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 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)