Monday, March 9, 2015

Mental Wellness Matters: Readiness for Change Matters

By Director of Mental Health Services Griselda Williams

As a mental health provider I am trained to remain aware of those we are trying to help and their readiness for change. A professor of psychology named James O. Prochaska, in the 70’s, developed the “Stages of Change Model” to identify the process that humans go through when making changes in their lives. Since the 70’s, the model has been used in counseling, health care, substance abuse treatment, domestic violence intervention and many other settings because it is backed by research, but also it has credibility due to its effectiveness in gauging readiness for change. How many times have we in our personal lives said that we were going to start an exercise program, end an unhealthy relationship, take a class, change careers or maybe even just eat healthier, but it takes some time for us to put into motion the goals we discuss.

The stages that Prochaska identified were:

                      Pre-contemplation---not currently considering change or aware that change would be helpful
                      Contemplation—not considering change within the next month, ambivalent about change
                      Preparation—some experience with change and testing making some change, plans to act within 1 month
                      Action—practicing new behaviors and new thinking, putting plans into action
                      Maintenance—continuing commitment to sustaining new behavior, new change
                      Relapse—resumption of old behaviors

Prochaska states that humans may not pass through each stage easily and may move backward and forward and even relapse as that too is part of the human reaction to the process of change. I think it is interesting that the stage that involves putting change into action is 4th; indicative sometimes just how long it takes us as humans to put new behaviors into motion. John Fisher developed “The Process of Transition” in the 90’s but revised his theory in 2012. He identified that the reason humans have difficulty with change is due to feelings like anxiety, anger, fear, denial, guilt, depression and others.

At Community LINC, we help our program participants work through the challenges associated with change and transition.  Through counseling and coaching meetings, most program participants attribute their greatest barriers to change as fear of the unknown, not knowing what to expect or not knowing what will happen if change is made. Recently, I met with one of our program participants, Ms. Gretta who appeared to be at the stage of relapse.  During her weekly counseling meeting focusing on employment, I learned she was no longer actively seeking employment.  She shared frustrations of securing the interview with employers selecting other candidates over her.    We were able to see that our perception of the situation was having an impact on her sense of self (anxiety and fear).  This small impact had rapidly dropped her self-confidence and negative self-image leaving her not knowing which way to turn – Who am I?  In any behavior change, relapses are common occurrences.  A person’s stage of change is used to decide which strategies are most appropriate to promote or maintain change.  We took the opportunity to reassess a new plan of action and resources to set realistic goals that would match her interest and skills.   This allowed us to go a step further to ensure sustainable success by making contingency plans to cope with difficult situation. 

Applying Prochaska’s stages of change model combined with Fishers process of transition to our residents at Community LINC is vital to understanding their readiness to make change, appreciating barriers to change, and helping them anticipate relapse.  At Community LINC, our programs focus on making sure that each program participant learns valuable skills by working through challenges, celebrating successes, and to gain invaluable skills necessary for maintaining self-sufficiency.  

We hope that when each program participant leaves the program they can each leave by saying, “I still have a long way to go but I’m already so far from where I used to be and proud of the change.” 



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