Archive of ‘Recovery’ category

Why Aren’t They Ready Yet?? The Stages of Change.

Have you ever been frustrated when you know somebody needs to change something in their life, but they just can’t seem to understand it the way you do? It could be anything from working on physical health, to drug addiction, to a quasi-bad habit that needs to be broken. The other person just doesn’t see how bad things are and that they need to change! What this COULD mean is that you and the other person are at different stages of change.

What are the Stages of Change?

The Stages of Change as discussed in this blog come from Motivational Interviewing, which is a type of therapy that can either be practiced independently or in conjunction with other therapeutic modalities. Here are the stages:

1. Precontemplation Stage

In this stage, someone would not even realize that there is something worth changing. They wouldn’t think they have a problem, and they wouldn’t be contemplating any change. They could be in denial, they could be back at square one after trying a change and giving up, they could be told by folks that they need to change/have a problem but they say “I’m the exception” or “That’ll never be me” statements. 

An example: Jonah smokes a pack of cigarettes a day, and his friends tell him they are worried about his long term health. Jonah responds to his friends “I’m not worried about it. It’s just a pack and I could stop any time I want to! Other people get cancer, but it doesn’t run in my family and it won’t happen to me!”

2. Contemplation Stage

This stage is when someone knows they want to make a change, and they begin weighing their options. Here, therapists and friends will often hear this person express ambivalence about making the change, fear talk, and “I would, but…” statements. 

An example: Mel has been having stomach problems with her anxiety for a few months and knows that a trip to the doctor would likely help her figure out ways to feel better. She is afraid that they may have to run invasive tests or change her diet, which give her even more anxiety and make her stomach issues worse. She has talked to her partner about her stomach issues and has said many times, “I should make that doctor’s appointment soon, but I’m just too busy with school to take a day off!”

3. Preparation Stage

Here, folks will start to get ready to make a change, or they may make small steps toward the change. This could be the point at which we hear someone say “I’m about to start doing ___” as they get ready to make their change. They may start sampling their new lifestyle, or dipping their toe in to test the waters, but haven’t taken any formal action toward the change. 

An example: Jess has become aware of the fact that social media consumption exacerbates her depression and anxiety. She decided that deleting her social media apps off of her phone will be a big step to helping her mental health. She recently posted to her friends that she will be deleting her apps and will be much harder to reach soon. She gave them her other contact information so they can still text and facetime, without the obligation to see everything that has been giving her FOMO and anxiety. The apps are still on her phone for the time being, and she is mentally preparing for the day next week that she will delete them. 

4. Action Stage

A person in this stage is actively trying to make their change happen. This is often where the bulk of therapy work occurs, as our clients have taken steps to call our office and schedule a session, sit with a therapist and discuss their concerns. It is possible to get to the Action stage multiple times (like, with a pesky New Years’ Resolution) only to revert to an earlier stage a few times over. 

An example: Evan started going to the gym Monday through Thursday after work, made an accountability buddy at the gym, and is loving it! He used to go to the gym about once or twice a year, and recently became fed up with his sedentary lifestyle. He is really trying to find ways to keep his gym habit sustainable this time. 

5. Maintenance Stage

This is the stage that we would aim to be in for the longest amount of time. Maintenance is the goal of making a change; we want to maintain our change over time. A person in this stage has become proficient at their action stage and is looking to maintain the change. 

An example: Ori calls himself a “recovering anger-holic.” He grew up with enormous difficulty with expressing his emotions, and often would have angry outbursts. When he became engaged to Amber in his thirties, she asked him to go to therapy for his anger. In this way, Amber helped Ori move from stage 1 through stage 4. He worked with his therapist to express his feelings in healthier ways, manage his anger, and grow his support network. Ori and Amber participated in couples therapy a few times over the years (especially when Ori’s anger looked like it was relapsing), but now that they are in their fifties, they hardly need outside help. He can still be triggered into what used to be fits of anger, but now are fits of coping and emotional expression. Amber knows all of his most reliable coping skills and they use code-words when he really needs to go cool off and take a walk. 

6. Relapse Stage

A relapse is when an individual returns to a previous stage for any amount of time. It is common, when making a change, to be tempted to return to the pre-change lifestyle. It is important during a relapse temptation to seek support and try not to relapse. A relapse could be small or large, and it doesn’t mean you or your treatment failed. After a relapse, an individual could return straight to maintenance, or it may require a return to an earlier stage. It is possible to return to precontemplation after a relapse, as someone could say “oh that wasn’t as bad as I remembered” and be enveloped once again with their pre-change lifestyle.  

An example: Ellee realized she had a gaming addiction when she was 22. After the challenge of quitting video games and seeking help, she maintains an abstinence from video games as a 28 year old. She recently relapsed when a new group of friends had a housewarming party for their friend. She didn’t know that there would be a console with the expectation to play some party games over drinks, and she had gone home afterward and continued a game-watching binge on Twitch. Ellee felt guilty and embarrassed the next day when she realized what she had done. She called her dad (her “biggest supporter”) the next day to tell him what happened, and told her therapist about it in their next session. She made a plan to tell the new group of friends how they can support her and why she has to stay away from video games. They worked together to make a plan to have console nights without her, and include her for other activities instead. It was her third ever relapse, and she commented in therapy that the aftercare seems to “get easier every time” when she relapses. She will easily get back into her maintenance stage, as she does not own any platforms that allow for her previous video game habits, and she has now blocked Twitch on her laptop to prevent another similar relapse. 

