The Five Stages of Change

by Christina Bruni Patient Expert

With the convention entries wrapped up, I'd like to re-visit the topic of setting goals, in a two-part blog series. First, I'll talk about recovery and in the second blog entry I'll detail the specifics of my three-year treatment plan.

I found in my file cabinet an Elle article by Lauren Slater that sheds light on the process of change. She refers to work done by James Prochaska, who has studied transformation and identified five stages of change: precontemplation, contemplation, preparation, action, and maintenance.

A stage-based model like this could indeed be useful in schizophrenia recovery. The idea is that people don't "have sudden epiphanies, then 'take the bull by the horns.'" The process takes time. You could enter and finish the precontemplative stage without being conscious of it.

For the past three years, I have entertained the idea in my head of moving into a co-op. Without articulating that goal on paper or in words, I began browsing apartments on CraigsList. My mother bought me a new dining table and chairs, and a TV armoire. I bought on my own a buffet server to complete the dining set.
The contemplation effort happened in the last five months, and I've begun now to do the preparation: I'm typing up a checklist of questions to ask when the real estate brokers show me apartments. The real action will take place in August, when I schedule appointments to talk with three brokers. The maintenance stage will be coming with the money to pay the mortgage and carrying charges, plus the upkeep of the apartment.

More elementally, the five stages of change as they relate to schizophrenia could be seen in how we grasp and execute our recovery. The precontemplative (subconsciously knowing that things have to change) and contemplative (consciously examining our lives) are expressed in each individual as he or she alone does, and at his or her own comfort level and pace.

I began subtly to perceive what could happen if I didn't take the meds, as early as my first hospital stay when I looked around at the others on the ward and felt I didn't want to spend my life revolving in and out of the hospital.

The preparation involves committing to educating ourselves about the illness, and making plans for the future such as working and finding a place to live. Through action, we do what we've chosen to do. In the maintenance stage, we solidify and improve our recovery, using the techniques we've learned work for us and discarding what doesn't. This last stage requires we act as the expert on our own recovery.

In my life, I know I have to write things down to articulate how I feel about what's going on and the changes I'm contemplating. I thoroughly research my options, taking time to do this, and only after that do I act. I feel better having a plan; and when things are settled and decided, I rest easy-for the most part. My goal of owning a co-op is the scariest action I've dared consider taking. I've spent sleepless nights agonizing over this. Having come to the decision to act swiftly in this depressed real estate market, I'm no more at ease with it. The worry crops up as I move closer to the date I've set to approach brokers.

What can I tell you about making changes? Deciding to change is easy; taking action is the hard part. "Action cures fear" was an expression I wrote down repeatedly in my journal in the 1990s when I was anxious about taking risks. The key is to keep doing what scares you until it becomes second nature.

The goal is not for a provider to prescribe to a patient a formula for recovery, or to imply recovery is a standardized model and can happen on a timetable. As always, the professional-whether a doctor or therapist or a counselor at a day program-must take each individual's needs, values and own desires into account.

My psychiatrist feels I will make home ownership happen; he believes I can do it. I feel I need to act quickly because this is my life: senior citizens with mental health issues often aren't taken seriously or are pushed aside. I don't want to turn 70 and at best, be priced out of rentals in safe neighborhoods, or at worst, be institutionalized when it's not necessary.

Having a co-op would give me peace of mind that nobody could take my home away from me if the mortgage is paid off. I'd own it free and clear. As I begin this journey, I'll let you know how it goes, maybe even post in here pictures of the housewarming party I intend to throw when I move in.

I'll leave you now with the hope that what I've written makes sense. Next up, I'll talk about my three-year treatment plan and a great book I read that sparked me to explore setting new recovery goals. It's one I recommend you read if you're in transition and about to make a change.

Christina Bruni
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Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.