Small change for the better.

For four decades I've worked with people who have problems with pain, anxiety stress, chronic health problems and an inability to be able to do what they want to. 

When I first started this work, I only had a few skills, but despite this, maybe because I’m a chatty communicator, a high percentage of people improved. 

But there were always those few infuriating people who didn't get better. To help those people I decided to train in more and more skills with the aim that eventually I'd be able to help just about everybody. 

My thinking went along the lines that with lots of skills, I'd be able to help lots and lots of people, to put them to rights, to fix them to sort them out!!

But things didn't work out quite that way. 

Despite having dozens of tools, in psychology, and physical therapy, all kinds of different forms of treatment, advice, techniques that I could offer, there were still people who didn't improve. 

In fact, it was almost as if some people seemed to be put off by the very idea of being able to improve. 

The more we talked about improvements and solutions, the more resistant to improving that they seemed to get. The more they mentioned failures in the past, and the more enthusiastically I came up with ideas, the more arguments they raised.

That got me wondering even more.

Because I knew it wasn’t to do with how they came to see me. 

Some of them were referred by their physician, and some made the decision to consult with me by themselves. It didn’t seem to matter how they came along, some engaged with change and improvement and some didn’t.

So, then I began to wonder about the whole process of change psychology and the way that different people differ so much in their capability and readiness to make changes. 

Could it be that some of the people that I was working with had a different motivation from other people that I was working with? 

Could it be that some of the people coming to see me had a different expectation?

When I thought about it, it was true that some people were ambivalent about making changes and lay on the couch or sat in the chair and expected me to fix them. 

It was as if nothing they did was part of the problem and they wanted me to take the problem away.

I knew that to really live a good life despite their problem, they needed to take responsibility for their problem. But if I told them, then it was likely they wouldn’t come back.

That was frustrating.

To know that they had so much potential to really move to a place of living a good life alongside their problem, but that they weren’t fully motivated to make changes. 

Fortunately, at around the same time, I was studying public health and the relationship between chronic health problems and behavioural psychology. 

Change is a complex process and in behavioural psychology, there is a model which breaks change down into stages.

The different stages of change start with a pre-contemplation stage, a stage of ambivalence, a place where change isn't even being contemplated. 

After all, change is tough. Most people don’t relish the idea of change, they have mixed feelings about it. There are good points and bad points, there is a lot to balance when you make a change. Not only does change impact yourself, but it impacts everyone around you, friends, family, relationships, work, everything. 

But sometimes, along with problems, comes time to think. So, the next stage is contemplation, where an individual begins to start to think about changing and having an idea about perhaps making some slight shifts in their behaviour. Wondering whether a change might be for the best or the worst.

If after all that thinking and realizing the pros firmly outweigh the cons, then comes a preparation stage. This is when the person is really beginning to start to tip over into change, gathering up resources, sounding people out. Here is also where people starting to explore new skills, trying out different practices and considering becoming better skilled.

The next stage is action, the actual doing, the putting into practice of the new behaviours. Doing the things needed in order to be different and manage their problem effectively. 

Finally, a maintenance stage where new behaviour is being maintained over time to ensure the new behaviour is really stuck. 

Interwoven with all these different stages is the possibility, at any stage, of a relapse. A chance of failure and a point where the whole cycle might stop and then start again.

So, the question then was how to discover where people were in relation to their problem and their stage of change. And that’s where psychometric tests come in. Because studies have shown that we can measure where people are in terms of their stage of change. It’s not a static place, more like an MOT, that varies from person to person. 

We do know that if we take measures over time then we are likely to see changes in the results. That’s not in straight lines, but the outcomes can help us know what’s best to do at different times.

So, we can input change work and skill training and coaching and counselling at the right times and in the right ways. It’s all an interesting intermingling way to work. Supportive, encouraging, safe, collaborative with the person with the problem at the centre retaining their autonomy.

If you’d like to know more about where you are on your stage of change in relation to your health problem then drop me a message and I’ll arrange to send you a link to a questionnaire you can complete.

Jill Wigmore-Welsh BSc MPH FRSPH

The Rare Bird