Contemplating Recovery: the stages of change

We know that people who reach out for eating disorder treatment have often thought about the decision a lot. In fact, a whole lot of recovery work takes place before even entering treatment as it takes a lot of courage to admit that there’s a problem and then to take steps towards reaching out.

A way to understand this contemplative process is through the Stages of Change (or Transtheoretical Model of Change) developed by James Prochaska and Carlo Di Clemente. This cycle, depicted further below and to the right, demonstrates the phases people go through when in the process of making change, and where they may be – psychologically – and the impact this may have on taking steps forward.

Stage 1: Pre-contemplation (not ready)

At this stage, people often don’t intend to make any changes and may not be aware of the need to change. Other people around them may have noticed something isn’t quite right, but the person with the eating disorder may not be willing to disclose their behaviour and might be demonstrating a lot of resistance and/or denial.

Often people enter into eating disorder treatment whilst in this pre-contemplative stage. They may be reluctant to engage in therapy and have little to no desire of letting go unhealthy behaviours. At this point, the pros in favour of behaviour change are often outweighed by the relative cons for change and in favour of maintaining the existing behaviour.

For the carer, this can be a really frustrating and painful experience. They may feel very distant from their loved one and feel powerless in helping them. At this point, it’s important to stay calm and to show compassion and understanding. It can be helpful to remind them of the pros of making changes to broaden their awareness and to provide context to their situation. Keep in mind that recovery is possible.

Stage 2: Contemplation (getting ready)

People at this stage have recognised that they have a problem and may well have shared this with their loved ones. They intend to make changes to their behaviour – just not quite yet.

Here, there is more recognition of the reality of their eating disorder and the negative impact it is having on their day-to-day lives. They may be more aware of what life could be like without their eating disorder and the benefits of recovering. At this point, the pros and cons are pretty balanced, but there is still a lot of fear associated with making change, and they may have a recognition of how the eating disorders ‘helps’ them to feel safe and in control. The concept of change may threaten this feeling of safety and control.

For the carer or loved one, it’s important to remain calm, compassionate and patient as the individual navigates this stage. Take comfort in the fact that they are intending to get better. Perhaps you can encourage them to share their thoughts and fears with you and let them know that you hear them and that you understand their struggle. Hold onto hope that recovery is possible for them and keep reminding them of the pros associated with recovery. Ensure that they feel in control of this decision by taking it step by step, at their pace.

Stage 3:  Preparation (ready)

At this stage, the individual is ready to take steps towards changing. They may be preparing and looking into options, engaging in treatment or the assessment process already, or, they may be unsure of how to take next steps and looking for guidance.

Whilst this is a really positive place to be in, it is still daunting and the individual may need a lot of support, reassurance and encouragement as they navigate the process and settle into treatment. The carer may wish to arm themselves with as much information as possible for their options for treatment, and help them to organise and attend assessments or appointments.

Step 4: Action (current action)

People at this stage have made progress in treatment and are continually making positive changes as they move through their recovery journey. They are working hard to untangle the hold of the eating disorder and discovering what life can be like when they let go of rules, routines and ritualistic behaviours. They may be trying new things, engaging in self-care activities and actively challenging the ‘voice’ of the eating disorder.

Carers are encouraged to continue being supportive and encouraging during this phase. Make an active effort to recognise the progress they’ve made and the incremental changes that have added up to big steps. There may be times where the individual is conflicted in their thought process and they may be tempted to return to old, eating disordered behaviours. Support them through these chapters with compassion and understanding, and let them know you believe in them to keep going.

Lapses, setbacks and opportunities for learning

Recovery is not recovery without challenge, and there will most likely be ups and downs in the process – called relapses (or lapses). These can be really painful for the individual and their loved one and they may perceive all their hard work being lost. This is not the case.

Rather, these moments are opportunities for learning. Every time that we are challenged in recovery we are growing and learning more about life, ourselves, and how we respond to life challenges. These are opportunities to build resilience and to identify triggers – knowing these can help us avoid (or prepare for) triggers in the future.

Hold onto hope that this is part of the process. Carers should remain strong and be a voice of reassurance for the individual, reminding them that everyone goes through challenges and this is merely part of the process. Remind them that they’re working incredibly hard and that you can see how much progress they’ve made – this isn’t lost.

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