Stages of Change

I often say, "change is the only constant". Seems a bit like an oxymoron doesn't it? Think about it for a second... as much as one might like everything to stay the same, it can't.  Change inevitably occurs. Seasons change, days end, relationships develop, recovery and illness evolves. 

There are many aspects of change I could focus on, however this post is going to look at one concept in particular.  A study on breaking smoking habits by DiClemente & Prochaska (1982), revealed a five stage process in understanding change. The five stages are: precontemplation, contemplation, preparation, action and maintenance.  Why is this important?  There are two reasons I want to highlight when it comes to recovery: a) it show that change is a process and b) change is an individual journey, meaning no one can make anyone else change. Let's use a case example to help describe the five stages. 

CASE EXAMPLE: Mary-Loo (M.L.) has been struggling with binge eating for years. If you were to ask her how long she has been struggling, she would not be able to tell you as this behaviour was normal to both her and her family. One day, while at the hospital waiting for her aunt Judith to come out of surgery, a pamphlet on the table caught her eye,  "Eating Disorders: Binge Eating". She picked it up and started to read it. At first, she denied relating to any of the facts presented in the pamphlet, however, as weeks went by, she couldn't help but notice that her behaviours and feelings were indeed quite similar.  She thought to herself, "could I really have an eating disorder? Everyone in my family eats like this." She started to surf the internet to see if she could find any more information on the subject. She came across a therapist's website who specializes in eating disorders. The website described more about the disorder and its common behaviours and feelings. She put the therapist's phone number in her phone and went to work. Throughout the week, she would shift from denying she had a problem to completely agreeing something was going on.  Eventually, she picked up her phone and made a call to set up an appointment to see what else the therapist could say or recommend. She clicked with her therapist right away and saw her weekly.  After a period of time of normalized eating and skill building, ML decided to cut back her sessions to bi-weekly and eventually monthly to maintain her new lifestyle. 

What's going on here? Let's break it down. 

PRE-CONTEMPLATION - This is when a client is in complete denial or is simply unaware there is an issue that needs change. In the case of ML, binge-eating was so normalized, she was unaware that it was a serious issue, and thus, never thought about it changing it. 

CONTEMPLATION - Here, one becomes aware that there is an issue and thinks more about whether or not a change needs to occur.  ML's thoughts after reading the pamphlet shows how she was sifting through the possibility that something more was going on with her relationship with food/weight. 

PREPARATION - After contemplating that perhaps something needs to change, there's a process of collecting information to help figure out what one will do next. For ML, she surfed the internet, read more information and learned where she could go to address her issues. 

ACTION - The act of calling the therapist and going to therapy is how ML took action in changing her distorted relationship with food/weight. This was an ongoing process that included learning and implementing new skills and exploring her underlying issues over a period of time. 

MAINTENANCE - Essentially, this final stage is the process of maintaining the change one has implemented. For ML, she did this by checking in with her therapist once a month.

A few quick points to make as we finish:

  • change is not a linear process. ML went from pre-contemplation to contemplation and back again a few times. Also, slips are inevitable in recovery.  It is not uncommon to have to return to an earlier stage (let's say preparation) in order to successfully implement change during the action stage. 
  • the only person who can change is YOU. Your mom can't make you change, your doctor can't do it, nor can your therapist.  The work has to come from you. This said, you are not an island and will need people around you to help make the transition. For caregivers, helping a loved one explore whatever stage they are in or letting them know you are there for them when they want/need it is completely okay! Just make sure you aren't doing for them what they can do themselves.
  • people will change only when they want to.  No one can force someone into it.
  • nothing changes if nothing changes. If ML knew she needed to make a change with her relationship with food and did nothing about it, there would be no change in her relationship with food! 

What stage are you in? What are you willing to do to move into the next stage?