stages of change
This is a model commonly used in discussing recovery and change over the course of treatment. While these stages can be applied to a myriad of situations and goals, for the purpose of consistency I will be writing directly about eating disorders.
Pre-contemplation Stage
Someone in this phase is actively endorsing eating disorder symptoms - bingeing, purging, or restricting - and may lack the education regarding long term consequence of the eating disorder nutritionally, medically, socially, emotionally, and in academics and career in the long term. This stage can look very different for a support person who may be observing patterns of restriction, isolation, and compulsive exercise, meanwhile their loved one is adamantly stating:“I’m not sick enough right now”, or “it’s not that bad”. These patterns of defensiveness and minimizing of behaviors are what maintain the eating disorder, and it may feel hard to leave this phase due to fear of failure in treatment and recovery, or uncertainty as to what recovery requires for long term change to occur.
Contemplation
Imagine you’re standing on a diving board. You’re peering over the edge and considering the height. What if the water is deeper than I anticipated? Am I a strong enough swimmer? Will I make it back to the surface in time for air? Is the dive worth it? Contemplation is acknowledging that change needs to happen but maybe you feel scared to make that leap off the diving board.
There may be feelings of ambivalence; while you have gained some insight about the problem and how it is impacting you, you don’t feel ready to jump in right away and create that necessary change. Maybe you don’t know where to start.
So much of treatment and recovery feels like a risk, and when you are in the contemplative stage you may find yourself acknowledging the behavior as detrimental, but you aren’t sure what steps come next to change it because you may feel scared or overwhelmed when considering a life without your eating disorder.
Preparation
You have acknowledged the maladaptive behaviors and you are ready to change! It feels scary to do, but you are setting small goals for yourself and taking action steps to accomplish these goals. You’ve researched treatment options, or have called your insurance to see who is in network for you. Maybe you are researching therapists to contact, or meeting with your current team more consistently. You have expanded your team to also include a medical provider or a nutritionist, and you scheduled an assessment for yourself to get a more complete picture of what you might need in terms of treatment regarding levels of care options. You are recognizing the need for change and coming up with a tangible action plan of what needs to be in place in order to feel the most successful as you start your journey.
Action
In this stage you are actively challenging yourself to meet your goals. You are stepping outside of your comfort zone and doing the emotional work in using affective coping skills you have learned throughout the process. You might feel motivated while challenging food rituals or weight restoration. Maybe you’re having more difficult conversations around boundaries with people in your life, or you’re donating those “just in case” clothes in order to make room for clothes which fit your body in recovery. Action stage is challenging because it often relies on working to create change even when you feel unmotivated, that is how you get to the next phase.
Maintenance
Maintenance phase is characterized by consistency regarding the use of the coping skills in the moment, maintaining weight restoration within the normalized range of weight fluctuation, meeting nutritional needs with a variety of foods, and seeking support as needed.
It feels important to reinforce that maintenance does not mean “the end” — these are phases, or seasons. This process is not linear which means that you might find yourself fluctuating between stages, such as moving between contemplation and action a few times before you enter maintenance. You can also enter maintenance and find yourself once more in pre-contemplation.
