January 14, 2004
New resolutions ring with same old challenges
Munson Medical Center counselor outlines five basic steps of change
By Carol South
Herald contributing writer
With the New Year come and gone, this early many of the resolutions are still fresh and doing their job of changing behaviors.
Sustaining the desired change, both for the short term and over a lifetime, can be another matter.
Why is change so difficult?
Doug Moser, a counselor at Munson Medical Center's Behavioral Health department, discussed the basics of change Thursday evening at Munson Medical Center in a public talk entitled "So You Want to Make a Change: Understanding Motivation." Moser's talk was timely for the season and worked to guide attendees through the change process, which for most people is a complicated one.
Moser first outlined the five basics steps of change, as delineated by two prominent researchers in the field of change: James Prochaska and Carlos DiClemente. Moser then solicited goals for change from the audience, garnering ideas ranging from better organization and greater punctuality to changing dietary habits and increasing exercise.
He then launched into a thorough discussion of the stages of change, which include pre-contemplation, contemplation, preparation, action and maintenance. This latter stage is often a cycle of relapse and recommitment to change.
Moser noted that a change helper, such as a professional therapist, must assess where in these stages a person is. A person who is in the pre-contemplation, contemplation or preparation stage will not be ready to take on concrete plans of action or demands for modified behavior.
All the brilliant ideas or motivational speeches in the world will not impact anyone until they are ready to change. Being ready means the person is taking action or in the action phase.
"Only 10-15 percent of individuals in the change process are in the action phase," he said. "Action is the easiest phase to recognize and helpers can provide support as support really does sustain people."
"You need to meet the client where the client is at, and being in the helping profession we forget that they have the right to fail," said Moser, noting a colleague's wry observation that: "They get better in spite of us."
Carol, a nurse by training, was particularly interested to see the change process broken down into its components. She also felt that knowing and understanding the process of change gives greater ownership to the individual making a change in his life.
"These are life saving things, when you walk away from a counselor you need to understand things not just have a Band-Aid on problems," she said. "It really helped to have him break down the tasks."
Moser said that, as a counselor, he has always been interested in the process of change and has kept up with the literature and studies in the field. The roots of understanding change stem from treatment approaches for alcoholics. A cycle of sobriety and relapse for what were then chronic alcoholics prompted researchers to delve into the mindset of people desiring changes in their lives.
As treatment moved away from 28-day inpatient facilities, prompted in part by insurance companies as well as common sense, modern approaches were more client-centered. These changes were guided by research into the psychology of change.
"Treatment was made to fit the client and not seen as just 28 days but a series of episodes that occurred over two, three or five years," Moser said. "Client resistance was now seen as the therapist rushing the change process not as denial or resistance as it used to be."
Moser also said that the first stage of change, pre-contemplation, is an educational phase, both for individuals and for counselors. The second phase of contemplation is usually marked by ambivalence and often a love-hate relationship with the problem issue, such as cigarettes, alcohol or unhealthy food.
"You don't want to be lecturing here, you want to be listening," he said. "I teach clients about the stages of change and invite them to tell me where they are at."
Once someone is through the preparation phase and has made changes, the maintenance phase allows them to consolidate their gains and learn to handle relapses.
"Many people who relapse go back to the contemplation phase because their ambivalence came back," Moser noted. "The thing about ambivalence, you can have all the best-laid plans in the world, but if you're not emotionally ready, the change won't happen."