Changing for Good

by James O Prochaska

  Now that you know your stage of change, based on the self-assessment above, and you have a basic understanding of the processes of change, you can begin to apply this knowledge, moving gradually from stage to stage. After completing your self-assessment, read through the rest of the book. Please avoid the temptation to skip a chapter or two and proceed immediately to that part of the book you feel is most appropriate for you. We believe that it will be most beneficial to read the book thoroughly, completing the work of every stage before proceeding to the next. You may feel ready for action, but you may not have completed all the preparation you need. Acquaint yourself with the chapters about precontemplation, contemplation, and preparation. They will be helpful to you, and may give you more confidence to move full speed ahead. Furthermore, a complete understanding of the processes will be invaluable as you tackle other problems in your life.

  Part Two

  THE APPLICATIONS

  We would rather be ruined than changed;

  We would rather die in our dread

  Than climb the cross of the moment

  And let our illusions die.

  —W. H. AUDEN

  CHAPTER 4

  Precontemplation—Resisting Change

  WHEN GEORGE FIRST CAME to see me, he was an unhappy, overweight, forty-year-old alcoholic. He began psychotherapy while in a miserable marriage filled with hurt, hatred, and betrayal; he fled after just a few sessions. There were more than a few factors contributing to his misery. His mother had failed to give him love or respect; his passive father had abandoned him emotionally, escaping into a series of extramarital affairs; and his belligerent older brother had mocked George’s inadequacies. George’s wife, Vera, cheated on him, making him feel still more foolish. To top it all off, his boss’s business was collapsing, which left him entirely unsympathetic to George’s problems.

  Yet George had no visible desire to stop drinking, lose weight, mend his marriage, or change in any way. He blamed others for all of his faults and failures, and felt he had no reason to change. Like most precontemplators, he wanted everyone else to change. George wouldn’t have minded turning his angry, egocentric wife into the loving and accepting mother he had never known. But until Vera changed, George preferred to sit in the local bar, commiserating with his drinking buddies. When George started to get anxious, angry, or depressed, his buddies knew exactly how to cheer him up—by bringing him another drink.

  There was certainly no way I could cheer George up. His marriage, career, and life were a mess. So I didn’t pull any punches. I told George and Vera that there was little chance their marriage could be saved; still, if they were willing to try, I would give them all the help I could. I also told George that if he wanted to save himself, he would have to quit drinking. Instead, he quit therapy.

  Experts like to call alcoholism the disease of denial. But this applies to most any problem: When we are mired in the precontemplation stage, it is denial that holds us there. If we are accused of doing something wrong, one of the ways we learn to avoid punishment is to deny responsibility. This is especially true if we take pleasure in our misbehavior. Another step we take is to admit but justify our behavior, creating good reasons for our bad actions. This is one of the reasons we so often defend our right to defeat ourselves.

  What is it that is appealing about the precontemplation stage that so many people struggle to stay in it? For one thing, it feels safe. You can’t fail there. It frees you from the demands of time—you can change some other day, not now. It also frees you of guilt. If you can avoid thinking about bad habits, then how can you begin to feel guilty about them? Precontemplators are free, finally, from social pressures. You need only create a few awkward scenes in order to convince those who care about you that you are not open to talking about your problems.

  I wish I could report that I exerted a magical influence over George, that my strong statements moved him and Vera to transform themselves and their marriage into something better. But this is a book about self-change, not miracles. George entered therapy in the precontemplation stage, and he was still in it when he left.

  I did find out years later that I had helped to raise some questions in his mind. George had expected his perspective to be validated, but discovered instead that he was participating in his problems. He began to recognize that although his early background and his relationship with his wife posed legitimate problems, he was using these as an excuse to avoid facing his own issues. There was a small crack in his defenses, and increased awareness was beginning to slip in. There were other forces and factors assembling to help George move out of the precontemplation stage. When he was able not to fight these forces—as he fought any person who confronted him—he was able to move forward.

  THE ATTITUDES OF PRECONTEMPLATORS

  Precontemplation indicates in many cases an active resistance to change. The irony is that most precontemplators are doomed to remain trapped in the precontemplation stage without help from others. As people become more aware of their problems, they become more receptive to help. At any other stage of change, the issue is not whether help should be offered, but what type of help is best. With precontemplators, the question often arises whether help is even a possibility.

  Some precontemplators are so demoralized that they are resigned to remaining in a situation they consider their “fate.” They may have tried to solve their problems in the past, and failed. They believe that even to think about change is to risk failing again. They have admitted defeat and given up on changing.

  Marie was five feet two, and had seen her weight climb steadily to over two hundred pounds. But she didn’t care anymore: Her marriage was over and her career was going nowhere. Marie felt that she had seen the best of her life already, and now would do what she damned well pleased—even if it destroyed her.

