Whose time? Mine or yours?

time for change

What is one sure fire way to predict behavior change (besides evidence of the change actually taking place)?

If we regularly engage with people regarding behavior change, how do we recognize whether others are ready for change?

By listening to what they are telling us.

Yesterday morning my husband was kissing me goodbye as he headed off to work. He knew I was going to visit with a colleague/friend whom I had not seen in a while later in the day. As he kissed me goodbye he said, “Give (him) my best,” but in my half-asleep/half-awake state I heard, “Give (him) a lead vest!” WHAT???? Clearly I wasn’t listening!

What specifically are we listening for with regard to behavior change?

Miller and Rollnick (2013) tell us we should be listening for change talk!

But what is change talk?

Change talk is exactly what it sounds like. It is talk about making a change; however, there are two types of change talk and one is more predictive of actual change than the other.

First there is preparatory change talk followed by mobilizing change talk. Let’s examine the differences:

Preparatory change talk occurs when people are starting to think about change while they are in the earlier phases of the stages of change we discussed earlier. Basically, preparatory change talk occurs during the ambivalence period up until real change actually takes place.

And I promised yesterday to talk about DARN-CATs. Let’s start with DARN!

D is for DESIRE: I want to make a change. I wish I could make a change. Life would be better if I made this change.

A is for ABILITY: I know I can make this change. I can do this. I have made similar changes in the past.

R is for REASON: I would feel better if I made this change. I would be better off.

N is for NEED: I need to do something different or I’m going to be in real trouble.

Anytime someone expressed desire, ability, reason, or need they are expressing preparatory change talk. There is understanding and a willingness to make the necessary change but the actual change has not taken place yet. This type of change talk often occurs in the precontemplative and sometimes the preparatory stages of change.

Mobilizing change talk is recognized by the acronym CATs:

Commitment: I am going to do this! I am going to make this change.

Activation: I am ready and preparing to make this change.

Taking steps: I followed through and did the following things this week toward my change goals.

These three types of change talk occur when people have fully moved onto the preparatory and into the action and maintenance stages of change and are most predictive of actual change occurring.

So back to my running example. These are some statements I might make about running according to each type of change talk:

Desire: I want to run more. I wish I had time to run more. I wish I ran faster. I wish I felt like running more. I wish it wasn’t so hot outside. I want to be able to wear those size six skirts in my closet. I don’t want to have to get rid of those size six skirts!

Ability: I have run many more miles per week in the past. I used to be a faster runner. I have run two marathons, including the Walt Disney World Dopey Challenge in the past. I have scheduled my runs better in the past.

Reason: I feel better when I run regularly. I sleep better at night on days I go for a run. My stress level is lower when I run. I don’t snap at my family members nearly as much when I regularly exercise.

Need: I need to get a handle on my weight because diabetes runs in my family. I need to lose some weight.

Commitment: I am going to start running more regularly.

Activation: I have scheduled my runs in my calendar. I have laid out my running clothes for a run tomorrow morning.

Taking steps: I laced up my shoes and went for a run this morning.

See how these statements fit into each category?

So think back to the change I asked you about earlier, then think forward to the stages of change. What types of statements do you find yourself making about that behavior change? Where do you find yourself? Are you still in ambivalence/preparatory mode or have you moved to mobilization?

Later we’ll talk about listening—for change talk, and listening in general.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.

Ch-ch-ch-ch-changes

Previously I addressed ambivalence. The behavior change looms out there but there are reasons that an individual remains stuck in the behavior and doesn’t move in the direction of change. Arguments made for change cause the person to dig in his/her heels and remain entrenched in doing more of the same.

At this point blame often shifts to that person and statements like the following are made, “Oh you’re just not ready,” “You’re in denial,” or “You don’t want this bad enough,” sometimes with the intention of shaming the individual into committing to change in that moment. But there is so much more underlying the decision to make a change. And what if the manner in which we approach the conversation made a difference in the outcome?

First, we must consider that there are different stages of change. Change is a process not a single action at a single point in time. The process is fluid but also unique to each individual.

