Helping People to Change
Helping People to Change
Section Menu
Introduction
This is a useful model that is used to show where someone is in the process of change:
Precontemplation - not considering change
Contemplation - thinking about change
Preparation - preparing to change
Action - making changes
Maintenance - maintaining changes
Relapse - change discontinued
Each one of the stages may last varying periods of time from a few minutes to a few years. The process is continuous so people may go through the process more than once and may also drop backwards in the cycle. How receptive people are to changing their diet and lifestyle will depend on where they are in the process of change.
The traditional approach of identifying a need to lose weight, assessing diet, discussing target weight and giving information will only work with those who are ready to change. The approaches about to be described are methods of working through behaviour change with people to help them in losing weight. However, despite using these techniques you will get people who are not wanting to change at present, or who will find it very difficult to change at the present time due to life circumstances. The important thing is to leave the door open so they can come back when they are in a better position to make changes.
Precontemplation stage
In this stage people are not considering change, or may not realise they have a problem. Try to discuss the problem with the individual to inform them of the risks of continuing as they are and raise the possibility of change through talking about the benefits. Exploring their understanding of their weight problem may be useful. 'Scare tactics' may have the opposite effect to what was intended and may actually cause people to do nothing at all.
Contemplation stage
These are the people considering a change. At this stage it may be useful to get the patient to consider the benefits and disadvantages of changing and to write them down i.e list the pros against the cons (see 'Decisional Balance'). The patient's readiness to change and their perception of their ability to change can be assessed by getting them to mark themselves on two continum scales (please see 'Readiness to Change').
These scales can be used as a starting point to discuss the patient's motivation and can be used to identify barriers to change. To help someone successfully lose weight these barriers/obstacles need to be identified and addressed.
Barriers to change:
|
|
Let the client do 80% of the talking, and encourage this by asking open - ended questions. You should recognise their agenda rather than your own and let them set their own targets after discussing them with you. This will mean they feel more in control and will have more responsibility over their weight management.
Preparation
This is when people have decided to make a change and are preparing for it. Again, this may involve discussion about various barriers to change and the strategies the individual is going to use to overcome these. You should encourage them to come up with their own solutions to the obstacles. As discussed before, let the person choose and set their own goals after discussion with you. It is good to set short term, intermediate and long term goals. This may be weight lost, or may even be a dress size or waist measurement. You need to encourage the patient to make realistic goals that can be achieved otherwise they may feel like a failure and give up.
Discussing their current attitude to eating and the 'diet cycle' can help. For more details, see the [Psychological, Behavioural and Emotional issues] section.
Action
In this stage people are actually making changes. Regular contact with a health professional or a group can help them to keep on track and lots of encouragement should be given. People may find it helps to give themselves rewards as they reach certain goals.
Maintenance
At this point people have reached their goal and are aiming to maintain their weight loss. It is probably where many have fallen down in the past and so plans need to be made in order to maintain their loss.
Relapse
Relapse is where people do not maintain the changes they have made and return to previous ways. A relapse is not the same as a lapse. A lapse, is very brief and may be, for example, somebody overeating one night on some chocolate biscuits. To prevent a lapse turning into a relapse people need to be encouraged not to fall into the trap of feeling guilty, then a failure and then give up. A relapse can vary in time and, if it happens, the individual needs to be encouraged to get back on track as soon as possible.
Areas of concern
If you are concerned someone may have psychological issues around food you may need additional help. Consider a referral to counselling, Mental Health Services or the Mental Health Dietitian.
Useful Resources
- Positive Ways to Better Eating (order from 01274 365033).
- Food and Mood Diary
Useful Courses:
Please see Guidelines, Training and Resources section.
Must do M.U.S.T in Bradford
