The number of change processes, however, is quite limited. There are a few more, but the nine discussed here are the most common and powerful approaches to change used by professionals and successful self-changers. To maximize your ability to use these processes, the coming chapters will describe at least three of the most effective techniques for applying each change process. Research suggests that people are more likely to be successful in their change attempts when they are given two choices of how to pursue change rather than one; the success rate increases with three or more choices. Your motivation to change increases, your commitment becomes stronger, and you become more able to free yourself from your problem.
As shown in the table in Chapter 1, all the processes have their origins in very diverse systems of psychotherapy. A weakness of many therapies is that they rely on a select two or three techniques for each process, and don’t give clients adequate alternatives. Some changers prefer to be told by an authority that there is a single superior technique. The research my colleagues and I have done makes it clear that many methods can be effective for applying each change process, and that individuals who believe that they have the autonomy to change their lives are more likely to act successfully than those who are given limited choice.
As soon as I arranged these therapeutic processes of change in a coherent and meaningful fashion, I wanted to know how they figured in the efforts of self-changers. Did they have processes of their own that bore no relation to the processes developed by psychologists? Or were the same processes used by both groups? There was only one way to find out, and that was to study the self-changers themselves. I expected that they would have something to teach me, but I did not expect the teaching to be as profound as it turned out to be.
CHAPTER 2
When You Change
FROM A COMPARATIVE analysis of the major systems of psychotherapy, I isolated the most powerful processes of change that psychotherapy had to offer. Once having done this, I interested a doctoral student of mine, Carlo DiClemente, in working with me to determine how frequently people used each of the different processes when struggling to change on their own.
First, we had to find a large enough sample of self-changers to study. The unguided efforts of all self-changers with any kind of problem fail at about the same rate. Because there is a much larger percentage of smokers in our population than drug or alcohol abusers or overeaters, there is a correspondingly larger sample of smokers who have successfully quit smoking. This practical consideration led us to begin with these changes. Not too long ago, almost 50 percent of adult Americans smoked; that figure is down to about 25 percent. Approximately thirty million smokers have successfully quit on their own, almost twenty times as many as those who did so following a treatment program.
We interviewed two hundred people who had tried to quit smoking, mostly without professional help. The individuals we interviewed varied from impoverished farmers living in trailers in the rural areas of Rhode Island to businessmen working in downtown offices. I remember in particular one middle-aged woman. She lived among the people whom we at the university called “swamp yankees”—indeed, she called herself one. She said she had never before met a professor from “Idiot Hill,” which I was surprised and amused to find was the locals’ name for our campus. Yet she was eager to share with me her struggles with smoking. This woman was convinced that quitting smoking was one of the greatest achievements of her life. She also felt that by quitting smoking she had lost her husband—he had refused to quit, and she had refused to go back to her habit.
I asked her how often she used each of the different change processes. She answered, “That depends on when you’re talking about. There were times when I used one in particular and times when I didn’t use it at all.” This was the most direct statement of what many of our other subjects were hinting at. Listening with the therapist’s third ear, Carlo and I began to hear what this woman and others like her were trying to tell us. They were teaching us something that was not part of any major system of psychotherapy or behavior change. They were teaching us that change unfolds through a series of stages.
I realized immediately that we had a major discovery on our hands. At certain moments in history, there are individuals whose minds are prepared to recognize the importance of things that unprepared minds ignore or throw away. Freud’s recognition of the importance of repressed sexuality to human psychology depended, to some extent, on the relaxing mores of fin de siècle Viennese society. The pieces of Darwin’s theory of natural selection fell into place after he read an essay by a statistical economist who had been writing on capitalistic competition. The historical moment was right for their discoveries; had Freud or Darwin failed to formulate their ideas, others would probably have come up with something similar.
Our discovery depended on the discoveries of psychology’s first one hundred years—principally of the various processes of change—and also on the historical moment. Because of the four hundred-some different therapies currently being practiced, other researchers were also intent on reconciling all the competing dogmas. We happened to be the first to make this integration in a comprehensive way. Intuition told me that the concept of stages was the key to relating all the various change processes from theoretically incompatible systems of psychotherapy in a coherent fashion.
Remarkably, this discovery was not based on sophisticated statistics or complex analyses. It resulted from paying attention to the common experiences of ordinary people struggling to be free of a deadly habit. I was reminded of what I had been taught by a renegade professor in graduate school—that science is the radical search for knowledge, no holds barred. Idiot Hill psychologists interviewing swamp yankee citizens were taught a fundamental lesson of change that had eluded most of the great thinkers in the field of psychology and psychotherapy.