Prochaska and DiClemente (1986) outlined several stages of change that include the following: Precontemplation, Contemplation, Preparation, Action, and Maintenance. What does this mean?

stages-of-change

Precontemplation: No consideration for change. This person is not ambivalent, meaning he/she doesn’t have mixed feelings about change. This person is content with the status quo.

Contemplation: This person is beginning to weigh the reasons why he/she might want to make a change. This person is definitely ambivalent. This person is starting to desire something different for himself/herself, outlining some of the reasons for wanting to make this change, and considering his/her ability to do so, but hasn’t begun taking any real steps in the direction of change.

Preparation: An individual in the preparation stage has decided he/she is ready to make a change and is putting together the resources to make this happen, but no real change has occurred yet.

Action: This is where the rubber meets the road. This person has decided to make a change and is taking steps to do so.

Maintenance: This stage occurs when the individual takes steps that help him/her sustain whatever changes have been made.

So, let’s put this together with my running example.

At one point of my life I was not a runner and I mentioned that I would have laughed if anyone had ever suggested I try it. At this point in my life I was clearly in precontemplation. No amount of persuasion at this point would have convinced me to lace up my shoes and go for a single run, much less regularly run. I was fine with life as it was.

However, later I did become a runner. Over the course of years since I made the decision to start running, I have been faced with the remaining stages of change in relation to my running. I contemplated what it meant to become a runner. In other words, I thought about going outside and putting one foot in front of the other. I thought about what equipment I might need which at first seemed as simple as a good pair of shoes. I’ve since come to understand that there is no shortage of running gear and it can be quite an expensive hobby especially when factoring in races and travel to said races. But these things were also part of the contemplation stage. What would keep me motivated to run or to continue to run? Ah, but I get ahead of myself. More on that train of thought later…

Okay, I decided I was going to commit to running. Now what? I needed to consider what equipment I needed which were the shoes I mentioned above, and I had to figure out when and where I was going to run, and how often. Once I had my plan then it was time to put it all into…

ACTION! I laced up my shoes, walked out the door, and started running! I would love to say all was glorious, I never looked back and have always been a runner since that day.

BUT…there’s another stage: Maintenance. It might have all ended that first day. I might have gotten out there and huffed and puffed and sweated and grunted, and decided running was just NOT for me. Yet, I didn’t. I (eventually) decided this was something I wanted to continue to do and so I had to plan for how I was going to maintain this new, healthy behavior.

And I also needed to plan for maintenance to avoid a final stage that has been added which is Relapse. I would like to say I planned well for maintenance and therefore stayed in the action stage since the first day I went out for a run. Sadly, I have gone through several periods of relapse sometimes all within the short span of a week!

Before moving into what motivates people to make a healthy change let’s think about these processes for a bit and consider where we might be with regard to the behavior change I asked about the other day. Are you completely satisfied where you are or have you considered doing something different? Have you thought about it and maybe started some of the preparations to be successful? Have you started only to “fall off the wagon?”

So what moves us forward in the processes of change? Stay tuned…

Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change (pp. 3-27). Springer US.

Ambivalence: To change or not to change?

Quick question: What is one thing you’ve thought about changing in your life that if you did make that change you would feel overall healthier or better off physically, mentally, emotionally, socially, financially, or spiritually? Maybe there is more than one thing. It could be big or small. You know stepping into that change would yield positive results and yet you haven’t yet committed to doing so. Or perhaps you have taken a few steps forward only to fall back into your regular daily habits.

Why is it we do this? We think about things we want to or know we ought to change because we know there would be benefits to doing so yet we never fully commit to making that change? This phenomenon is called ambivalence. Although we know there would be benefits to making a change there are also benefits of staying the same. We also know there are consequences to staying the same, as well as consequences/costs of making the change.

ambivalence

For example, I mentioned previously that I am a runner. At any given time I am training for an upcoming race. Right now I should be training for my next half marathon. I should be getting regular, shorter, faster runs in during the week followed by longer runs on the weekend. Sometimes I do but sometimes I don’t. Why?

