How to Change Your Life Using the Stages of Change Model, with Cummins Therapist David Bonney

“To improve is to change; to be perfect is to change often.” — Winston Churchill

At some point in their lives, most people will feel the need to make a change. Maybe they’d like to remove something that’s causing them distress, or perhaps they’d like to add a new behavior that will improve the quality of their life. For example, we’ve previously discussed the benefits that practicing mindfulness, getting enough sleep, eating a balanced diet and exercising regularly can have for a person’s physical and mental health.

However, change can be tricky. Common knowledge suggests that the main obstacle to change is knowing what needs to be done, but this actually isn’t the case. Research shows that the first step in any change is developing an intention to change and believing we have the ability to make that change. Without this internal conviction, any changes to our lives that we might like to make—or think we ought to make—are unlikely to succeed. Once intention is achieved, the change must then be planned out, executed, and maintained into the future.

In fact, the way that successful change happens is very similar regardless of the individual person and the exact thing being changed. Psychologists have found that people move through predictable patterns of thought and behavior as they prepare for and complete a change. This knowledge can be invaluable when we intend to make a change in our life, as it can help us track where we are in the process of change and how to move closer to our goal.

To better explain how someone can make positive changes in their life, we spoke with David Bonney, a therapist and IOT Group Leader at our Marion County office. In this post, David walks us through one of the most popular psychological theories for how people change: the Stages of Change model.

Dividing Change into Its Five Main Parts

David Bonney, MA, LCAC, MAC, CADAC IV, ICOGS
David Bonney (MA, LCAC, MAC, CADAC IV, ICOGS), Intensive Outpatient Treatment Group Leader at Cummins Behavioral Health

As part of their daily work, mental health professionals often assist people in changing their behaviors. This is especially true for therapists like David who specialize in substance use disorder. When coaching a client through a big lifestyle change, it’s helpful to know what they’re experiencing at present and how their intentions might shift. The Stages of Change model is a common tool therapists use to map a client’s journey.

“In the area of substance use counseling, the Stages of Change model is one of the predominant models, if not the most predominant model, counselors tend to use across all agencies,” David says. “It’s something that I support as well. I see a lot of validity to it, and it can apply to almost any consumer that we work with.”

The Stages of Change model divides behavior change into five discrete parts that a person progresses through in order. Although the goal of any change is continuous forward progression, a person may regress to a previous stage of the model if they have a relapse in behavior. The stages are as follows:

  1. Pre-contemplation: At this stage, the person has not yet considered changing their behavior. They have either not thought of a change they’d like to make in their life, or they don’t believe that an existing behavior poses a problem. According to David, “In some cases, pre-contemplation is denial. The person’s opinion is, ‘I don’t have a problem, so therefore there’s nothing to work on.’ “
  2. Contemplation: A person at this stage has noticed an opportunity or problem in their life and has started to think about making a change. “With substance use disorder, contemplation is, ‘Yes, maybe there is a problem here. I’m not ready to do anything about it, but I recognize that there’s a problem with my substance use in some way or another,’ “ David says. “They might even go so far as, ‘Maybe I need to stop doing this because it’s a problem.’ “
  3. Preparation: The person has now committed to making a change and is considering how to go about doing so. They may be seeking advice from other people or planning out a course of action. David says, “Preparation is, ‘What am I going to do about this?’ Maybe the person is talking to others or seeking out treatment. It’s the idea that there is a motivation to do something different, no matter what the motivation is.”
  4. Action: As the name implies, a person at this stage is taking measures to make a change. This is typically done by cutting back on harmful behaviors or adopting beneficial ones. “In the case of mental health, the person might be in therapy and actively trying to practice new coping skills and avoid triggers, at whatever level of success. The person is actually making those efforts,” David says.
  5. Maintenance: At the final stage, the person continues to practice their target behaviors and avoids relapsing into old behaviors. This stage is ongoing and does not have a definitive end. “Someone in maintenance is in compliance with whatever they’re supposed to be doing. The idea is to continue doing the things that have gotten them to this point and adapt to their new routines,” David says.

Taking the First Step Toward Change

Stages of Change model
An illustration of the Stages of Change model

Every stage in the Stages of Change model is an integral part of the behavior change process. However, the transition from pre-contemplation to contemplation deserves further discussion. Intention to change is the linchpin that holds the process together, and developing that intention is not always easy. This is especially true when the change is something that we ought to do but not necessarily something that we want to do.