Fun Facts

Fun Fact 1: Someone can bounce around to various stages many times before coming to their “final” maintenance stage. Even then, relapses may occur and require a re-do of some earlier stages before returning to maintenance. 

Fun Fact 2: It can be extremely frustrating when you are at a different stage of change from a loved one with a change that needs to be made. These stages can be discussed with your therapist, and you and your loved one can come to a decision about how best to proceed together in sessions. 

If you are ready to talk about making a change in your life, reach out to us at [email protected] or 512-298-3381. 

(The Stages of Change discussed in this blog are taken from Prochaska and DiClemente’s 1983 Stages of Change Model, and the book Motivational Interviewing, Third Edition: Helping People Change by Miller and Rollnick)

Written by: Kaity Dallas, LPC-Associate, NCC, Supervised by Kirby Schroeder, LPC-S, LMFT-S

When Is It Time To Get a Divorce?

As a couples therapist, I see couples who are struggling to re-invigorate their sex life, they are struggling with finances, they have trouble raising their children, etc. Having these reasons in mind as to why many of my couples come in on the brink of divorce, researcher Dr. John Gottman says that the main reasons why couples divorce is due to sex, finances, and raising children. I must say that though Dr. Gottman has a point, I disagree—couples divorce due to lack of emotional connection. 

If you are not emotionally connected and engaged in your marriage, you will not be able to manage a sex life together, manage money together, or create a safe parenting space together. Dr. Sue Johnson, creator of the dynamic Emotionally-Focused Couples Therapy, says that the erosion of an emotional bond between two partners is the beginning of the end to their relationship. As humans, we are wired to connect in a safe and emotionally healthy way. If we do not have this in a marriage, we will slowly disconnect and eventually divorce if no action for couples therapy is taken. 

Disconnection can look like many different things. Maybe you and your spouse keep arguing about household chores or who will walk the dog next. Perhaps a spouse can feel unsupported in their idea to switch careers. Maybe there is just an overall feeling of loneliness on both parts in the marriage. The main point to understand on a general disconnect in the marriage is that it can be understood and helped. Much of what we do in couples therapy at Austin Family Counseling is strengthen the emotional bond between partners as well as create a safe space for re-engagement and for couples to work on issues that have been reasons for feelings of disconnection in their marriage. Basically, a general feeling of disconnection is not a valid reason to divorce when there are many resources and tools to help build and strengthen your marriage. Rarely do couples come to me with the presenting problem of lack of engagement and leave the therapeutic process unhealed, reassured, and optimistic about their exciting new opportunities to re-spark their romantic life. 

Extreme cases, however, can absolutely be reasons to separate. In my years of practice, I have seen such reasons for a therapist to recommend separation as physical abuse, emotional/verbal abuse, and active addiction.

Physical Abuse

This is perhaps the main reason that couples should divorce. Physical abuse of any kind is not acceptable in a marriage or any other kind of relationship. Physical abuse is seen in marriages where one partner has significant anger issues and has not managed their emotion to the point of it being unsafe to be close and vulnerable to this person. Women who stay married to physically aggressive men are very likely to have come from abusive households where they see abuse as a “natural” thing. 

According to the American Journal of Emergency Medicine, since the stay-at-home order has been put into effect in 2020, an alarming increase of domestic violence cases has occurred in the US. More partners are shut into their homes with their spouse, putting them more at risk of physical danger when the aggressive partner becomes triggered. Other effects that are brought on by the stay-at-home order are alcohol abuse, depression, and symptoms of post-traumatic stress, all VERY easy triggers of physical abuse. 

If you are involved in a physically abusive marriage, I urge you to reach out for help and escape from a dangerous situation as soon as possible within your boundaries of safety. If you are in Austin, the Salvation Army’s Austin Shelter for Women and Children, the SAFE Children’s Center, and Casa Marianella are all places where women and families can go for refuge from a physically abuse situation. As a couples therapist who becomes aware of physical abuse, I am ethically bound to stop couples therapy immediately and let the abusive partner know they need to do their own counseling and anger management if couples therapy ever resumes. 

Emotional/Verbal Abuse

Aside from physical abuse, verbal and emotional abuse is another form of abuse that is sadly much harder to spot. Physical wounds leave visible marks, but emotional wounds can go unseen for sometimes decades. Emotional abuse is defined as any form of emotionally manipulative behavior perpetrated by one person to another that can cause PTSD, stress, or anxiety. Some forms of it are below:

  • Gaslighting: making the partner being gaslit think something is different than they actually experienced it.
    Example: “Something must be wrong with your memory because I never said that!”
  • Minimizing: making someone feel inadequate or unworthy based merely on how they are feeling
    Example: “I don’t know why you’re feeling that way, you didn’t have it that bad!”
  • Intimidation: using threatening language to reinforce a sense of control by the partner through invoking fear.
    Example: “I will hit you if you say that to me one more time!”

