Understanding Stages of Change in the Recovery Process
By Sarah R. Brotsky, Psy.D.
Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals, but the love and support of family and friends. It is not uncommon for someone who suffers with anorexia or bulimia to sometimes feel uncertain about her* progress, or for her loved-ones to feel disengaged from the treatment process. These potential roadblocks may, unfortunately, lead to feelings of ambivalence, limited progress, and treatment drop out. Therefore, knowing about the Stages of Change Model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.
What are the Stages of Change?
There are five Stages of Change that occur in the recovery process: Pre-contemplation, Contemplation, Preparation, Action, and Maintenance.
The Pre-contemplation Stage is evident when a person does not believe she has a problem. Those who are close to her are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape, and appearance even before the individual admits to it. She may refuse to discuss the topic and deny she needs help. At this stage, it is necessary to gently educate the individual about the devastating effects the disorder will have on her health and life, and the positive aspects of change.
The Contemplation Stage occurs when the individual is willing to admit that she has a problem and is now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the individual in discovering the function of her eating disorder so she can understand why it is in her life and how it no longer serves her. This, in turn, helps the individual in moving closer toward the next stage of change.
The person transitions into the Preparation Stage when she is ready to change, but is uncertain about how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to her personal needs. Potential barriers to change are identified. A plan of action is developed by the treatment team, (i.e. psychotherapist, nutritionist, and physician) as well as the individual and designated family members. Generally, a list of people to call during times of crisis is created at this juncture.
The Action Stage begins when the person is ready to implement her strategy and confront the eating disorder behavior head on. At this point, she is open to trying new ideas and behaviors and willing to face fears in order for the change to occur. Trusting the treatment team and her support network is essential to making the Action Stage successful.
The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, she is actively practicing her new behaviors and new ways of thinking as well as consistently using both healthy self-care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live her life in a meaningful way.
What do the Stages of Change look like?
The Stages of Change in the process of recovery from anorexia or bulimia are best viewed as a cycle rather than a linear progression. The person may go through this cycle more than one time or may need to revisit a particular stage before moving on to the next. She may also go through the stages for each individual eating disorder symptom. In other words, if she is recovering from anorexia, she could be in the Action Stage for restrictive eating (e.g., eating three meals a day along with snacks, engaging in social eating, and utilizing support system) while, at the same time, she could be going through the Contemplation Stage for body image and weight concerns (e.g., becoming aware of how body image is tied to self-esteem and self-worth, defining oneself as a body or number, and identifying the negatives of striving for the “perfect body”). This is precisely why recovery from an eating disorder is complex, individualized, and challenging.
The table on this page breaks down the Stages of Change for the average person who is recovering from bulimia.
Parents and friends…know your role in the Stages of Change
As a parent or friend of someone struggling with an eating disorder, you no doubt suffer right along with her. It is crucial for you to pay attention to your own needs as well as be present for your child or friend during her recovery process. Here is what you can do at each stage:
• Do not be in denial of your child or friend”s eating disorder.
• Be aware of the signs and symptoms.
• Avoid rationalizing her eating disordered behaviors.
• Openly share your thoughts and concerns with your child.
If your child is under the age of 18, insist that she receive professional help from a qualified eating disorder specialist.
• Educate yourself about the disorder.
• Be a good listener.
• Do not try to “fix” the problem yourself.
• Seek your own encouragement from a local eating disorder support group for family and friends.
• Identify what your role is in the recovery process.
• Explore your own thoughts and beliefs about food, weight, shape, and appearance.
• Ask your child/loved one and the treatment team how you can be best involved in the recovery process and what you can do to be most supportive.
• Follow the treatment team”s recommendations.
• Remove triggers from your environment: no diet foods, no scales, no stress.
• Be warm and caring, yet appropriate and determined with boundaries, rules, and guidelines.
• Reinforce positive changes without focusing on weight, shape, or appearance.
• Applaud your child”s efforts and successes.
• Continue to adjust to new developments.
• Redefine the boundaries at home as necessary.
• Maintain positive communications.
• Be aware of possible recovery backsliding.
A possible Sixth Stage: The Termination Stage & Relapse Prevention
So, how do you, the person with anorexia or bulimia, know when it is time to discontinue treatment? With the understanding that this decision is best made in consultation with your treatment team, ask yourself the following questions:
• Have I mastered the Stages of Change in the major areas of my eating disorder?
• Do I have the coping skills necessary to maintain these changes?
• Do I have a relapse prevention plan in place?
• Am I willing to resume treatment in the future if necessary?
To prevent relapsing do not forget to ask for help, communicate your thoughts and feelings, address and resolve problems as they arise, live a healthful and balanced life, and remember that you would not have made it this far if it were not for your strong determination and dedication toward recovery.
* The pronoun “her” is being used in place of “her/his” for the purpose of simplification
About the Author
Dr. Sarah R. Brotsky is a clinical psychologist specializing in the treatment of eating disorders at Dennis & Moye & Associates, Bloomfield Hills, MI.
Reprinted with permission from Eating Disorders Recovery Today
FALL 2009 Volume 7, Number 4
©2009 Gürze Books