Stages of Change Part 4 - Ready and Action!
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| Stages of Change - Action! |
Today’s Learning Moment – 06 21 21 Issue: Understanding Their Journey Part 4 Ready and Action! ( If you haven’t already, read Part 1, Part 2 and Part 3)
Well, here we are. Finally! After all that motivation building and preparation, like Mr Bean, our loved one has finally stepped off the edge of the diving platform: hopefully not by the knuckles but by a graceful swan dive into change (we wish but it’s rarely graceful). Especially the first few times we (person who uses drugs – PWUD) take that plunge. It’s usually more like Bean falling in butt first and floundering for a while at first.
For us who support them, we stand looking over the edge at our loved ones hoping, and often expecting, they will gracefully swim to the end of the pool and step out cleansed, motivated and committed to the promise of never using drugs again. We, (PWUD and family who supports them desperately wish).
But more often than not, the fairy tale Hollywood ending we’ve been programmed to expect doesn’t happen the way we thought it might. The swim is a long journey. Sometimes they get out at one edge of the pool and go back to the diving platform. They once again decide to jump off. Sometimes it’s awkward and usually, the more they dive, the more confident they get, not only in the jumping-off but in the swimming.
Often, when people have had some success in swimming and decide to get out before they are expected to. Maybe they tired or discouraged or they hit some barrier. The first few times, it is hard to get back to the diving board and jump in. Often, like Bean, they lose their bathing suits after the dive. People become extremely vulnerable and self-conscious.
However, what often happens is the more we take the jump, the more comfortable we are in taking the jump and in swimming. We prepare for the barriers, put on the floaty things around our arms, and eventually take off the floaty things and swim on our own.
This is where people going through the stages of change need our compassionate support and patience the most. We need to be reminded of goals and boundaries through motivational language.
This is where we (supports) have to be mindful of our
language, our expectations and our hopes. If there is one thing that is universal
in addressing substance use issues, it is how we support our loved ones. The
strategies below should help in determining how we talk with our loved ones
during the action stage. Don’t forget, this is where they have committed to
change and are following through with their efforts, such as they are.
As a clinician, and as one with lived experience, I don’t really need the
studies to tell me that healthy supports in the life of a PWUD are crucial to
moving towards mental and social health or wellness. I have watched those without healthy supports
flail and literally drown from the lack thereof. I have watched those,
including myself, eventually thrive from healthy support. That’s why I am so
committed to writing these articles and sharing what I know from both sides of
the fence. It is difficult at times, but not impossible work.
I will get to the dos and don’ts in a minute but first I want to share an
exercise I have found that really illustrates the dynamics of change, the
difficulties and the possibilities.
1
Take a piece of paper and a pen or pencil. Divide the paper in half top to bottom down
the middle.
2
On one half, write down up to three negative thoughts you
have about yourself. They could be about what you’re going through but for the
sake of this exercise keep them simple. For example “I’m such an idiot…” This doesn’t require a lot of detail, just
the main point.
3
Then, when you have finished writing, on the other side of
the paper, respond encouragingly or positively to your negative self-talk…
BUT WAIT BEFORE YOU WRITE
AGAIN THERE’S MORE!!!!!!
4
Switch the pen or pencil to your other hand and write your
responses with your weaker hand. Do your
best to finish the responses.
5
Now ask yourself; what was it like to write down my
negative self-talk; with my strong hand; was it easy, hard? Really notice your emotional and your
physical feelings
6
Now ask yourself the same of the responses you wrote; what
was it like to come up with motivating, encouraging thoughts? What was it like
to write with my weaker hand? Notice your emotional and physical feelings.
7
Now ask yourself; How did the whole exercise feel overall?
Did you complete the exercise, even with your non-dominant hand? Was the exercise
possible despite the challenges?
So you may have figured out what that was all about. I hope so. I will leave
the results up to you to interpret.
So now to Action, the 4th stage of change. All of what was said above is
extremely important, I believe, in supporting your loved one throughout the
stages of change and no less through the Action stage. Here is my
interpretation of the textbook version edited for supports rather than
clinicians:
As People supporting someone going through changes:
Reinforce the importance of remaining in action.
·
This involves encouragement, our hope, our boundaries, our
agreements, our goals both of us (People trying to change and those who support
them). This is a two way street by the way.
Support a realistic view of change through small steps. (included
in resources is a link to SMART goal setting)
·
Small goals like making a phone call, scheduling an
appointment, connecting with a counsellor, attending harm reduction, withdrawal
management, outpatient or residential treatment. Build up. You can do this by
setting a large goal and working backwards identifying the steps just prior.
·
Having some way to monitor achievement can be useful such
as marking off the accomplishment of small goals. This can help each of us to stay
motivated and to…….
Acknowledge difficulties for the person attempting a change
in the early stages of the process.
·
As we have learned, there can be many barriers. They can be
emotional, psychological, psychiatric, environmental and social. Small goals in
each area are important. Achieving goals helps build motivation. If they are
too big, there is a higher chance of “failure” which can be discouraging.
Help them identify high-risk situations and help them develop
appropriate coping strategies to overcome these.
·
It is important not to do this work for them. They must
hear themselves say what is a high risk, what is appropriate, what is helpful
and what is not. They must be the ones to accomplish their own goals. In the
end, they need to have their own power just as we, the people supporting them
also need our own power. This is motivating and increases their chances of
success. Suggestions, not lectures, are welcome. Brainstorm with them, not at them.
That way we both can…..
Identify new reinforcers of positive change.
·
This could be anything from feeling a little healthier to
completing a task, to gratitude from people supporting or anything that rewards
change. I would often help someone pick out a physical reward weekly that they
could give themselves for reaching a small weekly goal. This leads to our next
point which is to….
Help assess progress
·
This where we both can identify what’s happening, how the
experience is, where the barriers are, where the strengths are. Again, an
effective way to do this is through daily and/or weekly monitoring of goal
attainment.
Please remember what was said in the last articles. The
stages of change are not linear. People may climb out of the pool earlier than
expected. There is always a reason other than denial or malicious intent. This
is where the above strategies can help.
Remember that judgement is the hope killer!
We as supports must constantly be mindful and remind ourselves that we are in a
supportive role in our loved one’s journey, not an authoritative role. That
doesn’t mean we don’t set our boundaries and enforce them. We just need to do
so in a compassionate way while being firm. Remember, as their support, we are
guiding, not punishing. We don’t need the research to tell us that when a family
is educated and involved in the journey, the more likely the chance of success
will be.
Also, remember success is not a place, it is the small steps we take in the
journey.
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-4-ready-and-action.html SHARING is best done
by copying and pasting this link everywhere you want.
Author:
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/
https://addictionrehabtoronto.ca/smart-goals-for-substance-abuse-recovery/
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