  When people abandon change altogether, they give up on themselves. They accept one of the several self-change myths: “I’ve tried everything,” “I don’t have enough willpower,” “People don’t really change.” They exercise even less restraint than they did before their failure. Their drinking becomes excessive, their weight increases, their bad moods occur more frequently and last longer. By giving up on themselves they give in to their problems, which in turn become more dominant. Like Marie, they feel that life has passed them by.

  I felt that way when I graduated from high school. At the time I was convinced that everything would be downhill from then on, and I became anxious, depressed, and cynical. When I finally overcame my psychological distress, I felt fortunate that I had not given up on life.

  However, I did not learn my lesson well enough. After graduating from college, I chose a graduate school that turned out to be the wrong one for me. My feelings of despair returned. I began drinking too much, eating too much, and sleeping too much. I was training to become a clinical psychologist, and became nervous that my peers and professors would find out about my behavior. So I closed myself off from outside help, which made me even more distressed and demoralized.

  Fortunately, I was able to enroll in a university located near my friends and family. When I finally overcame this second period of distress, I felt foolish for not having learned more from the first episode. Only after three or four times of experiencing life as peaking and passing me by did I finally learn that life only passes you by when you give up on your abilities to change.

  Problem or preference?

  Is a certain behavior pattern a problem or a preference? Can people have problems if they are not aware of them? Who decides what a problem is? Is it ethical to try to help someone change if he or she doesn’t want to change?

  There are those who would have us wait to intervene with precontemplators until their problems become truly intolerable. This school of thought perpetuates the myth that alcoholics, overeaters, or drug addicts will not be ready to change until they bottom out. This approach presents several difficulties, not the least of which is that it is painful to watch others, especially
loved ones, deteriorate until they develop a host of ancillary problems that also need attention.

  Alcoholics may eventually lose their families, friends, jobs, money, and physical and mental health. By the time they hit bottom they may be so demoralized and physically debilitated that they do not care about changing. They don’t know where, much less have the ability, to begin.

  Waiting for precontemplators to hit bottom is not only painful and inefficient, it is risky. We would not consider this approach with purely physical disorders. If someone shows signs of heart disease or cancer, we would not wait to do something until the disease was undeniable. When people exhibit symptoms of an impending heart attack, even if they refuse to see a physician, their loved ones usually force the issue. Research shows that problems are almost always treated more effectively when they are less rather than more severe, and when they are of shorter rather than longer duration. The longer people wait to change, the more difficult change becomes.

  There are, of course, value judgments involved in evaluating psychological problems. Is heavy drinking a problem or a preferred lifestyle? Is smoking a problem or a valid choice? Who decides? And how do you decide whether you are in the precontemplation stage of changing a problem, or whether you have freely chosen behaviors that are your right?

  Answer the following three questions truthfully, and you will begin to see the distinction between problem behaviors and lifestyle choices:

  Do you discuss your behavior pattern? Precontemplators are usually defensive about their problem behaviors. Do you tell people to mind their own business, or do you appreciate their concern? People who are not in the precontemplation stage do not usually become defensive. They see the feedback from others as signs of caring rather than attempts to control them.

  Are you well informed about your behavior? Precontemplators avoid learning about their problems. Do you turn the page or change the channel when you see an article or program about your behavior? Or do you read the article or watch the program with interest? If you drink and you are willing to learn the signs of troubled drinking, or if you smoke and you acknowledge that smoking is harmful to your health, you are well on your way to becoming a contemplator.

  Are you willing to take responsibility for the consequences of your behavior? Precontemplators are uncomfortable with vividly imagining these consequences. Are you aware of the short-and long-term results of your behavior? Can you know how people are likely to feel forty-eight hours after drinking six beers? Have you any idea what impact suppressed anger has on your heart? Can you imagine developing lung cancer and feeling pleased and proud that you smoke? If you have frequent outbursts of anger, are you comfortable knowing your children live in fear of you? Will previous years of drinking seem wise when you have lost much of what you once cared for?

  Precontemplators rarely take responsibility for the negative consequences of their actions. If your chosen behavior eventually kills you, would you consider this outcome natural? We can now say with certainty that most of the leading killers in the United States, including heart disease and many types of cancer, are partly caused by lifestyle factors. If you are dying prematurely from lung cancer or heart disease, will you regret not having changed high-risk behaviors like smoking or alcohol abuse?

  Your responses to these three questions will give you a good sense of whether a particular behavior is a problem or preference. If you can honestly say that you are not defensive but are well-informed, aware of the consequences of and responsible for the long-term effects of your behavior, then perhaps it is a preference. If, however—like most of us—you answered no to one or more of the questions, you are probably in the precontemplation stage.

