Understanding Their Journey - Stages of Change Part 2 - Dithering

Stages of Change - Part 2 Dithering

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

Today’s Learning Moment – 05 31 21 Issue: Understanding Their Journey Part 2 —The Stages of Change: Sitting on the Fence  Officially Termed Contemplation

In Part 1, I briefly introduced the Transtheoretical Model of Change or Stages of Change. I talked about the first stage of change and also included the tool, Motivational Interviewing. Of course, there is tons of information on all of this online and I encourage everyone to look into both models in depth. However, they are not the only tools. Nevertheless, in my opinion, I believe they form the primary tools in counselling practice, especially with substance use challenges. This partnering of models was incredibly useful in my work with people on all levels and also when I applied it to my own lived experience. They can also be used by YOU, helping a family member work through potential change opportunities with MHSU disorders.

To briefly review, I mentioned that the first of 6 stages of change was Precontemplation. Stage one is described as a state of unawareness that a problem exists. Unawareness is a natural resistance to a change stage because people don’t see a problem in their behaviours. The traditional views of substance use disorder see this as a denial. It is not, — simply because there is a lack of awareness of the problem, for whatever reason. To deny something, you’d have to first be aware of it.

For instance, I used the example of smoking throughout the ’70s and ’80s. Very few people in society at the time (unless you were a non-smoker) saw it as a problem. Consequently, very few people ever thought of making the change to quit. It is not until we started learning more about smoking and talking about it socially that we, as a society, started seeing it as a problem. This brought many smokers, including myself, to the next stage of change.

Stage 2 — Contemplation:

Okay, there’s a problem, I should change, well, maybe tomorrow, okay right now, no probably after this next event, no not now, I’m too emotional, okay I’m ready, should I or shouldn’t I…….. I promise to change!  I promise to change!  I promise to change!  Why can’t I change??

Hopefully, you can see this stage as being very confusing. We often consider it as sitting on the fence. Again, we shouldn’t consider this as a denial. Even though we now are aware that there is a problem, there are a plethora of reasons why we don’t quite jump off the change side of the fence and start that healing journey. I liken it to jumping off the very highest diving board. If you’ve ever watched Mr Bean Goes To The Pool, you can see a hilarious version of what it’s like to make a change. Pay attention to the high diving board scene.

https://www.youtube.com/watch?v=gZujYUcY5xc

Watch to the end. You’ll laugh and hopefully get the metaphor as well.

So what can we do as we support our loved ones? We think we know that they need to make a change, they think they know they need to make a change, however as most of us know it truly is difficult to change the simplest of habits. Now imagine taking the first steps to change a neurologically wired disorder such as addiction to any drug?

Stages of Change

Language and actions are so important at this point. As I said in Part 1, what we say and do during these firsts two stages can result in either building motivation, trust, and confidence or building and solidifying resistance to change. I’ll use two examples from my own experience when I was learning about “the problem” of smoking.

Way back then, I was dating a special young woman. Our relationship developed enough so that we cohabitated for a while. She had never had a cigarette in her life. As our relationship developed she became quite rigid in her eventual stance that I needed to quit smoking. At this point, I agreed as I was well aware of the dangers and so on.  So I “promised” to quit. As happens with virtually all smokers, I relapsed after about a week or so. Initially, with virtually all smokers (and other people who use drugs), I hid my relapse. I believe I did so out of shame and embarrassment, out of fear of disappointing my partner and who knows why else at the time. When she asked how it was going, I promptly told her I had relapsed and was smoking again. I made a promise to try again. However, she lost her mind and to say the least, ranted and screamed at me. She took out a $10 bill and lit it on fire. She threatened to leave or kick me out. Did I quit after that?

Nope. I did try, multiple times, but I had to hide it and actually started to lie about it. I remember how I felt about her reaction to that first confrontation to this day. I felt confused (I had never seen this kind of reaction), I felt scared of many things including losing the relationship. Needless to say, that relationship ended. Smoking was tagged as one of the major causes. Think about that for a minute or two. ( I do own my role in the end of that relationship)

In the last article, I used an example of another young woman that I dated. Again a non-smoker. It was the ‘90s. Smoking was becoming a social issue. I mentioned that she approached me with curiosity. She had noticed that I frequently lit up a “smoke” when I was stressed, angry or anxious etc. I mentioned that this opened up my willingness to look at the issue. We were able to discuss my smoking in more detail. I learned that not only did I light up with negative feelings, but in certain situations, in certain places, times, people etc. “People, Places and Things” as is coined in many relapse prevention models. I mentioned that she helped me to move back to contemplation and eventually preparation which I will talk about in Part 3 in this series of articles.

