How many psychologists does it take to change a light bulb?
One, but the light bulb has got to want to change!
How do we help someone change? If a person wants to change, then the process can seem a bit easier. But what happens when a person is reluctant to change a habit or behaviour that is unhealthy, dangerous, illegal or causes ongoing problems with their friendships or relationships. For instance, what if we want them to change or give up drinking, smoking, eating the wrong foods, or gambling?
For a long time now, since the 1980’s psychologists have been using a model developed by Prochaska and DiClemente (1986) called the “Stages of Change” model. This model was first discussed in relation to giving up substance addictions, but has since been applied to a wide range of behaviours that people may want to change. Psychologists don’t use the model in a rigid way to pigeon-hole people, but more as a framework for helping people and assessing their willingness to participate in treatment.
In the “Stages of Change” model, there are five stages:
- A pre-contemplative stage – usually, the person who is pre-contemplative is not even thinking about changing. A person who is pre-contemplative about change will not usually attend for treatment or help. They may be forced to undertake treatment because someone else makes them – as part of a deal within a relationship, because they “have to” do it to satisfy some requirement to move forward on work or study, or because they legally need to do it.
A lot of young people I see are pre-contemplative. They might have been brought to see me by their parents or because school has said they need to come or because they have had brushes with the Law and have been told to seek treatment by a Court.
- A contemplative stage – in the contemplative stage, a person is thinking about change, but has not made any firm commitment. It might be that they “kind of” know they should make s change, but they haven’t gotten around to it. They know that there’s something they need to change
- A preparation stage – in the preparation stage, a person might be planning to take some action. They might be ready to try something or “give it a go”.
- An action stage – during the action phase, the person is actually taking the steps to make change – they might be going for treatment, getting to the gym, or staying alcohol free – but they are working towards their goal of change
- A maintenance stage – in this stage, a person has changed their behaviour and is in the process of sustaining that change.
At any of these stages, things can happen and the person finds they are back in the old habit. We call this a “lapse”. People can lapse at any stage and might return to any of the earlier stages.
The important thing about understanding where people are at with regard to their change is that different stages call for different strategies – each stage of change needs a bit of a different approach.
If someone is not even thinking about change (pre-contemplative), then we can demand change and police it – but that doesn’t always work or might not always be an option. It can be more helpful, sometimes, to provide a person with information about the behaviour that requires change, but we have to be careful that we don’t load the information with too many “have to” messages. If we want to bring about authentic motivation for change, it’s best that the person arrive at their own reasons to change – being too bossy or domineering can lock a person in to the “anti” or “opposite” position.
Rather than waste resources on telling them how to change if they are pre-contemplative, it can be more useful to focus on making sure they understand exactly what the risks of their behaviours might be. We need to provide this information is a collaborative way. Anger and scare tactics can rebound sometimes. In the case of alcohol, for instance, rather than tell a pre-contemplative teen that should not drink, we might give a person information about how much is a standard drink, the health and legal effects of alcohol, look at how much and how often they are drinking and let them arrive at their own conclusion.
If they are still not ready to change or they are not ready to even think about it, then it is important that we give them the information they need to stay safe. We call this “harm minimisation” – if they are going to keep doing it, how can they do so safely? For instance, if a teen is going to continue to drink alcohol after being presented with all of the risks about it (for them and others), then talking to them about, for example, staying close to good friends, making sure they don’t take their car, or pre-arranging safe lifts home becomes really important.
If a person is contemplating a change, this can be a good time to have them weigh up the pros and cons of change – what are all the good things about changing, what are all the good things about not changing, and also what might be not so good about change and what might be not so good about no change.
If a person is preparing for action we can help them set their goals and introduce them to various strategies for change. For a young person wanting to stay sober and not use alcohol, we might teach them refusal skills so they know how to say “no” to offers and deal with any anticipated ridicule that may occur if they say “no”.
There is some new research emerging from here in Queensland that is looking at the importance of helping people visualise their goals rather than just talking about them. Functional Imagery Training helps people visualise their goals and incorporate lots of senses in their images – the sights, sounds, smells of achieving change – and then to share their vision with us.
If a person has a lapse while they are trying to make change, it’s really important that we help them reflect and learn about the things that happened that made it easy for them to fall back into old ways. We don’t want them to give up, “throw the baby out with the bath water” and go back to their old ways. We like to look closely at it so we can learn and make plans for next time. Again, we can’t do this properly if we are being too police-y or judgemental.
There’s much more to be gained by working collaboratively with a person who needs to change than by just adding more judgement.
Maybe it’s time to change how you think about others making change??