Reasons to train:
•So I can cover the distance when it is time to run the next race
•So I don’t pass out or die on the race course
•So I finish in a reasonable time and maybe score a personal record
•I just feel better physically, mentally, and emotionally when I exercise
•Regular exercise helps with weight control and I have size six skirts in my closet calling my name that I haven’t been able to fit into for a while
•I like to eat and I like margaritas and sangria

Reasons I don’t train:
•It’s HOT and HUMID outside
•I like the comfort of my air-conditioned house
•I would rather watch Netflix and/or see what my friends are up to on Facebook and Instagram
•It’s HOT and HUMID outside
•I’ve done half marathons before without proper training and survived
•Because I’m so fair skinned I have to put on sunscreen and that’s just greasy and gross and did I mention…
•It’s HOT and HUMID outside!!!

I feel two ways about running. I love it and I hate it. When I get out there and do it I love it after I’m finished but thinking about it and preparing for it cause tremendous dread.

I bet you are thinking right now of ways I can remedy my situation that would counter some of the reasons I dislike it such as, “Why don’t you run INSIDE on a treadmill in an air-conditioned gym?” or “Why don’t you get up before sunrise to run.” Or maybe you’re thinking of some motivational tidbit like Nike’s slogan, “Just Do It!” or “No pain no gain.”

Research shows, however, that when we meet someone’s ambivalence with an argument why they should be doing something (making a change) the natural human response is to argue to stay the same (Miller & Rollnick, 2013). If you said to me, “just do it,” I would respond, “Yeah, I know, but…” And it is quite possible I’ve given consideration to running on a treadmill and/or running before sunrise but I have legitimate reasons for not doing those either. Although running outside is therapeutic for me, running on a treadmill does the exact opposite. It really agitates me. As for running before sunrise (or after sundown), I live in midtown Atlanta and prefer to run in daylight hours when I feel a little safer. Again, if you met my ambivalence with one of these arguments I would counter with, “yes, but…” and then outline my ambivalence. And the stronger you push in toward me to make the change, the stronger I’m going to push back to stay the same! Or, the harder you try to pull me in the direction of change the harder I will try to pull back. We’re then engaged in a full on tug-of-war!

So, what then is the best way to approach ambivalence and get someone to consider making a change they know they should make and have probably already thought about doing? This, friends, is my specialty. Stay tuned for more to come…

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.

That first step

I know I don’t look like a runner, but I am, in fact, a runner. Runners come in all shapes and sizes. I’m not a lean, 5-minute-mile runner, but I run and that makes me a runner. If you had told me many years ago I would be a runner I would have laughed in your face. And yet, I have a rack full of medals and a stash of running bibs and T-shirts that prove I’ve run dozens of races (5Ks, 10Ks, half-marathons and a couple of full marathons, including the Walt Disney World Dopey Challenge 2015) and hundreds of miles—and that doesn’t count the training runs.

The beginning of my running journey started when I saw something someone else had done and I wanted that for myself. It started with a friend attending a local boot camp, experiencing some healthy outcomes, and I wanted that too. Little did I know a lifelong love of running would result. But, I had to take the first step into the facility where the boot camp was held.

That particular journey was a conscious decision. Sometimes, however, our journeys are thrust upon us without warning and against our will. We are then faced with how we respond and which direction we go rather than whether we are going to go. Oh yes, we’re going. No question. But we have to decide whether we’re going kicking and screaming, or whether we’re going peacefully. Or we have to decide whether we’re going triumphantly or in defeat. Such was the case with my journey to become a therapist and now to subsequently launch my private practice.

journey of 1000 miles

Life threw our family a curve ball around 2005 that landed us in family therapy. Family therapy was the last thing I had ever imagined for myself and my family, and not what I wanted to be doing at that time. Turns out the circumstances that forced that outcome were the single step that has led me to where I am right now. If we had never sat face to face with an amazing therapist who challenged me to figure out my purpose in life my journey over the last decade would be measurably different.

Adversity can bring out either the worst or the best in people. We were able to take an adverse circumstance and capitalize on it to bring about family change and I was able to realize personal change. In addition, I came to realize my life’s calling to help others navigate the troubled waters of their lives.