This is a situation that David encounters frequently in substance use counseling. “We have some consumers who have been referred to Intensive Outpatient Therapy (IOT) who say, for whatever reason, ‘I’m not ready yet,’ or ‘I don’t want to go.’ What we might do at that point is meet with them individually to explore their reservations,” he says.

This type of counseling relies on a technique called motivational interviewing. During this process, the therapist or counselor guides the client toward behavior change by exploring their desires and intentions. Rather than telling the client what they should do, the therapist accepts where they are in the change process and helps them clarify any ambivalent feelings they may have. This format prevents therapy from devolving into a power struggle and empowers the client to take responsibility for their own actions.

As David explains, motivational interviewing can help a person decide to make a change by their own choice, on their own terms, and at a speed they’re comfortable with:

“Motivational interviewing is about meeting people where they are with the ultimate goal of building engagement. Sometimes in the pre-contemplation stage, consumers attempt to go in a circle. I try to step outside the circle right away by accepting the consumer for where they are and accepting their line of thinking, whether it’s misguided or not. Then I try to challenge any beliefs they may have that are contrary to what they’re saying. For example, if they say, ‘I want to get off probation,’ I’ll ask how they are going to get off probation. If they then say, ‘Well, I have to quit using,’ I’ll ask what it’s going to take for them to quit using. Then they might say, ‘I’m not going to quit using because there’s nothing wrong with what I’m doing, but I want to get off probation.’ In that case, I’ll try to point out the conflict in their thinking, but I’ll allow them to draw that conclusion rather than give them the answer. So, what we’re trying to do is break down defenses and avoid any power struggles, and by doing that, we’re trying to empower the consumer versus take their power away.”

When the time comes to make a change in our life, the Stages of Change model can be a useful tool both inside and outside of therapy. We recommend using it to track progress toward your goal and anticipate what will come next on your journey.

If you’d like professional assistance when working toward behavior change, you should know that our therapists and counselors here at Cummins BHS would be happy to help! Simply call us at (888) 714–1927 to discuss your counseling options and schedule an appointment.

If you’d like more advice related to changing your behaviors and improving your life, we recommend reading our New Year’s post about setting better goals!

new_year's_goals
How to Set New Year’s Goals You Can Actually Accomplish, According to Behavioral Health Professionals

Identifying Toxic Relationships: Dr. Armen Sarkissian Explains How to Escape the “Drama Triangle” Trap

Relationships with other people are a large part of what makes life worth living. This includes everything from parents and children to relatives, siblings, friends, acquaintances, co-workers, spouses and romantic partners. Healthy relationships enrich our lives and encourage us to develop as individuals. However, unhealthy relationships do just the opposite, making us dread or despise the other person and stifling our ability to grow.

Unhealthy relationships may also be called “toxic relationships,” a term coined by self-help author Dr. Lillian Glass in her book, Toxic People. According to Glass, toxic relationships are marked by conflict, competition, disrespect, and a lack of support and cohesiveness between the two people in the relationship. These malicious intentions can manifest in different ways depending on the nature of the relationship. For example, domestic violence is common in toxic relationships between intimate partners and family members, but less so between friends and acquaintances.

It’s not too hard to understand the difference between a healthy relationship and an unhealthy one—the difficulty is in understanding why unhealthy relationships develop in the first place. We often assume that bad relationships form because one or both of the participants are “bad people,” but this perspective is flawed and overly simplistic. In reality, many unhealthy relationships exist because the people in them are following unhealthy behavior patterns without realizing it.

In celebration of Valentine’s Day, we hope to shed light on some of the harmful patterns of behavior, or “roles,” that people sometimes adopt in interpersonal relationships. We spoke with Dr. Armen Sarkissian, Senior Psychologist at Cummins Behavioral Health, to learn more about one common pattern of dysfunction in relationships: the Drama Triangle.

The Unending Drama Between Rescuer, Persecutor and Victim

Dr. Armen Sarkissian, EdD, HSPP
Armen Sarkissian (EdD, HSPP), Senior Psychologist at Cummins BHS

In essence, the Drama Triangle (which is also called the Rescue Triangle or Karpman’s Triangle) is a set of three interrelated roles that people may play in a relationship: rescuer, persecutor and victim. Under this pattern of behavior, one person acts as the victim while the other acts as either a rescuer or a persecutor. When the victim is confronted with an obstacle in their life, they feel powerless to overcome it and believe they need someone else to do it for them. A rescuer or persecutor believes that the victim is powerless, and they either try to help them or condemn them for it.

This dynamic is harmful because it creates conflict between the people in the relationship and prevents either of them from solving the problem at hand. “The feelings that go with the triangle don’t let you use your potential because you’re stuck in one of the three roles,” Dr. Sarkissian says. “Basically, it is not a healthy way to behave in the world and relate to others.”

