Experiencing feelings of ambivalence before making an important change is normal, and this is especially common when one is considering seeking help for an eating disorder.
A person's readiness for recovery is likely to fluctuate throughout the journey. There are a variety of factors, emotions, and internal conflicts that can contribute to this ambivalence, and this can differ from person to person. If you are delaying reaching out out because you are feeling uncertain, here's the deal: you don't need to be 100% ready for change in order to take the first step.
There are 5 main stages of change a person often goes through when they make a change in their life. Becoming familiar with these stages of change can help us to better understand the thoughts and feelings that tend to interfere with seeking out and engaging in treatment. It can also help us to understand how we can best support a person with an eating disorder to move forward, no matter what stage of readiness they are at.
The 5 Stages of Change in Eating Disorder Recovery
Pre-contemplation Stage
A person who is in the pre-contemplation stage is likely to deny or minimize the problem, and will not be considering making a change. They may not be aware that their behaviours are harmful to their health, and might not yet be experiencing acute negative consequences of the problem. A lack of awareness, or misinformation about eating disorders and their signs and symptoms, might also make it difficult for loved ones to realize the extent of the problem.
Helpful Self-reflections at this Stage:
What have loved ones or others in my life said about my eating behaviours? What worries or concerns have they raised? What would need to happen for me to decide that there is a problem?
How Loved Ones Can Help at this Stage:
Be calm, compassionate, and non-judgmental in your communication with your loved one. Gently share your observations about how the eating issues are impacting their life now, and your worries about how they could impact their future.
Become educated about eating disorders and treatment options.
Encourage and support your loved one to seek out medical treatment if their health is compromised.
If your loved one is under the age of 18, insist that they access professional help. Facilitate accessing the help, and support and accompany them when they attend their appointment.
Learn more tips for talking to a loved one you are concerned about.
Contemplation Stage
A person who is in the contemplation stage of change has some awareness of the problem and is beginning to consider change, but is not quite ready to take action. They might be noticing the negative impact their eating behaviour is having on their ability to engage in usual activities, or on their relationships. They might be growing tired of the consuming, intrusive thoughts. Ambivalence can persist at this stage, and a person can become stuck in their internal conflict or fear about taking the next step towards recovery. It can be tempting to rationalize not seeking help if the person does not visibly appear unwell from the outside, does not exactly fit criteria for a certain diagnosis, or has a fear that they are not 'sick enough' to get help. If the eating disorder is still serving a purpose - such as coping with or numbing emotional distress - it can be very challenging to consider giving it up without yet having developed alternative distress tolerance strategies.
Helpful Self-reflections at this Stage:
Consider the pro's and con's of changing your eating behaviour, and the pro's and con's of not changing. How would you like your life to look 6 months from now? Or a year from now? What would need to be different to achieve that?
Educate yourself about eating disorders, correlated risks, and treatment options.
Consider taking a step forward by telling someone you trust about your concerns or about the ambivalence you are experiencing.
How Loved Ones Can Help at this Stage:
Encourage your loved one to express their thoughts, feelings, and concerns. Reflect back what you hear them tell you. Respond with compassion and non-judgment.
Gently point out discrepancies you notice between your loved ones thinking and actions.
Hold space for hope, and highlight positives of change.
Continue to educate yourself on eating disorders and the recovery process.
Preparation Stage
During this stage of change, a person has reached a point where they are not only willing to change, but are now motivated to make a plan to recover. This is a time for learning about recovery, exploring treatment options/making appointments, and possibly talking to loved ones about their intention to seek help, and seeking their support to do so.
Helpful Self-reflections at this Stage:
What initial step can I take? What barriers are interfering with taking the next step, and what strategies can I use to overcome them? What practical or emotional support do I need, and who are the people in my corner who can help?
How Loved Ones Can Help at this Stage:
Continue to encourage your loved one to express their feelings and concerns and respond with empathy.
Help to identify resources and treatment options. Continue to educate yourself.
Support your loved one to access therapy/treatment.
Action Stage
During the action stage, a person is engaged in therapy/treatment and has begun to make changes in their eating patterns. They are learning, and starting to utilize new strategies for coping with difficult emotions. Ambivalence can still be present however, and a person is challenged with resisting urges to return to old eating disorder behaviour patterns.
Helpful Self-reflections at this Stage:
Consider what has helped in your recovery so far - what specific strategies, daily practices, and people have contributed to the changes you are making? What triggers or challenges have you encountered, and how can you prepare for, and manage them moving forward?
Remind yourself that recovery is hard, and that progress isn't perfect. Be proud of your efforts, and remember that your treatment team is there to help support your continued progress.
How Loved Ones Can Help at this Stage:
Acknowledge and validate how challenging change and recovery can be.
Encourage and support your loved one through the challenges. Ask what they need.
Be mindful of your own feelings of discouragement when slips happen, and remember that progress isn't linear: it is normal for there to be challenges along the way.
Seek emotional support for yourself and have good self-care practices in place.
Maintenance Stage
A person who is in the maintenance stage of change has replaced disordered eating patterns with new, healthier behaviours. They are utilizing new coping tools, and eating disorder thoughts and feelings are less frequent and intense. With health stabilized and life getting back on track, this is also a time for nurturing other priorities, re-engaging in past loved activities, or exploring new interests and passions.
A risk for slips or relapse (a return of eating disorder thoughts and behaviour patterns) still exists during the maintenance stage. This is a normal part of recovery, and is an opportunity for continued learning and skills development. Planning ahead for managing potential triggers and stressors, continued self-care, and maintaining positive supports, can help to minimize opportunities for relapse.
Helpful Self-reflections at this Stage:
What passions, hobbies, activities or relationship am I able to nurture now that the eating disorder isn't taking up so much space? What other interests would I like to pursue?
What triggers do I need to be mindful of, and what plan can I have in place to deal with them when they arise?
Remember that slips and relapse are a normal part of recovery. What are the early signs of relapse I need to watch for? How can I manage when I notice these signs?
How Loved Ones can Help at this Stage:
Continue to be a supportive presence in your loved-ones life.
Help your loved one to identify potential triggers that could negatively impact their recovery.
Help put systems in place to minimize the potential for relapse. Know what signs/symptoms to watch for, and have a plan for managing slips if/when they arise. Remain calm in the face of relapse, and remember that your loved one is not starting from the beginning. Remember that relapse is not failure: it is an opportunity for continued learning and change.
No matter what stage of readiness or change you or your loved one are at, I can help to support your journey to recovery. Don't hesitate to reach out if you have questions or are feeling unsure. I will listen and help you to figure out your next steps.
Contact me to schedule an appointment or an initial free15 minute consultation:
Call 26-668-7296 or email cassie@nourishingchangetherapy.com.
References:
Stages of Change. (2021). Retrieved from https://keltyeatingdisorders.ca/recovery/stages-of-change/
Stages of Change. (2021). Retrieved from https://nedc.com.au/eating-disorders/treatment-and-recovery/stages-of-change/
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