A guru walks up to a hot dog vendor and says, “Make me one with everything.” A few minutes later, he is handed his lunch and offers a $5 bill in exchange, awaiting the balance. When it isn’t forthcoming, he looks puzzled and requests his change. The vendor slyly smiles and replies “Ah, change must come from within.”
Wouldn’t that be nice if it were that simple when it comes to behavioral change? Most people who are faced with the need to adapt their habits and choices are not as philosophical, and often fight it symbolically and sometimes physically kicking and screaming.
In Changing for Good (William Morrow, 1994), Prochaska and DiClemente describe the six stages of change:
Stage 1: Pre-contemplation
People in this stage may be aware that there are repercussions related to their addiction, but they minimize or justify their choices, seeing more benefit than deficit. Not a great deal of desire to change and to an outside observer, it may seem as if they are sleepwalking through their lives, quite unconsciously. This is when I plant seeds and do a written cost/benefit analysis with clients.
Stage 2: Contemplation
People in the contemplation stage have become aware of the greater impact of their addictive behaviors, yet they are uncertain if it is worth the effort to effect change. They may be open to considering change “someday.” I have had young clients who have said, “When I’m 18, I’ll stop smoking pot.”
In advance of stage three, people make a decision and have a glimpse that the costs overshadow perceived benefits. Behavioral change becomes a possibility. It is not a “one and done” decision, but rather a process over time.
Stage 3: Preparation
At this stage people begin to see that they are responsible for their choices and have the power to make life-changing decisions. They need to do it for themselves, but need not do it by themselves. They set an intention to gather resources, whether it is in the form of therapeutic intervention, 12 step meetings or other sober supports. They set a timeline and may make a verbal or written commitment.
Stage 4: Action
In stage four, people take the actual steps to engage in positive mental, emotional and physical change by immersing themselves in addiction recovery, not just abstinence from their drug(s) of choice. I call it a “life makeover” that could include developing a fitness plan, dietary adaptation, as well as time with positive people and activities that are heart- and soul-nourishing. I ask them to “re-write” their life story, reminding them that their history is not their destiny.
Stage 5: Maintenance
People in the maintenance stage have become able to sustain these patterns. I liken it to a fitness routine. On the first day of workout at a gym, you are not as strong, flexible and energetic as you will be a year later. The more you practice, the easier it gets. People are more aware of triggers and stressors that could lead to relapse. It is more than merely a rote exercise, but rather an integrated aspect of themselves.
Stage 6: Termination
At the termination stage people can gaze into the mirror and behold a new man or woman. I have heard clients proclaim, “I no longer want to be that guy.” They consider it unthinkable to return to their former lifestyle. It is when I also ask them if they could imagine anything worth losing their sobriety over. At this point, most say no. Even in the face of major loss, they know that if they maintain their resolve to remain clean, they can enjoy a new life.
Although the Stages of Change is an orderly approach to understanding recovery, it doesn’t exist in a vacuum and is not always linear. People can move back and forth through the stages and relapse is always possible. I frame it not as failure, but as a re-set and renewal of determination.
An approach with broad applications
An example of the need for change relates to my own experience of surviving a heart attack. For years, I have been cautioned and then warned by well-meaning family, friends and even clients that I need to slow down and provide the kind of self-care that I offered for them. I gave it lip service and would say things such as “Sleep is highly over-rated,” and would assure them that I would slow down.
Prior to the cardiac event, I was working 12 hour days and sleeping perhaps six hours a night; still not seeing the costs outweighing the benefits of my behavior. It wasn’t until I was actually lying in a hospital bed with an IV in my arm that I had the epiphany that I needed to make immediate and major changes if I wanted to live. Still a mental construct at that point, I began to plan out, with my support team who showed up en masse to cook, counsel, comfort, transport, shop for me, mow my lawn, and cover my clients while I was recovering, what my new life would look like.
When I was tempted to return to my former activity level, my body reminded me that I needed to adapt from Energizer Bunny mode to tortoise speed; from Wonder Woman who thought she needed to be all things to all people to the Bionic Woman (I had a stent inserted). At the same time, I happened to be reading a book about loss and came upon an example of a high-powered executive who intended to return to his former lifestyle following an MI. His therapist cautioned him not to let this heart attack go to waste. I took that to heart myself and see it as a wakeup call that I intend to heed for the remainder of what I see as a long and fulfilling life.