This pattern of relating is sometimes learned from childhood experiences. In particular, early research on the Drama Triangle found that it frequently plays out in families when one parent has a substance use disorder. “We’re talking about the early ’80s, when the drug of choice for most people was alcohol,” Dr. Sarkissian explains. “That pattern fit with most families of alcoholics. There was an alcoholic father, a rescuer mother, and the children. The wife would try to cover up for the husband’s drinking, and the children were the victims because they had no power.”

However, anyone can fall prey to the Drama Triangle regardless of their childhood and past experiences. Whenever someone believes that they or another person don’t have the power to help themselves, they are susceptible to falling into the Drama Triangle. Once in the triangle, they will alternate between the three different roles, and they’ll have a hard time getting back out of it. Dr. Sarkissian explains,

“We all, to a certain degree, do this without being aware of it. And once we’re in the triangle, we play all three roles. When relating to colleagues, especially, we can start to feel victimized, and then persecute the other person, and then feel bad and go into rescue mode. The interesting thing is that once you get used to this pattern, then you constantly get into it with others. People tend to identify with one role more often than the others, so once you’ve identified as a victim, for example, you’ll constantly find people who are either persecutors or rescuers—either ‘knights in shining armor’ or perpetrators.”

How to Break Out of the Drama Triangle

The Drama Triangle
Image from Claude Steiner’s "Scripts People Live." 1971. Grove Press, New York.

As mentioned above, the underlying theme of the Drama Triangle is a belief, conscious or unconscious, that people are essentially unable to help themselves. This is what leads a person to adopt one of the three roles and keeps them stuck in these roles. If they wish to break out of the Drama Triangle and begin having healthy relationships, they must learn to respect their own agency and the agency of other people.

“The idea is that I respect you enough to believe that you are able to take care of yourself,” Dr. Sarkissian explains. “I think one of the key points is that if I say ‘I can rescue you,’ in some way I’m saying, ‘I’m better than you. You don’t know how to do this. Let me show you.’ “ In the same way, someone in the persecutor role looks down on the victim, and the victim perceives themselves as inferior to their peers.

Of course, the person in the victim role is often in legitimate need of help with some situation or problem. If you choose to provide assistance, it’s important to hold the other person accountable for their own success or failure. Dr. Sarkissian suggests, “If you’re going to help somebody, respect them enough to believe that they can take care of themselves but just need help right now. Make an agreement about what you’re going to do and what the other person is going to do. If you jump in there and do it for them, you haven’t helped them at all. What you’ve done is emphasized and proved to them that they are not able to take care of themselves.”

There’s one final hitch that can keep people stuck in the Drama Triangle, and that’s the fact that it can be difficult to even realize when we’re in it. In many cases, a person becomes so familiar with the behavioral patterns of the Drama Triangle that they no longer appear abnormal. According to Dr. Sarkissian, the best way to detect these patterns is to pay close attention to the emotions you feel toward other people:

“If you want to work on your relationships, then you have to pay attention to your internal feelings when you’re relating to people. If you go through the three feelings of the triangle with one person—if you feel guilty and want to rescue them, and then you get angry because they’re not doing what you’re asking them to do, and then you feel like you’re powerless to do anything with that person—then you’re probably in a Drama Triangle with that person. If you feel these three emotions, then you’re probably going through the three roles.”

As we go through our lives meeting new people and forming new relationships, we always run the risk that one of them may become toxic. On this Valentine’s Day, we encourage you to examine all of your relationships for unhealthy behaviors such as those found in the Drama Triangle. If you discover that you are in a toxic relationship with someone, keep in mind that counseling or therapy with a mental health professional could help.

Happy Valentine’s Day to you and your loved ones from Cummins BHS!

How Stigma of Mental Illness Affects African American Communities

“People of color, particularly African Americans, feel the stigma more keenly. In a race-conscious society, some don’t want to be perceived as having yet another deficit.” — Bebe Moore Campbell, author and journalist

When it comes to delivering appropriate mental health care to people who need it, stigma is the enemy for everyone involved. Feelings of shame about having a mental health disorder can prevent a person from seeking help, which unnecessarily delays their recovery and could lead to their condition worsening. And although people of every race and ethnicity experience stigma, it can be especially formidable for those in the African American community.

