The Six Stages of Change

by Sheryl Karas M.A.

Heroditus in the 9th century B.C said "Nothing is permanent but change." Yet how often do we hold on to the status quo as though our lives depended on it? When the diagnosis is dementia we have no choice but to expect our lives to change but many of us fight those changes every step of the way. Unfortunately, when all our attention is focussed on keeping things the same, we have difficulty imagining how life could be better. This month I focus on how to prepare for change and make it happen in the healthiest way possible. What change you decide to make is up to you.

Understanding and Making Use of the Six Stages of Change

Most of the caregivers I work with want to make changes in how they handle their caregiving situation. Yet I notice that some people jump on the suggestions I make while others hold back and make little or no change at all. I notice this same dynamic in myself. I can dither around for years, driving my friends crazy with my obvious dissatisfaction and indecision, resisting their suggestions, spinning my wheels. Then, when "the time is right," I leap into action and accomplish in days or weeks what previously seemed impossible. What makes the difference? Do you ever wonder how the time becomes "right" and how you could get there sooner?

At a recent conference I was introduced to a concept called the Six Stages of Personal Change. Listening to the presenter I had what could best be called an "aha" moment when I recognized myself in what she was saying and recognized some of you as well. Understanding that a person's readiness to change is a process that can be mapped, understood and worked with instead of looking at it as a problem that has to be combatted and "fixed" was very helpful to me. I don't know about you but I'm very tired of fighting a losing battle and feeling bad about myself as a result. By recognizing what "stage" I'm at and working with the issues of that stage appropriately I feel there is a greater potential for moving my life forward in a positive way and hope that will be true for you as well.

Stage One: Precontemplation or Resisting Change

A person at this point does not recognize that they can make a change. They say the problem in their life is strictly outside of their own control. Things happen to them, it's somebody else's fault, it's always been this way, it's bad luck, and there's nothing they can do. They may be unhappy but that's their lot. I learned a long time ago that trying to push someone in this stage into action is a waste of time but giving up on them or enabling them to continue with behavior that contributes to their unhappiness makes no sense either. What does seem to help is listening to the problem, consciousness raising and helping a person see how their behavior contributes to the problems in their lives. For example, we may have no choice about the fact that our loved one has dementia but we do have the ability to make changes in how we communicate with that person so our day-to-day interaction is more peaceful. Understanding our part in the interaction is the first step to changing it.

Stage Two: Contemplation of Change

The person recognizes the need for change but is ambivalent. Stepping into the unknown is scary. "What if it doesn't work?" "What if it makes things worse?" "Maybe it will change by itself." "Maybe I should wait for a better time." "Things aren't that bad, maybe I can just do this a while longer." Worse, the person might have leapt into change prematurely in the past, before exploring what physical and emotional reserves they needed to succeed. People with that experience say "I tried that before. It was a disaster!"

Telling someone in this state "I know you can do it!" is a mistake. I wouldn't believe it. The reality is that at this point we don't know we can do it until we have the necessary information or experience to trust everything will be all right or to trust that we will be able to weather the storm if we take a risk and it goes wrong. A more appropriate approach would be to gather information about what other people have done. For example, if I want to find a respite provider for my relative but have fears about how my relative would react I might want to talk to people in my support group about what their experiences have been and how they handled any problems that came up. We also need to take an inventory of the physical and emotional reserves we have right now to assess whether any preliminary steps need to be taken. Do I have enough money? If mom gets upset about my choice, how will I handle it? What do I need to know, do or have before I can make this choice? I may also need to hear that there is nothing wrong with me for being cautious and that I will be liked and supported even if I do nothing different at all.

Stage Three: Preparation

This person is getting ready to go. They need help sifting through the information they have gathered and deciding to make this change a priority. When they are certain that the benefits of the change outweigh the potential negatives they'll be ready. The focus at this stage is on developing a positive image of the future they wish to attain and clearing away or preparing for any negative side effects of the change that they can. Some people find creating an action plan helpful. Others like to visualize the end result. I have a picture on my wall of a woman from Bali to inspire myself to be disciplined about saving money for travel so I can visit there. The most important thing at this point is to focus on a positive future and to turn away from attitudes and behaviors that interfere with that. At this point encouraging comments like "You can do it!" or "I'm with you all the way!" can be very helpful because this is the point where the person is ready to hear it.

Stage Four: Action

The person is making the change and some changes don't come easy. This is where positive reinforcement comes in very handy. We need rewards for even trying. Every time we take a step in the right direction - even if the result wasn't stellar - it's helpful to get a pat on the back. "Good try! What could make it better next time?" We need to gradually shape our behavior, step by step. This is hard for people like me to accept. I want to change all at once and get very angry and impatient with myself when I falter. But even I have learned that accumulated small changes in the right direction are better than taking a flying leap, falling and giving up because it hurts too much to consider leaping again. This is another place where support groups come in handy because who else is going to understand why making a nutritious dinner for yourself is such a great achievement when you're chasing after a patient who wanders all day? Who else is going to applaud you for not eating cookies instead? We all need acknowledgment of the little triumphs and having some teammates in the form of family members, friends, support group members or professionals who understand is a great way to get that. And it's easy for them to cheer you on if you tell them that's what you need them to do.

Stage Five: Maintenance

Ok, I've made the change. I joined a gym. But I know me, I always go full speed ahead and then little by little the old habits creep back in. It's easy to initiate change when it feels like the effort will be temporary but what if the desired change involves a lifestyle shift? It was easy to go to the gym every day last January and, boy, did I feel virtuous! Can't say that now. Now I'm lucky if I get in there once or twice a week. There are challenges in the maintenance phase: confusing what is ideally possible with what is realistically maintainable, feeling bad because we start overconfident and then don't achieve what we originally intended in the time frame we expected, dealing with daily temptation and self-reproach. Our support teammates can be invaluable at this stage in providing reminders of just how valuable the change we have initiated has been and how worthwhile it is to keep going.

Stage Six: Recycling or Learning from Relapse

It is said that it takes about six months of concerted action before a change moves into the maintenance phase. Most people cycle through the stages many times, relapsing into old behaviors because of distress, social pressure or problems beyond their control. It is important to be reminded that this is normal. We may need to revisit our choices. Maybe it did not go as we expected. What works best in this case is to review the main goal (for example, making more time for oneself outside of caregiving), noting any small or large successes we've had to date and noticing what has changed externally or internally to make it more difficult now. Then we can make appropriate adjustments in our game plan and get back on the horse. Expect that this is a healthy part of the process and instead of seeing relapse as "failure," reframe it as a healthy opportunity to review how things are going. We can't sail a boat straight to shore most of the time. We set sail, tack a little to the right, note that the wind has changed direction, tack a little to the left. A successful sailor expects to change direction many times but knows that eventually he'll reach the shore.

Would you like to learn more about the above topic? I have not read the book but the theory comes from Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward, by James Prochaska, Ph.D., John Norcross, Ph.D., and Carlo C. DiClemente, Ph.D. Avon Books, 1994.

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A new version of this article can be found in Sheryl’s latest book The Spiritual Journey of Family Caregiving.

Caregiving Articles

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© Copyright 2007 Sheryl Karas & Paul Hood