Ready for a change?

I wish to posit that any realistic change talk needs to be implemented contextually within the linear framework of the ‘Stages of Change Model’ of health behavior change.  If there is anything of any value that I have gleaned from my forays into nutrition counseling, it is that different clients react differently to elicitations for change within change talk modalities, depending upon where they are personally positioned in their stages of change at any given point in time.

A classic example of this principle was a client of mine a few years back who had just started working at his “dream job”, following a long period of unemployment that had lasted over a year, during which time I was able to help facilitate his transition from a sedentary junk-food lifestyle to an active healthy way of living and eating, in the process of which he had lost about 35 pounds of body fat, acquired greater energy, and was feeling better about himself in general, which may have been a contributing factor in successfully getting back onto his career path.  However, due to the pressures and time constraints imposed on him by his new job, he had slipped back into old ways and was starting to regain the weight that he had lost.  I would postulate that he had, within the expanded context of the Stages of Change model, relapsed from the ‘Action Stage’ back to the ‘Preparation Stage’, thus altering his linear relationship to the Stages of Change model.  But it also occurred to me that, when I first started working with him, I was not yet educated on the psychological counseling strategies of Motivational Interviewing (MI), which I later learned about during my grad school studies.  What I had done with this client was basically akin to well-meaning directing and bullying him into making changes in diet and lifestyle that did not originate from his own internal desire to change, hence any weight loss and improvements in his health were merely a temporary elusive accomplishment at best.

The aforementioned client was a great guy with tons of good intentions, but equipped with little in the way of concrete time-bound commitments to change.  I ran into him recently at a Costco and he told me that he is “genuinely happy now” and that he no longer sees much value in going back to the “Spartan diet and lifestyle” (as he calls it) that he had adopted when I was counseling him, known in Motivational Interviewing as ‘Sustain Talk’, not to be confused with ‘Change Talk’.  He acknowledged to me the value of weight loss and improved health, but he now questions his ability to change and can only seem to think of one good reason to change, i.e. “to get my wife off my back”, as he told me, and he realizes that he needs to change, because he understands that if he loses his health, he will also lose the new job that he loves so much, as well as respect and admiration from his wife.  Nevertheless, he has managed to rationalize his regression into unhealthy habits by stating that “this is just not a good time for me to get back on the program” (more Sustain Talk).

The greatest challenge for me, as a Nutrition Counselor, is to effectively elicit, via empathy and compassion, the three key components of Change Talk implementation: Commitment, i.e. “I will make changes”, Activation, i.e. “I am ready and fully prepared for change”, and Taking Steps, i.e. “I am taking specific actions to change right now”.  We know that we are truly ready for change when we do it because it is what we want, instead of a behavior that a clever counselor manipulated us into doing.  So before you try to talk someone that you care for (including yourself) into adopting a healthier diet and lifestyle, first make sure to accurately pinpoint their current location on the Stages of Change model.  Change is analog, not digital!

Stages-of-Change-graphic

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