For example, even though rates of mental illness are similar for all races, only 31% of African American adults with mental illness receive treatment for their condition, compared to the U.S. average of 43%. Qualitative research has found that some African American mental health consumers reported delaying their treatment due to concerns about stigma. And most worryingly, the rate of suicide death among African American youth is increasing faster than for any other racial or ethnic group, suggesting that stigma and other barriers are preventing them from receiving the mental health care they need.

Although mental health stigma affects everyone, these statistics show that it’s especially challenging for the African American community. In observance and celebration of Black History Month, we here at Cummins Behavioral Health wanted to bring awareness to the unique difficulties that African American people face when seeking treatment for mental health issues. After all, it’s only by calling attention to problems in behavioral health care that we can begin to do our part to fix them.

To get a better understanding of the issue of stigma in the African American community, we spoke with Michelle Freeman, our Director of Operations for Marion and Hendricks Counties. She explained some of the roots of stigma among African Americans as well as what mental health organizations can do to address the needs of the community.

Trust and Distrust: A Key Facet of Stigma

Michelle Freeman, LMFT

There are several common explanations for why African American people tend to experience stigma differently, and in some cases more strongly, than people of other races and ethnicities. Many of these explanations involve trust, either of individuals or of entire institutions.

The African American community has endured many unique hardships throughout its history, from slavery to the civil rights movement and socioeconomic inequalities that continue to this day. Over the centuries, the community has developed a strong sense of resilience and self-sufficiency that has allowed it to endure the many struggles it has faced. The flip side of this resiliency is that acknowledging a mental illness can sometimes be perceived as an admission of weakness.

“I think part of the issue with stigma is around this long-standing idea in the African American community of who can be trusted with deep, personal issues that may be impacting a family, whether it’s ongoing trauma or medical or mental health issues,” Michelle says. If a person doesn’t trust that their community will support their decision to seek therapy or counseling, then they might refrain from doing so or feel ashamed that they need help.

On the other hand, centuries of institutional oppression and inequality has made some in the African American community distrustful of government organizations and even the medical establishment. Adding to the problem is the fact that African American mental health patients have historically been misdiagnosed at a higher rate than White patients, and that African Americans are far more likely to be criminally charged for substance use than their White counterparts. These factors often create feelings of suspicion among the African American community, adding to the stigma of seeking mental health care.

“We have to admit that we have a historical component regarding trust and how active one in the African American community would be to seek out services as a result of fear,” Michelle says.

How Mental Health Organizations Can Help Erode Stigma

Fortunately, the stigma surrounding mental illness can be challenged and weakened in two main ways. The first way is by individuals being open and honest about their mental health struggles and encouraging others in their community to do the same. Over time, this communal vulnerability can go a long way toward reducing stigma. However, mental health organizations can also help reduce stigma through community engagement.

“I think we really need to be engaged and active in the community, such as at the Black & Minority Health Fair, so that we can make sure people are getting the information they need and that individuals understand that we’re a safe place where they can come and seek treatment,” Michelle says. “We also need to engage our faith communities regarding education of mental health and seeking help when symptoms arise, because in the African American community, faith and the church community are often protective factors.”

Of course, the effectiveness of community engagement will be limited if mental health organizations don’t also take steps to better understand that community. According to Michelle, this is why it’s crucial to promote cultural competency among care providers:

“We need more culturally-competent physicians, therapists and psychologists. When we’re meeting with someone who belongs to a particular subculture, we need to recognize the role that might play in how we approach treatment. At Cummins, we’ve established a Cultural Competency Committee that helps us look at diverse populations, identify best practices for treating those populations, and engage our employees across the organization to be a part of this conversation so we can make sure we’re providing the best possible treatment for every population.”

Last but not least, ensuring that care is financially accessible for everyone in the African American community can help erode stigma by making therapy a normal self-maintenance practice rather than an extravagant expenditure. “It’s important that we’re looking at accessibility, affordability of services, and socioeconomic factors that might limit a person’s access to health insurance. It’s a multi-pronged issue that needs to be looked at systemically,” Michelle says.

Here at Cummins, we recognize the mental health realities and difficulties faced by the African American community, and we are committed to providing life-enriching care to people of all races and ethnicities. If you are having concerns about your mental health and would like to discuss the possibility of treatment, please give us a call at (888) 714-1927.

On behalf of the entire staff at Cummins Behavioral Health, we’d like to wish you a wonderful Black History Month 2020!

Black History Month 2020

If you’d like to learn more about the unique mental health challenges of people from diverse backgrounds, we recommend our blog post from last year’s Minority Mental Health Month!

Minority Mental Health Month 2019
Shining a Spotlight on Minority Mental Health Month with These Indiana Organizations