Changing for Good

by James O Prochaska

  ____ I read about people who have successfully changed.

  ____ I recall information people have personally given me about the benefits of changing my problem.

  ____ = Score

  TABLE 5. TRANSFORMING DEFENSES INTO COPING

  Defense: Denial: refusing to face painful feelings or thoughts; ignoring painful and dangerous feelings

  Coping: Concentration: setting aside painful thoughts or feelings in order to stick to the task at hand; returning to those feelings at a more appropriate moment

  Defense: Rationalization and Intellectualization: “explaining away” problem behaviors; retreating, with words and abstractions, from painful emotions

  Coping: Logical Analysis: thoughtfully and carefully analyzing problem behaviors without becoming overwhelmed by emotion

  Defense: Projection: unrealistically attributing objectionable feelings or thoughts to another person

  Coping: Empathy: seeing a situation through another’s eyes; imagining how others feel

  Defense: Displacement: “taking out” negative feelings on another person

  Coping: Sublimation: releasing negative emotions through alternative, socially acceptable channels. Exercise, chores, sports, art, and music can be forms of creative aggression.

  Defense: Internalization: blaming oneself for all problems

  Coping: Self-determination: motivating positive actions. Attributing painful thoughts and feelings appropriately, to the environment, other people, or oneself—when justified

  Your score is the sum of the four numbers under Frequency. The cutoff scores provided for each self-assessment are general guidelines based on many problems, not specific absolutes for any one problem. These scores, derived from our research with thousands of self-changers, should be regarded as rules of thumb, not strict laws.

  On this self-assessment, precontemplators usually get a score less than 10; people who have successfully passed into the contemplation stage usually score 10 or more. However, self-changers struggling with certain problems—such as weight control—often obtain scores of 12 or more. There is so much information on obesity in our society that even precontemplators have trouble avoiding it.

  This, and the other change-process self-assessments that follow, have direct implications for your progress. When your score is low, we advise that you spend more time with the process in question. The importance of timing cannot be overstated. A haphazard, trial-and-error application of the processes leads to ineffective movement through the change cycle. It is always better to make certain that you have made full use of a process than it is to advance to the next stage inadequately prepared.

  HELPING RELATIONSHIPS DURING PRECONTEMPLATION

  A solid helping relationship is as important to most self-changers as the relationship to a therapist is to those who change in therapy. The helping relationship provides you with a supportive context within which you can process developmental or environmental events, and see yourself as others do. This, in turn, allows you to ease up on your defenses and to contemplate making intentional changes.

  Our defenses rarely fool others, especially those close to us. That is why our spouses, children, parents, friends, and others who know us well are usually aware of our problems long before we are. Our defenses, however, not only serve to keep us in the dark about our problems, they often get in the way of those relationships that could be most helpful in solving them. Intimate relationships can be seen as either a threat or a special source of support, depending on whether or not we welcome help.

  Because the helping relationship is so critical to self-changers, we will review helping skills as we discuss every stage of change, for the benefit of people who care for and are close to self-changers. Here, however, we examine the role of the helping relationship in breaking down defenses and helping you move toward contemplation.

  Examples of the potent influence of helping relationships abound. You undoubtedly have had several accepting people who valued you enough to help you through troubled times—a soothing parent, a best friend, a special teacher, a trusted confidante, a loving mate. Sometimes the simple, nonjudgmental presence of an intimate friend or mate is enough. The dramatic rise of self-help support groups also attests to the efficacy of helping relationships.

  Mike, a media personality, was anxious about a big Memorial Day party he and his wife were planning. Mike feared that his alcoholic brother, Tom, would spoil the party and embarrass the family. But he didn’t dare say anything to Tom—his brother didn’t admit to his drinking problem. This continued a family pattern: Mike’s father died from alcoholism, but no one ever said anything to him about his problem. Tom was defended not only by his own denial but also by an unwritten family law.

  Mike wanted to break this defensive law and help his brother, his family, and himself, but he doubted that he would be able to do so. All he could think of to say to Tom was that he needed to quit drinking. This is one of the common mistakes people make in trying to help precontemplators—they rush them toward action. Tom was in no way ready for action. His likely response would have been, “Quit trying to control me, big brother!”

  I advised Mike to try to inspire Tom to begin thinking about his drinking as a potential problem rather than pushing him immediately to do something about it. We agreed that approaches like “Tom, let’s talk about your drinking. I’m concerned that it is becoming a problem,” or “Tom, what could I do to help you with your drinking?” would be appropriate. But Mike was still afraid to say anything. In his family, as in so many others, intervening is seen as interfering. Precontemplators defend their right to damage, defeat, or destroy themselves. How then can we help precontemplators? How can we be our brother’s helpers without becoming their keepers?