THE STAGES OF CHANGE
My original research concerned how people changed; I was trying to identify what tools people used as they struggled toward their goal. But the truly surprising discovery was that successful changers used these tools only at specific times, choosing a different one whenever the situation demanded a new approach. And these specific times were constant from one person to the next, regardless of what their problem was. We named these times “the stages of change.”
If you think about a specific problem that you have resolved, chances are you will recognize immediately that its resolution did not happen all at once, but rather that the solution took time and changed over time. Perhaps for a while you ignored the problem; then you considered tackling it; after that, you may have made definite plans to change. Then, once you had garnered your forces—mental, physical, and social—you acted and began to struggle with the problem. If you succeeded, you worked at maintaining your new self. If you failed, you probably gave up for a time, then went back to the drawing board.
Each of these experiences is a predictable, well-defined stage; it takes place in a period of time and entails a series of tasks that need to be completed before progressing to the next stage. Each stage does not inevitably lead to the next—it is possible to become stuck at one stage or another. However, by understanding these stages and the processes that are most useful within each one, you can gain control over the cycle of change and move through it more quickly and efficiently, and with less pain.
There are six well-defined stages of change:
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
If this book helps you to progress just one stage through the cycle, it will greatly improve the chances that you will take effective action on your problem. A key to successful change is in knowing what stage you are in for the problem at hand. Our research has consistently shown that people who try to accomplish changes they are not ready for set themselves up for failure. Similarly, if you spend too much time working on tasks you have already mastered—such a
s understanding your problem—you may delay acting upon it indefinitely. Matching your challenges to your stage of change will help maximize your problem-solving efforts.
Although nearly all change begins with precontemplation, only the most successful ends in termination. But you cannot skip stages. Most successful self-changers follow the same road for every problem. You may be at different stages of change for different problems; this book can help you work on problems regardless of what stage you are in.
Precontemplation
The writer G. K. Chesterton might have been describing precontemplators when he said, “It isn’t that they can’t see the solution. It is that they can’t see the problem.” People at this stage usually have no intention of changing their behavior, and typically deny having a problem. Although their families, friends, neighbors, doctors, or co-workers can see the problem quite clearly, the typical precontemplator can’t.
Take the case of the fifty-five-year-old manager of a manufacturing plant who fell asleep early each evening in front of the television, even when company came over. Usually irritable and tense, he had lost interest in all activities—including sex—except for his work. He couldn’t understand why anyone was worried about him; he could not see that the fact that he had checked out of life was a problem. All he wanted to change was the incessant criticisms he received from his family and friends.
Most precontemplators don’t want to change themselves, just the people around them. Precontemplators usually show up in therapy because of pressures from others—a spouse who threatens to leave them, an employer who threatens to fire them, parents who threaten to disown them, or judges who threaten to punish them. When coerced into therapy, their first focus is often something like, “How can I get others to quit nagging me?” When this fails, precontemplators may change, but only as long as there is great and constant external pressure. Once the pressure is relieved, they quickly return to their old ways.
Precontemplators, in short, resist change. When their problem comes up in the conversation, they shift the subject; when newspaper articles reveal new information about it, they turn the page. They lack information about their problem, and they intend to maintain ignorant bliss at all costs. In the United States, nearly thirty years after the Surgeon General’s report on smoking, there remain ten million smokers who refuse to believe that smoking leads to premature death. And we all have met troubled drinkers who deny that they have a drinking problem. Denial is characteristic of precontemplators, who place the responsibility for their problems on factors such as genetic makeup, addiction, family, society, or “destiny,” all of which they see as being out of their control.
Precontemplators are often demoralized as well. They don’t want to think, talk, or read about their problem because they feel the situation is hopeless. There is a certain comfort in recognizing that demoralization is a natural feeling that accompanies the precontemplation stage—and in realizing that if you take yourself systematically through the stages of change, you can change. Many professionals tell us one of the wonderful features of our program is that it helps counter the demoralization experienced by both patients and professionals.
At the end of Chapter 4 we shall tackle the paradox of helping people change who don’t intend to change. The answer is in the approach; even precontemplators will progress toward change if they are given the proper tools at the proper times. Chances are good that you are in the precontemplation stage with at least one behavior that may be self-defeating or damaging.
