Understanding How We Change

June 4, 2013

butterflyMotivation for a given action (like, for instance, stopping smoking pot) is different at different times, and changes over time. Because of this, if we are trying to help motivate someone to make a change, we do best to try to understand a person’s stage of “readiness” for the change we are discussing, and start there. And “starting there” means adopting different helping strategies depending on where they are. In order to do that, we need a model of change to guide us, which we already have!

James Prochaska and Carlo DiClemente’s “stages of change” model was developed to help describe how people change. With this model, we can describe the person’s readiness as being in one of five stages: pre-contemplation (not even thinking about the issue as an “issue”), contemplation (just starting to think something might be amiss), preparation (starting to think through actual changes and how to accomplish them, action (taking action/changing), and maintenance (the work of maintaining and consolidating the changes made for the longer haul).

In a motivational treatment approach, we are taking these stages of readiness into account. How? By first understanding, acknowledging and accepting the person’s level of readiness (a huge deal for most people), and then tailoring our collaborative goals to fit in with this level of readiness. For example, compare: a) the 20 year old college student suspended for intoxication by his college who thinks they are “way overreacting”, and b) the 20 year old who just finished rehab after a 7 month run of heavy cocaine use and is incredibly grateful to still be alive. We can think the first guy should be grateful to not have died of alcohol poisoning too, but he’s not. Jumping in with him to work on skills for saying “no” to drinking with his buddies is NOT what he wants to do, almost not something he can even conceive of doing, and as a result would be a really ineffective way to approach this with him. Is that what he “should” be learning? Well, it would help him navigate college more safely. But because he is in a different “stage of change”, there is little point in having that discussion, because he is not ready to learn and use those skills. In fact, insisting on teaching him those skills could easily result in him shutting down and leaving, with no change/movement accomplished at all! His 20 year old counterpart from rehab? He’s ready to eat up those skills and be safer for it. We would like to make the first 20 year old safer, but force feeding is not the answer.

And this is what we mean by readiness. Twenty year old #1 is in the pre-contemplation or contemplation stage (if we’re lucky and not too pushy); twenty year old #2 is in the action stage, and wants those skills. So do we cut #1 loose? Of course not, and with a motivational treatment approach, we can start where he is at and develop a tailored plan. It might be a one-time consultation where we validate how hard it is to not be at school and try to help him understand what led to that evening of intoxication past a certain point. We could also help him think through what matters to him (not being suspended, parental upset, how to prevent that again, how to talk to girls without being so drunk), and do a “pros and cons” of drinking with him to understand if he perceives any downside at all to drinking (“don’t like being hung over, don’t like missing class, don’t like being sloppy in front of girls”). We could also help him start to think through some ways to achieve the “pros” of drinking without overdoing it. Multiple paths forward could come from this, but the point is this: in a motivational approach, you start with their level and type of motivation, not yours, and let the paths forward make sense to them. This is an enormously powerful tool in helping people move forward at all, which would be the goal. This understanding also ties directly in with point #1 from above: our actions as treatment professionals (and yours as family members) have a direct impact on your loved one’s motivation; when we can start with them, they are more likely to come along.

When we are thinking about how to best help someone make change, it is best to take a motivational approach and think about where they are in the process of change. If you can meet someone where they are, and provide them the support that they want/need in that moment, it can help move them along through the stages of change.

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