Willingness to Change

Alright, so it’s been a while since my last entry. Just over a month, in fact. I’ve got a couple of entries in various stages of completion, but I never quite felt like I had enough to say to make it worth posting them; they didn’t seem like much more than the kind of stream-of-consciousness thinking I occasionally get when I’m up way too late (though some of those lines of thought did lead to some good papers). I’ve been mulling over my current topic for about two weeks now, trying to figure out what to say about it, and them my class today touched on it really well – I had no idea that there were essentially several social work theories related to it.

So one of the things I noticed most when I was in Menninger for really intensive treatment was that the people who actually wanted to be there, the ones who knew they had a problem, acknowledged it and how serious it was, and actually wanted to find a way to get better? Those were the people who both put the most in and got the most out of the various classes we had to attend, whether they were on Perfectionism, or Family Dynamics, or Cognitive Behavioral Therapy.

I know, right? It seems pretty obvious that the people who admit they have a problem and want to do something to change it would be the ones who actually get the most assistance out of treatment. But some people seemed to be genuinely confused about this, and there were quite a few who were just in treatment because they were told they had to be, or because going through treatment would get them something else they wanted. Oddly, the people who were in treatment not because they wanted to try to manage their mental health issues but because theory had other reasons to be going through treatment were the ones who didn’t get much out of it.

I have to admit, when I was in Menninger, these were the people who frustrated me. I was paying a lot of money to be there and get treatment, and I figured that others would be serious about it, too. I found it aggravating that there were people who would sit in classes and either give one-word answers, or unhelpful answers, or make fun of the whole proceeding, because their unwillingness to admit their issues made them really disruptive, at least to me. I didn’t know why the MHAs, social workers, and psychologists, as well as other professionals, put up with their behavior. But now that I’m in a social work program, I think I’m getting more insight into what’s going on.

There’s a theory in social work called the Transtheoretical Model of Behavior Change. That’s a pretty big mouthful, but it also goes by Stages of Change. Essentially, it breaks down people’s willingness to change, and progress in making change, into six stages. Depending on where someone falls in these stages, some approaches will work better than others on them, and some approaches for helping those further along in the stages will completely drain the motivation from someone in an earlier stage. The stages are as follows:

Precontemplation. This is the earliest stage. Essentially, people at this stage have no intention of change, and may not have even thought about it. They might have some vague wish that something was different, but they probably don’t have any specific ideas as to what. It is likely that others around this person, though, have noticed a problem that should be addressed; someone who goes into any kind of treatment at this stage likely is doing so due to pressure from others.

Contemplation. At this stage, the person is aware that there is a problem, and is thinking to some degree – possibly quite seriously – about how to overcome it. Still, while they acknowledge a problem, they haven’t quite gotten around to doing anything about it, and this is the stage a lot of people are likely to languish at for some time – usually at least six months.

Preparation. This is the stage where action is about to occur, on some level. someone in this stage may have tried to change, but without much success, or have finally worked up the motivation to actually make an effort; they may not be working on change immediately, but it it generally imminent over the next month or so.

Action. This is the stage where most change occurs. It requires not just acknowledging a problem, but being willing and motivated to do something about it. It is likely to be both energy- and time-consuming, and while change might be slow, it is starting to occur.This is the stage when intensive treatment – someplace like Menninger, for example, for someone with a mental health issue – is going to be the most effective.

Maintenance. This stage is one of the hardest, because it assumes change has been made, and that once made, that change will continue to occur or at least be maintained. To hit this stage, a person needs to have been in the process of change for six months or more. This stage is where a lot of relapses occur – someone who went on a diet for half a year, or a year, gives in to the temptation or a week-long binge, or someone who quit smoking has to have just one more cigarette. It’s also the stage at which most people dealing with mental health issues, once they are managing them successfully, stay at, because there’s generally not a permanent cure.

Termination. This is where change is permanent; the challenge is overcome once and for all. With mental health conditions, this is a stage that is unlikely to ever be reached, but some personality disorders, like Borderline Personality Disorder, can be worked through to a point where they are no longer affecting a person.

With a model like this one, what a therapist, social worker, or other professional trying to assist a client needs to do is first assess where along these stages their client is. Once the client’s progress is assessed, the therapist can begin to tailor treatment accordingly; gently nudging someone to move from Precontemplation to Contemplation, for example, is unlikely to bee effective for someone into the Action stage. And treating someone who refuses to acknowledge that they have a problem as if they are in the Action stage might put a client off of seeking treatment – once they eventually acknowledge the need for help – entirely.

In fact, one of the articles we read for class (Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011). Stages of change. Journal of Clinical Psychology, 67(2), 143-154) notes that those in the precontemplation stage should be treated with special care, because if they are pushed too hard to admit something they aren’t ready to admit yet, they might well give up completely. People in precontemplation often tend to underestimate the pros and overestimate the cons of their situation, while not being very aware that they are even making value judgments like that, and trying to force them into seeing their problem is likely to delay their ability or willingness to get treatment for quite some time.

So, like I’d been thinking over the past two weeks or so, it is the people who acknowledge their need to change, and are willing and motivated to attempt to make such change, who are the most successful in getting treatment to work for them. But those people I found aggravating, the ones who made snide remarks or zoned out in class? They have to be treated with care, so that when they do acknowledge that they might have problems, they trust the people (like therapists and social workers) willing to help them rather than avoiding treatment.

So if you have a friend or family member who seems to have issues – particularly mental health issues – don’t be surprised if they aren’t willing to see or acknowledge them; they just haven’t reached that stage yet. Asking them to see a therapist or similar professional could work, but you can’t force someone else to change; they have to change on their own, and trying to force them to move faster than they are willing to go might result in them abandoning help altogether. It might be frustrating, but maybe you could ask said therapist if they can help you match your behavior around this other person to the stage they are in, and maybe help things move a bit more smoothly. Just remember to take care of yourself, as well – you can’t help anyone else if you’re falling apart.