Review of the evening Talk, The Cycle of Change: with Bob Hammett on August 17, 2016

The August evening meeting explored a motivational approach to change. In opening the discussion was about how motivation to change is not fixed, but is an internal process that fluctuates over time, Bob Hammett then went on to introduce ‘the cycle of change’, exploring how motivation is measured by the extent someone may want to change, feels they can change and decides that they will change now.

The cycle of change provided a useful model for describing how degrees of motivation develop into stages of change. The model suggested tasks that typically need to be achieved within each stage, in order to move onto the next stage. The discussion covered the cycle model and how it can be used in everyday work. There were exercises to help service users understand their current stage of motivation to change and to help identify relevant skills to use at each stage.

We were invited to explore a change for ourselves, and thought about how we would describe the stages which led up to our decision to change. At the initial stage of change we may not be aware that there is a problem, the unconscious stage. We might be gradually putting on weight, or driving over the speed limit, or not taking prescribed medication. We either don’t notice it or don’t care. If we think about our behaviour at all, we might be saying “I don’t need to change” and we might feel angry if others are trying to persuade us to change. We have yet to contemplate any change.

In order to move onto the next stage we will become aware that our behaviour is linked to an outcome we don’t want. For instance, we can’t get into usual clothes, we receive a speeding ticket, or we start to feel unwell. This is the stage where we start to be uncomfortable with our behaviour. We may struggle with the thought “Do I want to change or not”?  “Can I change even if I wanted to”? We can see both the advantages and the disadvantages of change. At times we think we might change and might even make a small step to do so, but the next day we return to our previous behaviour. We may feel confused and uncertain. This is the contemplation stage.

We begin to move towards the decision stage when our reasons to change become greater than our reasons to stay the same. We may realise our reasons to change are linked with longer term values. We start to identify how to overcome the barriers and feel confident that we can make a start.

At the decision stage we make a clear decision to change our behaviour. We may feel happy and focussed or we may feel anxious.

To move into the action stage we plan what we’re going to do. We start to change our behaviour. We may still be aware of our previous behaviour and experience a tendency to revert to old ways. Gradually or sometimes suddenly, we like our new behaviours and are clear that we really do want this change. We develop the skills and confidence to maintain our new chosen behaviour and overcome the day-to-day temptations to return to the previous behaviour. This is the maintenance stage.

A slip or lapse is common when changing behaviour, and on average occurs about seven times before the change occurs. We may therefore have a lapse for a period of time. We return to our previous behaviour. In order to rejoin the cycle we treat this as an opportunity to learn from our experience. We return to contemplation, however briefly and remind ourselves of the main reasons we want to change and reassure ourselves that we can change.

Moving back around the cycle we settle once again into the maintenance stage. We keep the change going, and the change behaviour will start to become part of our life.

This model of change, the cycle of change, is taken from Motivational Interviewing. A motivational approach has been found to be particularly effective in the early stages of change when someone is uncertain if they want to change, (the unconscious and contemplatives stages of change). At the decision stage, when someone wants to change, they still need to develop the confidence to feel they can. The integration of the motivational approach with information giving and skills development works well.

Stages of change can be in constant fluctuation Service users may be at a particular stage of change for one behaviour whilst at quite another stage for different behaviour. Even within one session a stage of change may alter.

Bob showed us a rather amusing video of a Motivational Interviewing-based session with a young man who was unemployed, had never had a job, and was failing to attend any interviews arranged through the job centre. Whilst amusing, it showed the dance around the cycle of change that the facilitator had to make.

At the end of the session Bob showed another shorter but equally amusing comedy sketch showing exactly the wrong way to help clients achieve change.

Gloria Hammett