Stages of Change Part 3 - Standing On The Edge

Stages of Change Part 3
Standing On The Edge

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

Today’s Learning Moment – 06 14 21 Issue: Understanding Their Journey Part 3 —The Stages of Change: Preparation; Standing at the edge of the diving board.

This is the third of six articles on the stages of change as seen through the eyes of a mental health and substance use counsellor and someone who has lived experience with substance use disorder aka yours truly. ( Read Part 1 and Part 2 )

In the last two articles, I discussed what are considered to be the first two unique stages of change that we all tend to travel through when we decide to make a change in our lives. In this article, I will scratch the surface of the third stage of change otherwise known as Preparation.

As we explore these stages, please consider something in your life that you have decided to change; it could be a diet or exercise, a job, a move, a relationship. It might even have been with substance use.

Think about how you might recognize these stages as you went through those changes in your life.

In the last article, I provided a link to the hilarious Mr Bean episode where he is at the pool and decides to jump off the diving board. You remember he didn’t just jump. He was kind of coerced at the end. This scene is full of metaphor for this particular stage of change although not quite as funny in real life for sure.

If you remember, Mr Bean goes to the edge of the diving deck all full of confidence and resolve to make his stupendous dive off the highest board. When he gets to the edge, he panics. For me, this symbolizes the back and forth or nonlinear nature of the stages of change. When our loved ones commit to their “change talk” eg “I think I’m ready to take the next step, maybe go to treatment or detox or ….” they (we, as I was there too) are often experiencing sincere confidence and resolve that we can do this. often we get support and encouragement from our families and friends. So we walk to the edge, the threshold, the precipice, the gaping void of unknown……. and sometimes we panic.

In our current world and traditional approach to addiction, this is usually seen as denial, avoidance, failure and broken promises. I have experienced both sides of this scenario, those reactions are seemingly unavoidable. It’s really hard not to feel betrayed when you’ve been told by your loved one that they (we) will follow through, then backs away at the last second. As someone struggling with the disorder, it’s hard to peer over the edge at the vast unknown, with the knowledge that this might hurt….a lot.  It will hurt, either way. But we, (the person who uses) and we, (the person supporting), can make this work. In the end, it’s on both of us to be clear about our needs. This is the opportune time to really discuss them from both sides.

If we change the way we see things we change the way we say things, if we change the way we say things, we change the way we see things.

How would you describe how you see things at this moment?

Back to Mr Bean.  So we notice, then, that he returns to the edge of the diving deck and peers over.  We also notice that despite his terror, he is trying to find a way to accomplish his goal of diving off. He comically crawls and slithers and grasps, trying anything to get to the jumping-off point. We could liken this to the preparation stage of change. Technically, we (people who use drugs - pwud) must try to find ways that will work for us. We might slither, we might crawl, we might run and go for it (Mr Bean didn’t think of that one). He finally finds himself hanging off the edge by his fingers. At that point, the kids behind him stomp on his fingers and Bean falls in with the grace and prowess of three stooges.  Often that is how we (the supports) find ourselves in our first attempts to help our loved one do the right thing as we see it. We (pwud) often find ourselves awkwardly and sometimes painfully in a state of change we don’t know how to handle.

Did Bean make the change successfully? Let’s look at the kids on the diving deck as people in the life of Bean. Was there anything they could have done differently to achieve what they were looking for?

You may notice that the boys behind Bean get to the point where they are impatient and even mocking Bean as he tries different ways to get to the jumping-off point. In the end, one walks up and stomps on Bean’s fingers. Again, notice how Bean fell in the water of change, and how supportive ( or not) the boys were. I hope this message is getting across.

By viewing this through the stages of change, one will see that supportive encouragement, creating motivation and helping with ideas is the more effective supportive approach. Bean was crossing into the preparation stage. Notice that all of the strategies, good or not, were Bean’s ideas. This is key in this stage to listen carefully. It is about collaborative planning, and contrary to the example, not necessarily jumping into action yet. That’s the next step. Preparation is determining how we (pwud) are going to get to the jumping-off point and jump, and how we (the supports) are going to be most helpful through collaboration rather than stomping on fingers.

This is the long way of saying preparation is planning to make the desired move that both we’s think will work most effectively. It is predicting, critical thinking, collaborating re: each other’s needs. So the language at this point is about validation, encouragement, and recognition of needs. It is recognizing initial risky things, barriers, hopes and desires, all identified in the pros and cons exercise. Remember that people won’t plan or take action if they feel unsafe or hopeless. So hopefully the first two steps have brought us (pwud and supports) to this point.

So here is the text book version:

Clarify your loved one’s own goals and strategies for change.

·         Offer a menu of options for change or treatment. You can explore this on your own or together with online resources and literature. Look at the options realistically.

·         With permission, offer advice.

·         Negotiate a change--or treatment--plan and behaviour contract.

·         Consider and lower barriers to change. These can be elicited from the pros and cons list done in the previous stage.

·         Help your loved one enlist social support.

·         Explore treatment expectancies and your loved one’s role if that is an agreed-upon decision. Remember, treatment can take many different forms from harm reduction, outpatient, through to residential treatment, to low barrier housing through to recovery housing.

·         Elicit what has worked in the past either for them or others whom they know.

·         Assist to negotiate finances, child care, work, transportation, or other potential barriers.

·          Identify those to whom your loved one can be accountable. 

See the difference between precontemplation, contemplation, and preparation.  The language you use at the preparation stage is much different than at the pre-contemplative stage.

Remember, judgment is the enemy. It will divide and conquer both the loved one who uses substances and their supports.

We might now be ready for Action……

All our past articles can be found here: https://ptalbcat.blogspot.com/
The link to this specific article is: https://ptalbcat.blogspot.com/2021/06/stages-of-change-part-3.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 behaviour. 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/