We often think of behavioural change as a linear process. That is, we identify the behaviour we’d like to change and we go ahead and change it. It seems straightforward, doesn’t it? Unfortunately not. It’s rarely that simple.
In this post, Joanna Glebocka, clinical psychologist, explains the concept of motivation to change, in particular, in the context of eating disorders.
This insight will help to understand why it can often be extremely difficult to implement the solutions we know need to happen, but also, how we work through motivation to change during eating disorder therapy.
The importance of understanding motivation to change
It’s easy to overlook motivation to change, and simply focus on the practicalities of the change itself. However, change is a process. A natural process, which can take time and patience to work through.
While some people are ready to make active behavioural changes when they begin eating disorder treatment, most will experience a degree of inner conflict. Despite the behaviours associated with an eating disorder causing stress or pain, it can be frightening and very hard to let go of them.
It’s therefore really important that during the initial consultation, we take time to understand which stage of the process you’re at, so we can determine the right support needed. Failing to do this omits a big part of your internal experience, which can result in feelings of frustration, inadequacy and of being misunderstood.
The stages of change
Change is often a complex and challenging process for those living with an eating disorder.
For some people, the first stage of change occurs before they even recognise that they‘re unwell. This is called the precontemplation stage.
1. Precontemplation stage
During this phase, it can feel very hard to bring yourself to therapy independently. That is, it’s quite common for a third-party such as a friend, family member, or health professional to raise the alarm, as you’re typically unaware that you have a problem.
At this stage, the eating disorder may be providing a helpful function that feels more compelling and powerful than any negative effects it may also be causing. For example, it may be helping you to cope with difficult emotions. Therefore, thinking about change may simply not be in your mindset.
As therapists, our role is to gently help you realise there’s an issue, and to consider the possibility of making a change. We try to help you see the damage your eating disorder is causing to your physical health, relationships, social life and work. Launching in with change-oriented strategies at this stage would be a mistake. It could be damaging to the therapeutic relationship and would likely cause you to disengage from therapy.
2. Contemplation stage
At this stage, you’re likely to be aware that you have a problem, but you may be experiencing conflicting thoughts and feelings. You may want to change, but at the same time you may find the concept of changing your behaviour terrifying. Your eating disorder may be providing you with a sense of safety and security, and without more functional alternatives to turn to, change may feel too risky.
During therapy, we help you to make sense of what’s going on and to understand that these feelings are natural. We work to help develop an understanding of what it would mean to consider change, what it means if we explore change, and what it means if we don’t.
We also outline the pros and cons of change and what obstacles make it hard to change. These obstacles, or ‘barriers to change’ may include the familiarity of the current behaviours, the function these behaviours perform, or the uncomfortable feelings that change causes. You can read more about these barriers in detail, in our post: Why Change is so Hard.
3. Preparation stage
Our work during the contemplation stage lays the groundwork for us to be able to prepare for action in the preparation stage.
In therapy, we work on conceptualising goals and on putting strategies in place to achieve those goals.
Often clients choose goals that are quite abstract, for example, “I want to be free of my eating disorder”. But, we recommend setting goals that are easily measurable, otherwise they can feel overwhelming. An example of a measurable goal might be, “I want to be able to order from a menu in a restaurant”.
At the same time, therapy during the preparation stage allows us to help you distinguish between your behaviours, thoughts, and feelings around your eating disorder. This is important, because it’s easy to confuse a thought for a feeling, and doing so can make behavioural change even harder.
For example, you may make the behavioural change of starting to eat regular meals, but you might still experience strong thoughts telling you that you shouldn’t, which can cause intense and difficult feelings. Learning to tease out these thoughts from your feelings and behaviours can make them less powerful, and allow you to choose recovery-driven behaviours with more ease.
4. Action stage
With a plan in place, it’s now time to implement some changes and tackle behaviours one by one.
Those living with an eating disorder can be very self-critical, so a big part of therapy is helping to recognise and celebrate achievements (even small milestones), to become more compassionate towards yourself, and to reward and appreciate yourself.
While some aspects of change might prove more challenging, it’s important not to forget how much has been achieved already.
Read more about how therapy can help you with change here.
5. Maintenance stage
By now, you will have made changes to adopt more healthy behaviours. For example, eating a wider range of foods, having regular meals, or eating with others.
During therapy, we support our clients to maintain and develop these healthy habits and work on coping strategies in the event of a relapse. We consider what circumstances could make a person more prone to ‘slip back to their old ways,’ and also the warning signs to look out for.
Often, it will be similar behaviours that appeared at the very beginning of an eating disorder, i.e. attempts to eliminate certain food groups, cut down on carbs or fats, or the strong desire to ‘eat clean’ and avoid all processed foods etc.
6. Relapse
If this happens, don’t be disheartened, a relapse is a completely natural part of this cycle of change. It’s something we discuss with our clients and plan ahead for during the maintenance stage. It’s often helpful to revisit what worked during the contemplation and preparation stages.
Having said that, it can still be a very difficult and painful time, and those living with an eating disorder will need a lot of emotional support and encouragement during this time.
How do I know what stage of change I’m at?
Knowing what stage of change you’re at is a mixture of how you feel, but also your thoughts and actions.
Often in therapy, we’ll set a task to be completed at home. The type of task will vary depending on the stage of change you’re at.
For example, in the initial stages, the task will typically be more reflective, e.g. completing a food record, thinking about the pros and cons of change, or writing a list of ‘forbidden foods’. As the motivation and readiness grows, the task might be more ‘action-based’, e.g. to start having breakfast, to eat at regular times, or eat a ‘forbidden food’.
If the task is completed, it’s a good indication that you’re ready to move on with the process. But if not, it may mean we need to take a step back and understand what obstacles made it too difficult for you to complete it. It might be that the task is not suited to your current stage of change.
Change is a complex process, and it’s absolutely fine to revisit or spend more time in the earlier stages of the process. What’s most important is to be kind to yourself and go at your own pace.
Can I benefit from therapy if I’m not in the action phase?
Just because you’re not currently in the action phase, it doesn’t mean that therapy cannot be useful for you. As we’ve outlined in this post, developing motivation to change is a process, which therapy will guide you through.
It’s our role to offer you the right support to facilitate the change you deserve. Please get in touch to find out how our licensed and trained professionals can help. You can book a free, 20-minute consultation with us by clicking here.
Take care,
Joanna Glebocka
