done. But I also want to talk about your concerns with your spouse, as many people who had a partner who smokes have a hard time quitting. Does your spouse know the risks associated with smoking?”

“No”

“would you be willing let me to refer him to the stop smoking line, or would he be willing to come talk to me” (trying to deal with her barriers so she can move to preparation)

Patient: “he is in the waiting room, can I bring him in?”

Provider “sure”

(after introductions ect)

“Provider, “so I understand you smoke, have you thought about quitting?”

Spouse, “No way - my parents smoked and they lived long lives” (pre contemplation)

Provider “really, may I ask how old they were and what they died from?”

Spouse “My father died at 55 from a stroke, and my mother died at age 60 from stomach cancer.”

Provider “you know those are both conditions associated with smoking, and that is much shorter than the typical life span in the US.”

Spouse, “Well, they lived good lives.”

Provider “Would you mind taking this pamphlet, and we can talk more at your next visit.”

Spouse “sure”

So here what the provider is trying to do is address them at the stage they are at, and move them to the next stage. The goal is to get the spouse to realize there is consequences to smoking, so that he may move into the contemplation stage.



 

[LtlFirecracker]

Now to illustrate the rest of the changes, I will use a bad relationship.

“I see that bruise on your ear, how did you get that?”

“Oh, I am clumsy, I bumped into a door.”

“Really, because that bruise is located in a place that would be hard to hit by a door, in fact, there are very few ways to bruise an ear in that area.”

“Like what?”

“Well you could get a bruise like that from someone pinching your ear”

“Well, that’s what happened”

“Who did it.”

“My husband.....look he is really sweet, and so nice, except for when he is angry, than he is just out of control. He hasn’t hurt the kids yet, but I am afraid for them. I need to get out, but I don’t work, have no job skills, and no money. And I am worried he will come after me. What can I do?” (the person is ready to move into preparation)

WRONG ANSWER: Well, you should just leave him tonight before anything bad happens.

By saying this, you have ignored her feelings for him, and her concerns about safety and being able to take care of herself.

BETTER ANSWER: Well, I can give you some numbers to some helplines and shelters that can take you and your children. They can also provide you with on the job training. You should probably keep these out of site of your husband. I can also send you to counseling, but you really should go alone, I would not advise couples counseling at this time. You can look into this stuff, figure out if anything works for you, than when you are ready, we can meet and talk again and go over things. If there are other concerns you have, we can address those too.”

What you are doing here is moving her from preparation into action, knowing that she could go back to an earlier stage at anytime, and hence the need for reassessment.




 

[LtlFirecracker]

Here is an example of a situation that is a little more common to every day life. This is a generic situation and not directed at anyone in particular, I do not have anyone in mind while I am posting this

"I am annoyed with my boyfriend."

"Why?"

"He just told me he dosn't want kids, and I want a big family."

"well isn't that a problem if you are planning to get married in the future?"

"Well, I figure he will come around and it will be fine, it's not a big deal, anyways, I don't think I could do better, but things are ok otherwise."

So the root problem is that she does not think there is anyone else for her, so she is staying in a relationship despite a big difference in what they want in life. And she is not ready to leave him. The best way to help this person is not to tell her to leave the guy, but to help her start to deal with her issues, or else even if she does leave, she will find her self in the same situation with a different face.

"Why do you think that?"

"Because....I don't want to get into it, things are fine."

"Well, you have a lot of great things about you, and not thinking positively about yourself will keep you from getting what you want in life, and if you do want children, don't you want to have a positive outlook on yourself so that you can help pass that on to them? "

"I never thought about it that way, but I guess things go in cycles."

"You know, there are several things you could do to start exploring this. You could talk to a professional, a trusted friend, or journal if you don't want to talk about it."

"I will think about it."

"OK."

Once again, these are the early changes of stage, and all you can do for someone else is help them move through them. But at the end of the day, change needs to come from within.

 

[ladypirate]

Great thread, Ltlfirecracker. Thanks for posting it!