I can now look back and also see where other seemingly random circumstances have come together to shape my current practice and expertise. In the years leading up to the above-mentioned family crisis I did medical transcription from home. I then went to work as a medical receptionist as I began my master’s degree in marriage and family therapy. My therapy internship was within a family medicine residency clinic and my subsequent post-graduate jobs were working within that same clinic system. I’ve gone on to develop an expertise and become a trainer in a therapeutic model (Motivational Interviewing) now regularly being taught to medical students that focuses on helping patients navigate change in their health behaviors. I’ve trained dozens of physicians, nurses, and other healthcare practitioners, as well as other human service and mental health practitioners in the same model.

All the while I was walking my journey as a mental health practitioner I couldn’t escape the medical field. But, I believe there was a reason for that. My master’s program was one of only two marriage and family therapy programs at the time housed within a school of medicine and we were taught the biopsychosocial model of medicine and therapy. “Biopsychosocial” is a big word. What does it mean? Basically it means that as humans our entire well-being is a function of not only our physical health, but also of our mental/emotional health, and our social support system. In addition, the spiritual aspect of life is now also being incorporated into this model.

So what does that mean for my practice and my clients? It means that I am trained to think systemically about health and all the factors that contribute to well-being. It also means that having worked with dozens of physicians over the past several years—some very well known nationally and internationally for their specializations—I have a depth of knowledge about health conditions that the average therapist might not have. I know how to speak the language and/or I have medical colleagues that can help sort out the specifics.

The discovery of a new or chronic health diagnosis is a circumstance many people find themselves faced with rather unexpectedly. They are thrust into a health journey about which they are totally clueless and that brings about much stress and worry. It can lead to depression or anxiety. It can lead to grief over loss of quality of life. It can cause relationship issues as persons and their families learn to navigate all the new requirements associated with the diagnosis such as increased costs of medicines and treatments, transportation to appointments, loss of work, etc. People find themselves unsure of their options. They’re confused about what their diagnosis means. They fear the unknown. Where do they turn for support and understanding?

My life’s journey has prepared me to be someone who can help others navigate new health crises and the ongoing management of systemic issues related to chronic disease management. I not only have a healthcare background that has paved the way of understanding of medical jargon and how the medical field works, but as I mentioned previously I have also experienced a major life detour requiring a complete rethinking of how to move forward. I understand unwanted but forced change. And, the therapeutic model I alluded to above is a collaborative, compassionate, and empathic model for determining what is best for the individual facing the crisis. It is not about me telling others what they should or should not be doing. It is about walking through the journey together to figure out what is best for my clients and their family based on their overall goals, desires, and wishes.

And, as an added bonus, I take therapy outside of a sterile, clinical, office environment to nearby nature for the added therapeutic benefit of fresh air and exercise. Are you or someone you know facing a health crisis or struggling with managing a chronic disease? Could you use a little extra support in this part of your journey? Call or email me to schedule a walk-and-talk session: 404-895-1525 or Denice@WalkAndTalkAtlanta.com.

I am also a Distance Credentialed Counselor and offer online therapy appointments for those who are located within the state of Georgia.

Through rose-colored glasses

“Wasn’t it weird and stressful to stand up in front of a bunch of people and tell each other how much you meant to each other?” our daughter asked last night over dinner referring to our wedding ceremony. Thus ensued a discussion about that particular day in our lives.

I recounted how angry I was walking down the aisle. Yes, you read that right. I was angry. Not “Bridezilla” angry, but mad nonetheless. Why? We had hired a videographer and as my daddy was walking me down the aisle I did not see a video camera anywhere in sight! This was well before cell phones and small video cameras. Video cameras were huge back in the day and I was wondering, “Where the hell is the video camera?!?” It wasn’t until we stepped up onto the platform at the front of the church that I finally saw the videographer crouched down below the choir banister trying to be clandestine and not show up in the broader still shots being taken from the back of the sanctuary. Great, but you completely missed shooting me walking down the aisle with my daddy! If you look very closely at the attached photo in the bottom right hand corner you can see the top of the videographer’s head peeking over the choir loft rail.

IMG_9623

I went on to describe some other minor disasters that occurred that day. For instance, the pianist we had hired had a death in the family and couldn’t make it. The organist also played piano and we asked him to get up and walk around to the other side of the sanctuary to accompany my now sister-in-law on the piano on the piece we had asked her to sing. He refused and thus he accompanied her on organ. It was not the best choice of accompanying instrument. His sister sang beautifully, by the way, despite the horrible accompaniment.