Contemplation
“I want to stop feeling so stuck.” Those simple words are typical of contemplators. In the contemplation stage, people acknowledge that they have a problem and begin to think seriously about solving it. Contemplators struggle to understand their problem, to see its causes, and to wonder about possible solutions. Many contemplators have indefinite plans to take action within the next six months or so.
Contemplators, however, may be far from actually making a commitment to action. They are much like the pedestrian encountered one evening by the psychotherapist Alfred Benjamin. As Benjamin was walking home, a stranger approached and asked directions to a certain street. Benjamin provided them and, after clearly understanding and accepting the instructions, the stranger began to walk in the opposite direction from the one Benjamin had indicated. The therapist yelled after him: “You are headed in the wrong direction.” To which the stranger replied, “Yes, I know. I am not quite ready yet.”
That is often the nature of contemplation: You know your destination, and even how to get there, but you are not quite ready to go yet. Many people remain stuck in the contemplation stage for a very long time. Self-changing smokers whom we studied typically spent two years in contemplation before taking action.
It is not unusual for self-changers to spend years telling themselves that some day they are going to change. Fear of failure can keep them searching for a more complete understanding of their problem, or a more sensational solution. This stalling can be interminable, as it was in the case of a thirty-seven-year-old director of a data analysis department who had been thinking about quitting smoking. Since she worked at an insurance company, she was well aware of the risks heavy smokers like herself faced. But she also knew that smoking cessation programs failed with a majority of smokers. So she kept on reading the latest books and articles on the subject, telling herself she would quit once the perfect program was developed.
People in psychotherapy can get stuck as well. Recently the cover of New York magazine featured a client behind bars yelling, “Help, I’m being held captive in long-term therapy!” Match a therapist who likes to contemplate with a client who likes to contemplate, and therapy can go on forever.
People who eternally substitute thinking for action can be called chronic contemplators. When contemplators begin the transition to the preparation stage, their thinking is clearly marked by two changes. First, they begin to focus on the solution rather than the problem. Then they begin to think more about the future than the past. The end of the contemplation stage is a time of anticipation, activity, anxiety, and excitement.
Preparation
Most people in the preparation stage are planning to take action within the very next month, and are making the final adjustments before they begin to change their behavior. An important step now is to make public your intended change, announcing, for example, “I will stop overeating Monday.” But although those in the preparation stage are committed to action, and may appear to be ready for action, they have not necessarily resolved their ambivalence. They may still need to convince themselves that taking action is what’s best for them.
This last-minute resolution is necessary and appropriate. People in the preparation stage may already have instituted a number of small behavioral changes, such as cutting their cigarette intake or counting calories. Awareness is high, and anticipation is palpable. People who cut short the preparation stage, for example, those who wake up one morning and decide to quit smoking cold turkey, lower their ultimate chances of success. You can make better use of this time by planning carefully, developing a firm, detailed scheme for action, and making sure that you have learned the change processes you need to carry you through to maintenance and termination.
Action
The action stage is the one in which people most overtly modify their behavior and their surroundings. They stop smoking cigarettes, remove all desserts from the house, pour the last beer down the drain, or confront their fears. In short, they make the move for which they have been preparing.
Action is the most obviously busy period, and the one that requires the greatest commitment of time and energy. Changes made during the action stage are more visible to others than those made during other stages, and therefore receive the greatest recognition. The danger in this is that many people, including professional therapists, often erroneously equate action with change, overlooking not only the critical work that prepares people for successful action but the equa
lly important (and often more challenging) efforts to maintain the changes following action. The sometimes devastating result is that encouragement is scarce for those who are in the stages that precede and follow the action stage. Support for changers dwindles when they need it most, during the precontemplation and contemplation stages, and during the crucial stages following action.
Professionals who equate change with action design terrific action-oriented change programs, and are bitterly disappointed when sign-up rates are minuscule, or when a large number of participants drop out of the program after a brief stay. As you will see, successful programs designed to help precontemplators are vastly different from those designed for people in the action stage. Programs must be geared to the different stages they are in, not just to action.
Remember that the action stage is not the only time you can make progress toward overcoming your problem. Although modifying your behavior is the most visible form of change, it is far from the only one; you can also change your level of awareness, your emotions, your self-image, your thinking, and so on. And many of those changes take place in the stages that precede action.
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