RESISTANCE TO CHANGE
or How Hard Can We Make This?
It was a particularly trying morning; plans had changed at the last minute, chores were piling up, the AC went out on mom’s car just as the temperatures were climbing into the summer 90-degree-plus pattern, and I made a comment in a short text about something I read in the Parkinson Report (Summer 2017) publication that I had kept for some reason. In a short column entitled Tips for Activities of Daily Living, I read “Placing a plastic shopping bag on a seat before sitting helps reduce friction when sitting down and getting up.” Mom had long complained that she had difficulty getting dad up from his Sherpa covered chair and that he did not sit straight and became agitated, even combative, when she or the caregiver tried to adjust his position. At first, I thought she should pick her battles and let him sit the way he wanted to, but I decided my own frustration was at the root of that unhelpful suggestion. Her reply from the text? “Wouldn’t he just slide around?” I silently simmered, “OMG!! You won’t know until you try it!” But the most pressing thought in the back of my mind was why must everything be so difficult??
The answer is resistance to change. It is my belief that resistance to change is part of the grieving process. It is a set of responses that parallel the conflict cycle and exacerbate the ability to make progress, grow, or change behavior. We all experience resistance to change within ourselves, in others, and in our environment. A seedling will grow in what seems to be the worst of places, but it still grows and tries to adapt to its environment regardless of the conditions. One might argue that it cannot move, so why not? Alas, would it move if it had the ability to do so?
Prochaska’s Stages of Change Model (Prochaska et al, 2015) discussed in detail the six stages of change. Each stage, with a very brief explanation, is listed below.
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Precontemplation. Not acknowledging that there is a problem behavior that needs to be changed.
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Contemplation. There is a problem, but not ready or wanting to make a change.
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Preparation/Determination. Getting ready to change.
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Action/Willpower. Changing behavior.
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Maintenance. Maintaining the behavior change.
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Relapse. Returning to older behaviors and abandoning new changes. (Prochaska et al, 2015).
In the first stage, the problem is not acknowledged by the individual. In the second stage of contemplation, the problem is acknowledged and the pros and cons of addressing it are considered. Stage 3 is the commitment to change or to make a change. This is the phase for gathering information. Mom was not at this stage. Stress had caused her to decide that things were not going to change in general so small incremental steps to improve the situation weren’t viable. It is important to note here that there is usually at least one individual in the family system that wants to change the situation and tries to find all kinds of strategies, aids, and tips to change it. They research and discuss and suggest and wonder why their suggestions fall on deaf ears. Have you figured out that I am that person in our family system? The answer to why these suggestions are not heeded is simple. Mom is not in the same stage of change. She sees the dementia as the entire problem—i.e. she must take care of dad—and this problem is not the sum of its parts. It is a whole problem that should have one solution, not multiple solutions.
Stage 4 is where one believes one has the power to change. This is the stage when one is open to receiving help and may seek help from others. An example of this was when my mother needed to go to the clinic for a day surgery procedure. She had made all the arrangements to have caregiver coverage for dad but insisted on driving herself to the procedure, not knowing if she would feel well enough to drive home afterward. There was much discussion, and she mentioned a friend of hers that had offered to drive her to and from the appointment and stay there during the procedure. My mother did not want to accept the help offered despite the peace of mind it might give her – and us.
A few days before the procedure, she decided to call her friend and ask if she was still available. Stage 4!! It should also be noted here that we can be in different stages regarding separate issues in our lives and we may flow easily in and out of them.
Stage 5 is maintenance of the new behavior.
Stage 6 is self-explanatory: a relapse to old behaviors.
The reason for this section is simple. In dealing with a dementia diagnosis, the client and family will experience these stages of change. It may be extremely difficult to convince a dementia client that they cannot drive, or for a primary caregiver to hire outside help or sign up for palliative care or hospice. Every individual responds to change at his/her own pace, and the acceptance of the need for change can be a slow process. Family members and siblings need to realize that others might not be on the same page—or at the same stage—to initiate change in their behavior or level of support in the caregiving situation.
Source:
Prochaska JO, Redding CA & Evers K (2015). The transtheoretical model and stages of change. In Health Behavior and Health Education: Theory, Research and Practice, 3rd Edition. San Francisco, CA: Jossey-Bass.