The organist did agree to play piano at our reception and turns out he was quite the accomplished jazz pianist; however, neither my husband nor I ever got to hear him play because we waited until the conclusion of the ceremony to take pictures due to the belief “it’s bad luck to see each other before the ceremony.” By the time we all made it down to the reception the hour or so we had paid for reception music was over and the not-so-great organist but exceptional jazz pianist was long gone.

Add to this some other stressors including a torrential downpour that flooded the church at the conclusion of the reception, the caterer refusing to make (or even serve) my husband’s favorite carrot cake as his groom’s cake because “it would crumble and make a mess”, and my husband leaving his suitcase in the trunk of his parents’ car as we headed to our hotel for the night and his parents headed two hours in the opposite direction home. By the way, he sure was handsome the next morning still dressed in his tux while I was in my slouchy jeans and sweatshirt.

After describing all the things that went wrong that day our daughter asked, “So it wasn’t one of the best days of your life.” Au contraire. I got to marry the love of my life and we were surrounded by so much love from family and friends. And that day was so very memorable for a variety reasons, some of which are the above stories we get to continue to tell.

That led to a discussion of some of the best days of our lives. The birth of each of our daughters tops the list. My husband standing in Red Square in front of Lennin’s tomb with the Band of the Air Force Reserve playing Stars and Stripes Forever was another. Interestingly enough, none of those days were perfect. In fact, many of those days we count as some of the best days of our lives were incredibly stressful—which is what this post boils down to. How do you frame the narrative of your life and your memories? Can you reframe the tragedies and stresses into the foundation of something good? What is the lens through which you view your life and relationships? Can you let go of the negative and embrace the positive?

This is one of the things therapists/counselors seek to help others do: examine how our past circumstances & relationships served to shape current thoughts, behaviors, narratives & patterns of relating.

Why was I angry on my wedding day? Because I like order and to be in control of my circumstances. From where did this need to be in control stem? From some childhood experiences of feeling out of control, such as my parents’ divorce.

On my wedding day there were things that were well beyond my control once the wedding march began on the organ. I could have viewed that day through a lens of “that was a disaster and an omen of all things to come in our marriage.” And yet, 28 years later we’re still going strong.

Why revisit the past? Why not just create a new life moving forward? Why not just focus on the here and now? Because we are shaped by our pasts. The complex overlap of all our life experiences serve as the filter through which we view our present and future, and determine how we think and act moving forward. Granted, there isn’t anything we can do to change the past, but by examining the past we can come to a point of greater self-awareness that serves to explain our thought processes which can then, in turn, help us overcome any negative/detrimental patterns and move forward.

At times I still get upset when things don’t go my way despite my best efforts to plan. I understand now where the sense of panic and need to be the master of my domain is rooted. I could be paralyzed with fear and frustration if I had not come to understand some of my neuroses; however, now I am able to capture the thoughts, be mindful of the here and now, and remind myself that not being in control is not the worst thing that could happen. In fact, I now know some wonderful memories stand to be made in the midst of the chaos and just living for the moment.

And yes, I had a therapist or two to walk me through some of this journey of self-discovery and that is how I approach therapy—as a partnership in the journey of life to develop a greater understanding of self for the purpose of breaking maladaptive patterns of thoughts and behavior in order to live one’s best life moving forward.

Would you or someone you know be interested in developing such a partnership? Come join me for a walk-and-talk session in the park. I can be reached at 404-895-1525 or by email at Denice@WalkAndTalkAtlanta.com.

Lost? Stuck? What now?

Ever been driving or walking somewhere and got turned around or lost? What did you do? Did you continue driving or walking around for a bit thinking you could find your way only to realize you were now REALLY lost? What then?

whatnow

These days many of us have GPS-enabled smart phones that point us in the right direction; however, even these maps fail at times. For instance, during one particular family vacation several years ago we hit a detour not included in our driving instructions. This was before our phones were smart enough to reroute us. More recently, however, I have been driving to a location (or two or three) only to find out the map app was ever so slightly off and the destination was a mile or two in another direction entirely! What do you do then? Stop and ask for directions? Keep driving? Turn around and go back home?

