Surfacing After Silence

Life. After.

Stages of Change


Stephens Lake Park; Columbia, MO 11/7/09

So this was my view yesterday as I was lying on my blanket in the park in a tank top in November. That’s right. 75 degrees in November. Pure craziness, but welcome craziness.

The leaves falling is a sign that the season is changing, and this is not a change I particularly like as someone with Seasonal Affective Disorder (SAD).  I use my light therapy box and make sure my sleep schedule is consistent.  But the winter season is just, well, it just plain sucks.

But there’s another type of change, one that we have control over, and I was thinking about it because of the recent entry about my lightbulb moments and the person in a private message mentioned the Stages of Change.  I am well aware of the Stages of Change model; at the treatment center where I was last hospitalized, we had a weekly group by that title and it was a check in to see where along the Stages of Change we were and, if possible, what was keeping us from moving to the next stage.

Stage 1: Precontemplation–Not yet acknowledging there is a problem that needs to be changed.

Stage 2: Contemplation–Acknowledging there is a problem but not yet ready or sure of wanting to make a change

Stage 3: Preparation–Getting ready to change

Stage 4: Action–Changing Behavior

Stage 5: Maintenance–Maintaining new behaviors

(This particular site includes a Stage 6: Relapse.  I am not including that.  I thinking that planning for  a stage 6 almost sets you up for it.)

We often criticize people for being in Stage 1.  But come on, I know I didn’t even think I had an eating disorder the first time I was hospitalized for anorexia.  I grudgingly admitted, “maybe purging isn’t good for me” but the restricting and exercising was not a problem and my weight was certainly not an issue when in reality that was the issue with the most priority health wise.

Stage 2, I like to think of that as when I finally acknowledged I had an eating disorder.  And I knew it wasn’t good for me.  But I couldn’t possibly imagine letting go of it or wanting to because, if we use the metaphor of the eating disorder as a life preserver, I had no idea if I could swim on my own.

Here is where people, sometimes quite violently, jump and berate people who are “pro-ana” or “pro-mia.”  I know I have a controversial point of view.  Unless someone who is pro-ana is trying to convince you to become anorexic, I have no problem with him or her declaring him or herself pro-ana or pro-mia.  And yes, google me.  I’ve been interviewed on this, although I was misquoted.  And I’ve presented papers at conferences on this culture.  These men and women are in Stage 2.  They are fully aware there is a problem, but they know they are not ready to change.  I admire that honesty.  It’s better than telling everyone how wonderful you are doing in recovery even though we can take one look at you and tell otherwise.

Stage 3 is the preparation stage.  This was when I was debating, “Do I want to go into treatment or not.”  Am I ready to try to give up my eating disorder.  This is the scary stage.

Stage 4 is the action stage.  For a lot of us, this means going IP.  But it also means setting up your environment outside of the hospital to be conducive to recovery for when you leave.  I think this latter part is often left out, unfortunately.  This past time I was in the hospital for a med change, I sat down on my bed the last night there and wrote a list of things I need to do on a daily basis to keep from slipping into a major depressive spell.  I keep that list in the book I take to therapy each week.

Stage 5 is the maintenance stage.  This is by far the most terrifying stage, at least for me.  To leave the hospital or residential facility and maintain all those positive changes on your own.  To life live without the eating disorder.  Sometimes it was a matter of simply following the guidelines to the exact letter.  At least if I knew I ate exactly what was on the meal plan at the exact time scheduled, I wasn’t doing anything wrong and I wasn’t relapsing.  I spent a lot of time at this stage of maintenance.  And that’s fine.  It convinced me it was possible to be OP for a long period of time.

How did I maintain the maintenance stage?  I made changes–to my meal plan, to my exercise plan–very very slowly.  I had clung to that life preserver for twelve years.  You don’t rip it away all at once, unless you want a backlash.  So yes, at first, I followed the meal plan and exercise plan very strictly.  I planned my meals a week in advance.  Then, I started planning three days in advance.  Then one day in advance.  I did the same with my exercise plan.  I did not let myself do any more or less.  I was afraid to vary anything.  Then I took a day off when I hadn’t planned on it–and I found I was okay.  I even physically felt better for it.

I don’t believe these stages are like steps of a staircase.  They’re a ramp.  You get to and from each one gradually.  And yes, we all know Stage 6 is a possibility, really at any point along the ramp, but hopefully we all know you can choose to stop the relapse and you don’t have to go back to stage one.

Never go back to stage one.


November 8, 2009 - Posted by | Eating Disorders, recovery | , , , , , , , , , , , , , , , , , , , , , , ,

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