  First, we must recognize that precontemplators are powerless to change without assistance. We can help by lending our eyes, ears, and hearts. We must see for those who are partially blinded by their defenses, hear for those who are too embarrassed to speak, care for those who are too demoralized to care. Gently, we must encourage the precontemplators we love to move into the contemplation stage so that they can open themselves up to change.

  Helping another person may seem a herculean task, requiring enormous effort, patience, and strength. Patience, however, can be acquired, and strength in this context is really the knowledge of what works and what doesn’t. A helper’s first task is to enable the precontemplator to consider his or her problem behavior. There are a number of mistakes helpers make in trying to aid the change process. Here is an overview of what not to do when trying to help another person:

  Don’t push someone into action Remember, change does not equal action. The most common error is to push someone to take action too soon. A precontemplator is not ready to take action, but may be ready to consider changing. Encourage this inclination.

  TABLE 6. DIFFERENCES BETWEEN ENABLERS AND HELPERS

  Enablers: Avoid discussions and confrontations.

  Helpers: Address specific disruptive and distressing behaviors.

  Enablers: Soften consequences by minimizing the import of events.

  Helpers: Ensure that each negative behavior is followed by a consistent consequence.

  Enablers: Make excuses, cover for, and even defend problem behaviors.

  Helpers: Insist that precontemplators accept responsibility for actions.

  Enablers: Indirectly or rarely recommend behavior change.

  Helpers: Directly and frequently recommend behavior change.

  Don’t nag Repetitive, insistent comments usually backfire. Worse yet, they weaken the helper’s special relationship with the changer. “It got to the point where I wanted to divorce my wife rather than lose weight,” one self-changer told me.

  Don’t give up A precontemplator may mistake a helper’s apathy as a sign that a problem behavior is really not serious after all. To a precontemplator apathy looks like approval of the behavior.

  Don’t enable Enabling begins naturally eno
ugh, when the helper cares about the precontemplator and wants to understand his or her concerns. However, the enabler is actually colluding in the precontemplator’s denial and minimization. Denial is strengthened rather than diminished by well-meaning attempts to soften the damage. Enabling continues when the helper fears that any challenge to the precontemplator’s problem behavior will risk a break in the relationship. If the problem is ever to be resolved, however, it will be because the helper dares to intervene.

  Using helping relationships

  As a precontemplator, you can take advantage of people who care about you by letting them help you. Acknowledge that loved ones can see you as you cannot, and allow them to assist you to enter the cycle of change.

  Ask others to identify your defenses Ask someone you trust to describe, clearly and directly, how you defend yourself and what it is you defend. This is not easy to do, since normally people do not want to confront others’ defenses; in fact, they are supposed to “go along” with your defenses. This is where therapists traditionally are helpful. They tell you what your best friends won’t.

  Convince your helper that you are serious, and be prepared for impressive results. If your helper knows you well, this will not be as difficult a task as you might imagine. He or she knows what your problems are, and whether you tend to deny them, rationalize them, or blame them on others or yourself. Encourage your helper to let you know when he or she senses that you are becoming defensive.

  This open discussion is a major step in not allowing those defenses to defeat you. And it serves another critical purpose—you will have enlisted a helper in your struggle.

  Become aware of your defenses As you realize that your defenses do not fool others, you will become less invested in fooling yourself. After all, if your friends are already on to your act, what do you have to hide? It may be embarrassing to discover that you are the last to know about your problems, but is it not a relief to realize that your friends and family have decided not to reject you? And, as you become less defensive and more open about your frailties, they will probably come to care even more about you. Remember, it is hard to live with a saint—especially a self-righteous, defensive saint.

  Begin to guard against your defenses. Let your helper know when and why you are feeling defensive. You might say, for example, “I notice I’m becoming uncomfortable about talking about smoking because I don’t want to admit to myself that it is a problem.” Or “I realize I changed the topic because I get self-conscious when the subject of obesity comes up.” These simple statements identify defenses and help defeat them.

  At first you will be aware that you are becoming defensive; but try to acknowledge your defenses as soon as possible. You will quickly begin to notice them, and will reach the point where you can say, “I’m starting to get defensive and I really don’t want to.” This means you have attained some control over your defenses, and they will stop controlling you. Don’t expect, however, that you will be able to shut them down entirely; they are powerful forces that will continue to win out at least some of the time. Keep working on developing openness and awareness, and your chances of successful change will increase.

  Help others to help you Most people assume that the best way to help is to push you to take action. Taking action before you are ready for it is usually a mistake. When helpers try to rush you into doing something, they are actually diminishing the effectiveness of their help, since you will become resistant to the pressure.