Sometimes while on our life journey we might hit a roadblock, or detour or two. We might think we’re headed in the right direction and have almost achieved our goals only to realize the destination to which we thought we would arrive shortly has since relocated and although we’re closer to our goal we still have quite some way to go. Or what happens when our phone battery dies and we forgot our charger? During these times we might need a little extra help in the form of guidance from someone familiar with the area, or perhaps someone to bring along a gas can and refill our tank (or a loaner phone cord) so we can push on through the extra miles we’ve now discovered we still have to cover.

I have been describing various metaphors for life and therapy and this is no different. Sometimes in life we get lost and/or just plain stuck. We lose our way and we need some extra help to get back on track. This extra support and direction may come from any number of sources including a counselor or therapist. Counselors and therapists are trained to help people look at their life circumstances from a different perspective and to help people get back on track, find a different way to achieve a goal, or choose a different destination altogether.

A good therapist serves as a guide working with you to achieve your personal goals in a way best suited to you and your needs. Some people need more specific direction than others. For some, “hey–you’re going in the wrong direction,” is all the correction they need. Some people get way off track and need a lead car or someone to ride alongside them until they have reached their destination safely.

Are you (or someone you know) currently lost, stuck, or struggling to find your way? I would be happy to walk alongside you and help you figure out where you would like to go and the best way to get there. Give me a call at 404-895-1525 or email me at Denice@WalkAndTalkAtlanta.com. Let’s get you where you want to be!

You are worth it!

What does self-care mean to you?

Often care-givers are the WORST at caring for themselves. There seems to be a belief that martyrdom will somehow produce positive outcomes and one’s own good health will result. I must admit that I fall guilty to this reasoning at times. As a therapist I often preach self-care but I am one of the worst at actually following through with it. As I painted my fingernails today I was reminded of the importance of self-care.

Why is self-care important? Caregivers are, by virtue of their description, GIVERS. They give of themselves: their time, their energy, their resources, their joy, their strength. But where do they get those things that they give to others? If, at some point in time, they do not plug into whatever source feeds their souls they will eventually lack sufficient resources to continue giving of themselves.

This begs the question, “What constitutes self-care?” It can be different things for different people. For some it can be meditation or prayer. For others it can be a trip to the beach or the mountains. For me, self-care ranges from a massage or a mani/pedi to a good, sweaty run.

I imagine some of you reading this may wonder about the cost of self-care. I must admit that I have struggled with this as well. How can I afford to ________ (insert your preferred method of self-care here)? Self-care requires sacrifice of other resources such as time or money.

I would argue, however, that self-care doesn’t have to cost much, if anything at all. At times I am willing and/or able to afford to go to a salon and pay for someone else to give me a manicure or a pedicure. At other times, such as this morning, my manicure was self-administered with polish I already had. And sometimes my self-care is as simple, and (monetarily) free as taking a few minutes to practice deep breathing and mindfulness or putting on my running shoes and pounding the pavement.

nail-polish-1

Self-care is best exercised as a preventative measure. There is some truth to the proverb, “a stitch in time saves nine.” Taking time to manage stress on the front-end can prevent higher levels of stress and potential disastrous results on the back end. It is my desire that people will come to view therapy/counseling in the same way.

Oftentimes therapy/counseling is seen as a last resort. It is seen as a crutch for the weak, a last-ditch effort for those for whom nothing else has worked. What if we treated mental and emotional well-being in the same manner as physical health? What if we implemented regular “well-checks” and practiced good mental and emotional health habits such as self-care?

I painted my nails this morning and it felt good to treat myself during that brief period of time. I’ll have the bright pink polish on my nails for many days to come to remind me that I am worth it. My health—physical, mental, emotional, spiritual—is worth the effort and time I invested and will determine the results I get out of it. I’m also a firm believer that physical, mental, emotional, spiritual, & relational health are all intertwined but that is another subject for another blog…

How will you exercise self-care today?

If you are interested in exercising some self-care contact Denice at 404-895-1525 or Denice@WalkAndTalkAtlanta.com.