Though no form of abuse is ever acceptable, there tends to be more hope for emotional abuse than physical abuse in the couples I see. Sometimes, separation is key for partners where verbal abuse is going on before they are able to come back together and make the decision to either stay together or divorce. However, in my sessions with couples, a hard boundary I hold is to have no gaslighting, minimizing, intimidation, or name-calling in session. If you believe your partner has narcissistic qualities in them, definitely seek help for mental health as these can have longlasting negative effects on someone’s sense of self.

Active Addiction

Though many treatment modalities indicate couples can survive an active or recovering addiction, in extreme cases a marriage cannot always survive. If a partner is currently abusing alcohol and becomes physically or emotionally abusive, it is in the other partner’s best interest to leave when the marriage becomes an unsafe place. Unless the addicted partner commits to going to AA or therapy to work on their addiction, the marriage will become an unsafe place for both people, triggering an abusive cycle that both partners will be feeding into. 

When a partner is addicted to an illegal substance (i.e. cocaine, methamphetamine, heroine, etc.), the marriage is further complicated due to the unlawful possession of illegal substances in a household. Not only is the marriage riddled with addiction and addictive patterns, but this presents the marriage with far more dangers and reasons to divorce. Though only one partner is using, both spouses when living together are subject to legal ramifications that puts the non-addicted partner in a very precarious position. 

When couples come to me with an addiction present, I hold a firm boundary that the person who is addicted seek help through groups (i.e. AA, NA, SLAA, etc.), separate individual counseling, or in further cases checking into a detox and addictions treatment center for couples therapy to continue. It is unethical to do couples counseling while a noticeable addiction is going on due to the fact that the vulnerability needed in couples therapy can at times exacerbate the addicted spouse’s addiction. 

Written by: Ian Hammonds, LPC, LMFT

Shame: The Insidious Defeater

It wasn’t until after I was out of graduate school and well into my professional career that I really learned about shame. While many of my clients seemed to receive help and work through tough problems and even trauma, there seemed to be a few areas where we would sometimes get stuck. After training with Dr. Brené Brown and her team on shame resiliency, I began to notice huge progress both within myself and in my clients.

Jennifer Alley, LPC

By: Jennifer Alley, LPC

Most of us don’t talk about shame. By definition, shame is that which feels unspeakable; the things that keep us awake at night or nag us throughout our daily tasks. They are the messages we hear in our head when we want to be vulnerable or make a connection with another person; the voice that discourages us when we think of taking a risk or doing something brave. For many of the clients I work with, the voice shows up as something like, “not ____________ enough” (fill the blank with words like good, smart, pretty, skinny, sexy, funny, etc). It also dresses up in messages like, I’m unloveable, flawed, disgusting, broken, worthless, a phony, or a fraud. When we have a fight with someone we love, shame is often the feeling that causes us to curl up in the corner feeling completely defeated and “bad” or lash out and blame the other person, perhaps even shaming them.

For many people, these messages and statements are so insidious, so ingrained that they are perhaps not even really consciously noticed. Instead, they may just be internalized as “truth,” minimizing the chance that the person feeling shame might take that risk, share something vulnerable, or succeed at something hard. It often keeps people from having the close relationships that they would like to have because they fear that if people only knew the “truth” about them, they wouldn’t be liked or considered worthy of connection.

As part of the work I do with clients, I ask them to notice the “tapes” that play in the back of their minds. When they feel challenged, when they are trying something new or difficult, when they feel scared or hurt, what messages are they hearing? They often come back surprised by the amount of negative self-talk or shaming messages that are on replay throughout their days.

Particularly in my work with individuals who have a trauma history including family of origin mental illness or dysfunction, domestic violence, assault, or abuse, with clients who have experienced divorce or made the difficult choice to abort or give a baby up for adoption, and with clients who are in recovery from various types of addiction, there is often a great deal of shame happening consciously or unconsciously.

The biggest problem with shame is that it jeopardizes relationships, stunts our growth, keeps us from connecting with others, and makes us feel very alone. The anecdote to shame is owning our story with self-compassion and love in addition to sharing our story and our shame with those that we trust.

To learn more about Dr. Brown’s work on shame, visit http://www.brenebrown.com. If you are interested in joining a group or receiving individual counseling about shame/shame resilience, visit http://www.austincounselors.org.

Upcoming Group Offering:

Daring Recovery™– an eight week group for women in recovery based on the work of Dr. Brené Brown. Facilitated by Jennifer Alley, LPC, CDWF-candidate at 5000 Bee Caves Rd. Suite 100.

Mondays 6:15-7:45pm

October 27-December 15

Group objectives:

  • Gain courage to own, share, and live our stories
  • Learn how to live life sober, transforming the way we live and love
  • Choose authenticity over numbing, pretending, and perfecting
  • Increase self-compassion, empathy, and connection
  • Understand our shame triggers and what drives that feeling of not being enough
  • Connect bravely with other women

Contact Jennifer at [email protected] or 512-761-5180 to register or for more information. You can also visit http://www.austincounselors.org.