  Tell your helpers that you are trying to be more open and less defensive, but that you are not ready for action. You need to talk, get feedback, and feel cared for; criticisms or personal attacks will only serve to increase your defensiveness.

  Helping relationships self-assessment

  This self-assessment will allow you to measure your progress in using helping relationships. Be honest and realistic. Fill in the number that most closely reflects how frequently you have used the method in the past week to combat your problem.

  1 = Never, 2 = Seldom, 3 = Occasionally, 4 = Often, 5 = Repeatedly

  FREQUENCY:

  ____ I have someone who listens when I need to talk about my problem.

  ____ I can be open with at least one person about experiences related to my problem.

  ____ I have someone on whom I can count when I’m having problems.

  ____ I have someone who understands my problems.

  ____ = Score

  The level of helping relationships should be high and sustained throughout the cycle of change. People in the precontemplation stage who are ready to move forward into contemplation generally achieve scores of 12 or higher. If your score is lower, review the techniques we have mentioned, and try to put them into practice within the boundaries of your relationships. Don’t be unwilling or afraid to enlist the support of those who love you. Continued progress through the stages of change will depend on the sustained support from your helpers, so it is important that you establish good working habits with them now.

  SOCIAL LIBERATION

  The process of social liberation involves creating more alternatives and choices for individuals, providing more information about problem behaviors, and offering public support for people who want to change. No-smoking sections in airplanes, restaurants, and workplaces are well-known examples of change that are designed to free people from smoke or from the temptation to smoke. Community-sponsored post-prom parties provide a healthy alternative for high school students who do not want to drink or use drugs. Even the simple act of naming a “designated driver” is a form of social liberation.

  Self-help groups are the most familiar social liberation activity in the United States. There are more than a million such groups, with 15,000,000 members, ranging from Alcoholics Anonymous, Overeaters Anonymous, and Neurotics Anonymous, to self-help groups for people with phobias and panic attacks and those for relatives of those with schizophrenia, to relatively new groups for AIDS sufferers. In addition to consciousness-raising inherent in such groups—in which the latest information about problems and their treatment are always an important focus—these groups provide a social environment in which people can maintain their dignity and feel they will not be stigmatized or ostracized.

  Self-help groups send out a powerful message to isolated precontemplators who are embarrassed or ashamed to admit that they have personal problems. The very existence of these groups says, “You are not the only person in the world with this problem; we can help you to accept yourself as a person with a problem and to do the best that you can to change it.”

  That precontemplators experience the forces working for social liberation is inarguable. But just how do they experience these forces? This process can be extremely helpful to the ones who experience it positively; others see social liberation as just another coercive force. How precontemplators respond to social liberation can determine whether they will progress to the contemplation stage or remain stuck defending their troubled behavior.

  There are huge struggles occurring in our society, between social forces seeking to liberate people from their problems and commercial forces that profit from them. The United States government spends $50 million a year, for example, trying to help people stop smoking. The tobacco industry spends ten times that amount to win new smokers and retain old ones.

  Both sides in this battle target precontemplators. Publichealth campaigns develop effective methods for getting their messages through the defenses of precontemplators. Witness, for example, the emotional depictions of car crashes involving young people who drink and drive, that seek to hammer home information about one of the dangers of drinking to an audience that is well defended against such information.

  Meanwhile, advertising campaigns counter with messages designed to shore up defenses. The old slogan “I would rather fight than switch” is a blatant example, but others come along every year. Establishing no-smoking sections, alcohol-free parties, and self-help groups might not seem to be coercive approaches to change.
Nonetheless, they are seen as threats not only by precontemplators, but by the commercial forces that profit by peddling the tools of self-destructive behavior.

  The tobacco industry periodically funds advertising that portrays antismoking campaigns as antifreedom forces. In these ads, they claim that there are three types of people: smokers, nonsmokers, and antismokers. The first two groups, they say, are basically the same: freedom lovers who respect the right to smoke or not smoke. Conversely, antismokers, who want to limit people’s rights to smoke, are depicted as being antidemocratic. Therefore, the message goes, antismoking activities should be resisted not only by precontemplators who want to smoke, but by freedom-loving people everywhere, even those who do not smoke or would like to quit smoking. This campaign is undoubtedly effective, especially with resistant precontemplators.

  Appendix A outlines the differences between foolish freedom and responsible freedom. If you have difficulty distinguishing between the two, please review Appendix A before proceeding further in the cycle of change.

  Using social liberation to help you change

  How can social liberation work to your advantage? Here’s an obvious example: It’s great to be in a public no-smoking area when you have been thinking about quitting anyway.