Expert: Nobody wants to change
Carlo DiClemente, a professor at the University of Maryland and a leading expert on Change Theory in regards to the mental health profession, spoke to 180 mental health workers from Vermont, New York, Massachusetts, and New Hampshire about the processes people use to change their behaviors.
For the past three years, United Counseling Service of Bennington County has held such conferences featuring speakers like DiClemente. David O'Brien, the director of Mental Health and Substance Abuse Services at UCS, said the organization has already implemented many of DiClemente's ideas into its treatment services.
In his opening remarks, DiClemente said change comes in three forms, either stopping a behavior, such as doing drugs or smoking, starting a behavior, such as exercising, or by modifying an existing behavior, such as diet.
"Nobody wants to change," DiClemente said. "Change is disruptive; we don't like change."
He said mental health workers should be aware of what they are asking from their patients when they talk about changes. To illustrate his point, DiClemente gave the example of a doctor listing all of a patient's problems, and telling the patient how to fix them. The patient will nod in agreement and go find another doctor rather than change.
He said changes in behavior require self-control, which he defined as control of the self, by the self. Sitting inside listening to a lecture when the sun is shining outside is an example of exercising self-control, DiClemente said. Most people have enough of it to hold a job and get things done, however, self-control is not infinite.
DiClemente compared self-control to running a marathon. A person may start out unable to run one, but with training, they can build up their endurance and finish a race. However, they can't run two in a row. Mental health professionals, he said, have to be aware of the things taxing their clients' self-control.
"Most of our clients are not facing one challenge," he said. Someone with alcoholism may also be going through a divorce, job loss, depression, or any number of other issues that take a toll on their self-control.
DiClemente said change is a process and involves multiple facets. "Many of the behavioral changes people make in their lives are made without assistance," he said, citing studies that show the process involved in self-change is the same as an assisted change.
A common obstacle to change, he said, is that people with everything to gain from a change in behavior don't want to do it. Often a person with two divorces and three DUI convictions will not see their drinking as an issue. DiClemente said many highly effective treatments for disorders such as anxiety exist, but the trick is getting patients to follow the treatments.
Change requires self-control and self-observation, he said. Lack of motivation is rarely the problem with patients. The problem is many are simply not motivated to do what the mental health worker wants, such as stop taking drugs.
"There's a lot of work in being a drug user," DiClemente said. Drug users have to find dealers, avoid being caught, and be thinking immediately about how to get their next fix.
DiClemente said the ability to change is not rare, as evidenced by pregnant women and some drug users. He said pregnant women who smoke will often quit smoking while pregnant, only to pick the habit up once their baby is born. Likewise, studies have been done on drug users who were paid money for clean urine samples. As long as they were paid, their urine was clean. Once the payments stopped, so did the clean urine.
Contact Keith Whitcomb at email@example.com.
TALK TO US
If you'd like to leave a comment (or a tip or a question) about this story with the editors, please email us. We also welcome letters to the editor for publication; you can do that by filling out our letters form and submitting it to the newsroom.