  Developmental and environmental pressures

  How can defensive, demoralized people become unstuck? There are things we can do to help precontemplators, about which we will go into detail later on. Sometimes, however, movement out of this stage occurs without anybody’s help. This is unintentional change. Some common causes of movement from precontemplation to contemplation are developmental and environmental forces over which we have little or no control.

  The developmental forces that move us from one stage of life to another can also help us to contemplate changing certain aspects of our lives. The advent of the fortieth birthday, with its accompanying increase in the awareness of mortality, is a powerful force for change in our society. Many smokers, for example, begin to contemplate seriously quitting as they approach forty. It is no coincidence that our research shows that the most successful self-changers who set out to quit smoking take action at a mean age of thirty-nine.

  Age milestones are not our only developmental opportunities. Marriage, childbirth, promotions, illnesses, retirement, and other supermeaningful events often provide the needed push to move us from one stage of change into the next. For instance, before he became a father, John Norcross routinely brought home stacks of work for the class he taught and for his clinical practice, despite his awareness that he was a borderline workaholic, and despite repeated pledges to his wife that he would cut back. Only after the birth of his son—a high mark of adulthood—was John able to translate this awareness into action.

  Changes in the external environment can be equally compelling. One of the couples we interviewed in the course of our research asked their soon-to-be twenty-one-year-old son what present he wanted for this special birthday. He said that the most important thing they could do for him would be to quit smoking. The request immediately moved them to contemplate giving up tobacco. Such stories are not uncommon.

  Even without direct requests, people may realize that their environment no longer supports their lifestyle as it once did; suddenly, they are punished rather than rewarded for their habits. People now experience escalating social pressures to lose weight, get in shape, reduce stress, control their drinking, eat healthfully, and quit smoking, and each of these pressures can have an effect.

  Sometimes coercive environmental changes can lead to unintentional change. Bill, a forty-year-old speech pathologist recovering from alcohol abuse, went through a long period of coerced participation in alcohol programs. Bill had been assigned to an alcohol education program in the army after wrecking a car; he took part in a hospital rehabilitation program in order to regain his driver’s license after a DWI conviction; and he “dropped in and out of A.A. meetings” for years.

  After several years and many different programs, Bill finally achieved an increased awareness that helped him to tackle change on his own. “I resisted all attempts to help me,” Bill now says, “but some good stuff must have sunk into my brain.” After being “locked up for drunken behavior, I got the message: Getting drunk got me in trouble.” Bill had once hoped to be a police officer himself, and this time his shame at being incarcerated finally tipped the balance of his awareness.

  Precontemplators can advance more freely into the contemplation stage if they can identify with the developmental or environmental forces that are urging them to change. Take aging. People often have trouble identifying with the aging process, even though it comes from within. Whether we look at aging as a life crisis or an opportunity for growth depends on whether we see it as a natural process or an imposition. Many of us look forward to becoming twenty-one, which our society marks as the beginning of adulthood. Turning forty or fifty can in contrast feel like an imposition, especially since our society idealizes youth.

  Some people can experience the developmental force of aging as liberating. A widow with four children, who had smoked heavily for forty years, told us she finally left the precontemplation stage when she became a grandmother. For her, smoking didn’t jibe with her new identity as a grandmother, or with the increased sense of dignity she felt as a senior citizen.

  Unfortunately, there are countless examples of the self-defeating ways in which precontemplators resist the effects of aging. They may deny new health problems so they needn’t contemplate changing their drinking habits. They turn to cocaine or other
stimulants to regain the energy of youth; they then turn to barbiturates to help them sleep. They indulge in meaningless affairs to deny any slight decrease in their sexual drives.

  We are at our healthiest when we balance our need for control with an openness to external influences, when we satisfy our need for autonomy within a community and our personal lives within a family. Most of this chapter will focus on the realization of that goal, using the first three change processes—consciousness-raising, helping relation ships, and social liberation—that can help move you toward the contemplation stage. First, however, we must examine a major stumbling block for precontemplators: defenses.

  THE DEFENSES OF PRECONTEMPLATORS

  We are all born without defenses; we develop them as we get older. It’s a good thing that we do. Without the protection of these “mental shields” we would be bombarded constantly by undesirable feelings and external threats, both real and imagined. Defensive reactions allow us to avoid, temporarily at least, what we cannot confront, and let us get on with our lives.

  Valuable as they are, we pay a price for these necessary psychic protectors. They alleviate pain but distort and disguise our experiences. Because defenses do not resolve problems, although they may help us feel better in the short run, they can damage us in the long run. And defenses can prevent precontemplators from seeing their problems. Defenses, generally, serve to distract us from the difficult and uncomfortable task of self-analysis.

  The very act of noticing this distraction is the first step in breaking down defenses. Out of the more than twenty-five defenses we have at our disposal, there are seven that precontemplators specialize in, and they come in four main varieties. Let’s look at these individually, so you can see whether any seem especially familiar.