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"No one can persuade another to change. Each of us guards a
gate of change that can only be opened from the inside. We
cannot open the gate of another, either by argument or by
emotional appeal."
- Marilyn Ferguson
In the end,
deciding to change is personal. It can happen in an instant,
or be a process that unfolds over time. Either way, it is
the result of making a decision and then acting on it
accordingly
(actually, many decisions over time). As simple as this sounds, the idea that we
each hold the key to our own change is powerful and...
not so easy to understand. Clearly, we all know things we
should do that would improve our lives - lose some weight,
save more money, get a new job - yet we don't do many of
them - why? When it comes to deciding to change addictive
behavior answering the question is even more perplexing.
This leads us directly into the messy territory of
motivation and what ultimately makes people do what they
do (or not do).
The topic of motivation is not new to research, and decades
of studies have revealed that it is best understood as a
complex system, involving both internal and external
factors, that energize and direct our day to day actions and
behaviors.
The
PRIME Theory of Motivation is among the
most recent and comprehensive attempts to describe this
complex system, and was developed specifically to better
understand the role motivation plays in addictive behavior.
Although still in its infancy, the theory helps us to
understand that deciding to change addictive behavior can
happen on multiple levels (impulses, motivates, evaluations
and plans), and involves various aspects of memory and
learning.
Although the motivational system is complex, many studies
have revealed that change is most strongly influenced by
interpersonal factors within human relationships. More
concretely, people most often change their behavior in
response to a relationship with a trusted friend, counselor,
pastor, spouse, or other concerned party that challenges
addictive behavior with empathy. When a person is
acting-out addictively, and their behavior is causing so
much pain to those around them, how is it possible to
confront a person with empathy?
In 1999 a book titled
Motivational Interviewing:
Preparing People to Change Addictive Behavior
by William R. Miller and Stephen Rollnick strongly
challenged some of the basic tenants of how and why people
change. Central to their case was the idea that addiction is
fundamentally a problem of motivation, and that the
resolution of ambivalence was key to helping people
change. They also believed certain strategies resolved ambivalence
better than others. Up to that time, many treatment programs
used aggressive confrontational tactics on patients to break
down denial, believing it was the only way to ultimately
help an addict. In fact, even today denial is often
considered to be at the root of addiction, so much so that
loved ones will go to great lengths to try and get a person
to change including (1) coercion (2) intimidation (3)
manipulation (4) threats and (5) pleas. Interestingly, in
one research study the more a counselor confronted during
the treatment the more a person was drinking a year later!
Even when their is overwhelming evidence of the need for
change people often do not change their behavior. In the
12-step programs lack of change is most often associated
with not "hitting bottom." Yet, many people who change their
behavior never come close to hitting bottom or suffer as a
precursor to change.
Why then do people change? In the
second edition of
Motivational Interviewing
(2002) the authors conclude that "constructive behavior
change seems to arise when the person connects it with
something of intrinsic value, something important, something
cherished. Intrinsic motivation for change arises in an
accepting, empowering atmosphere that makes it safe for the
person to explore the possibly painful present in relation
to what is wanted and valued (p. 12)."
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