I don’t need to point out the difference between the two approaches. I did not quit until some time later. I had solid support from my new partner though there were times she was angry when I lied about relapse and rightly so. It took some time to build back trust after I finally quit, also rightly so. It’s hard as a support person to hear “I promise” only to have that broken time and time again. Quitting smoking was likely the hardest thing I have ever done, or at least felt like it at the time. As I write this article I am approaching 15 years since I quit. J

So lots of clues from my experience and I can confidently say my experience has many similarities to people who use other drugs. It’s important to note that mental health was a consideration as well as I realized one cause for my smoking was my anxiety levels. I also experienced abuse and trauma as a child and grew up in a home where smoking was mainstream. Was the anxiety first? I don’t know, probably. But I know that smoking and eventually, other drugs when I was very young became an issue.

So I hope I have illustrated some of the dos and don’ts through my examples.

Here is the summary from the literature and the actual researchers:

·         Normalize their indecision. It is normal and natural to sit on the fence when deciding whether or not to change something. Think of dieting or exercising. Not a whole lot different in many ways.

·         Help your loved one "tip the decisional balance scales" toward change by —

o    Drawing out and weighing pros and cons of substance use and change. I mentioned the exercise of asking “if I do change?” and “if I continue the way I am?” Help them do the pros and cons of each question. Do not speak for your loved one.

o    Changing external motivation to self-motivation. This is empowering your loved one to believe that change is possible despite the outer and inner obstacles. “I believe in you” “I have faith you can do this” “I know it’s hard for you and I believe.”

o    Examining the individual’s values about change. The pros and cons can help identify these values. “If I change I will feel healthier” for instance. Don’t put words in their mouth.

o    Emphasizing their free choice, responsibility, and self-awareness for change.  In the end, it is completely their choice.  Knowing the impact on both sides of the fence is an informed choice. 

·         Prompt self-motivational statements of intent and commitment from them

·         Prompt ideas regarding their perceived self-awareness and expectations concerning change.

·         Summarize self-motivational statements.

These last three points are so important. I describe this as looking for change talk.  “ya I know I should change…” “I really don’t want to use…” I wish I could stop…”

There are all kinds of hints that you can focus on when you look for change talk.  Summarizing or repeating or reflecting them back to your loved one is effective.

“Ya, I can see you really want to change and it sounds like it’s really hard. I would love to see you make that change that you want as well. How can I help?”

Someone is more likely to change when they say they need to and not when we say they need to. It seems to be part of being human I guess.

So don’t burn money or have a tantrum to make a point. Not only did it discourage me, but I can tell you from the thousands of stories that I have heard from the people I worked with, that it did not help them either. It does not motivate change.

I hope this has been helpful and I will move towards preparation in the next article (pun intended). 

All our past articles can be found here: https://ptalbcat.blogspot.com/
The link to this specific article is: https://ptalbcat.blogspot.com/2021/05/stages-of-change-Part-2.html SHARING is best done by copying and pasting this link everywhere you want.

Author: Ben Goerner— Ben is a retired BSW MHSU Clinician. He advocates for people with substance or mental illness.

Families Helping Families is an initiative of the Port Alberni Community Action Team. We send out “Learning Moment” articles regularly to help folks understand substance illness. Knowledge is vital in understanding the illness of our family members. You may copy, distribute or share our articles as long as you retain the attribution. You can be added to our distribution list by dropping us a note at - albernihelp@gmail.com

This article was written using info from the following sources:

References

Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. The Guilford Press.

Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy: Theory, Research, Practice, Training, 38(4), 443–448. https://doi.org/10.1037/0033-3204.38.4.443

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/motivational-enhancement-therapy

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) [Table], Figure 2-2: Appropriate Motivational Strategies for Each Stage of Change. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK64963/table/A62587/