 

[LtlFirecracker]

Thanks

 

[lucyandroger]

Wow, Ltlfirecracker!!! You put a lot of work into this...awesome thread

I think this will give a lot of us something to think about.

 

[Dreamgirl]

I can''t wait to read this! I''m always interested in these sorts of things. Thank you for posting LtlFirecracker!

 

[LtlFirecracker]

Thanks everyone.

I think this helps me, because I often hint at this, but without the whole context, I know most people are not fully understanding what I have been trying to say in some of the discussions that have been going on recently.

 

[Gypsy]

Okay. I''m making a mental note to read this in detail when I get home. Thank you so much for the time and effort LT, from what I read (I scanned) it looks really great.

 

[misskitty]

Thanks for posting this!

 

[isaku5]

Thanks so much for posting this! It''s amazing advice...and you''re not a counsellor?? Maybe you should consider that area for your next career.

I think I''m following your advice already; if not, let me know where I de-railed myself.

 

[mrscushion]

Great post! It makes a lot of sense. I will keep this in mind for future situations in which I may be advising a friend or loved one.

 

[smiles]

Thanks so much! This is so interesting especially as I am doing my undergrad in social work! Makes complete sense to me! I think it is easy for me to see how I could easily do this with a client but it is much harder to do in your own life so gives me lots to think about!

 

[kama_s]

Very insightful, LtlFirecracker. Thanks for posting!

 

[miss_flo]

This was really helpful, thank you so much for posting it. I think the natural reaction for most women who see their friends in pain is to say "Run, run fast." Clearly (and I speak from the receiving end of the advice) this doesn''t work because some couples live in bubbles and don''t realize what the world is like outside of them. This post is a reminder that change/action must be coaxed, not forced.

Thanks again, this is great!

 

[Gypsy]

OKAY. Read through and this is a WONDERFUL post. Ask questions, figure out what stage the person is at, provide them with a plan to get them to the next stage. Realize that even if you get them to the end, they will probably relapse, but that with enough relapses they might get to a breakthrough.

COOL. Is there a book to read to folllow up?

 

[LtlFirecracker]

Date: 4/3/2009 1:36:27 AM
Author: Gypsy
OKAY. Read through and this is a WONDERFUL post. Ask questions, figure out what stage the person is at, provide them with a plan to get them to the next stage. Realize that even if you get them to the end, they will probably relapse, but that with enough relapses they might get to a breakthrough.


COOL. Is there a book to read to folllow up?

Wow, I wish I could say it one paragraph. That is pretty much it. But I want to say, that even with multiple relapses, people do get through. The more times they try to change, the more likely they are to be successful with those later tries. So when a smoker is angry and mad about their relapse, we tell them that most smokers don't quit on the first try and not to give up, because each time they quit, they up their odds of being successful. The other thing is that people can go backwards, I think what we see the most on these forums is people shifting between the first and second stage. I will ask the guy to taught this to me at work tomorrow if there is a book. I learned this through lectures. There are a ton of websites (mostly addiction related but has the concept) if you google "Stages of Change"

Thanks to everyone else who commented.

 

[LaraOnline]

Thanks FireCracker! I have just cut and pasted your posts, and will get my DH to read them, he has staff (a whole bunch of women!) that can actually be very difficult to manage, because of all the interactions between them... and him, the token male Boss!

Thanks again.

 

[Lorelei]

This is very useful info and thank you for taking the time to share it with us, I know it will be very helpful.

 

[Guilty Pleasure]

Thank you, I enjoyed reading this information, and I think it is very useful in everyday life.

 

[somegirl932]

I read this last night, and I wanted to wait until I had a chance to intelligently reply... but now I''ve forgotten what I wanted to say.

Thanks for the information, it was an incredibly interesting read. I think a *lot* of conflicts would be solved with a little more understanding between people... particularly the idea that everyone does not have the same perspective.

 

[tlh]

very thoughtful and constructive post LtlFirecracker, thank you.