Motivational counseling is a powerful and useful therapeutic paradigm that has helped motivate many people to get over their psychological inertia.
By MICHAEL GROPPERLegs on scales (illustrative).(photo credit: ING IMAGE/ASAP)
Sir Isaac Newton’s First Law of Motion (Law of Inertia) states: An object at rest remains at rest and an object in motion remains in motion, unless acted upon by an outside force. When applied to the mental health field, we see this can also help in understanding our psychological behavior.The psychological meaning of the word “inertia” implies an indisposition to change – a certain “stuckness” due to human programming. It represents the inevitability of behaving in a certain way, the way that has been indelibly inscribed somewhere in the brain.It also represents the impossibility – as long as a person is guided by his habits – of ever behaving in a better way, as per Dr. James Kowalick’s definition.Psychotherapists commonly encounter examples of psychological inertia in their psychotherapeutic work with clients. In fact, a common problem that brings clients to therapy is that they feel stuck and unable to make essential changes in their lives.Leon is a 70-year-old widower who knows he should take his morning walk, but has ceased doing so ever since his wife died two years ago.Rivka, a single woman of 25, has been overweight all her life. She knows she needs to lose weight and is tired of feeling so heavy; she hopes to meet a guy and settle down, and doesn’t really like the way she looks or feels. Yet she just can’t seem to turn the corner, and start changing her diet and exercising.Jay, 45 and married with two children, is an accountant; he makes great money, but feels like a slave to his work and his cigarette addiction. “Don’t worry,” he insists, “I will quit smoking after tax season ends.”Sarah, 20, is lonely and suffers from social phobia. She is terrified of going to public places and being around people. Sarah knows she should call a psychotherapist to get help, but keeps putting it off.The above examples sound all too familiar to many people. So when it comes to change, why do so many people get stuck in the mud, and what can be done to help them? While it is important to understand why you have trouble changing, this alone is often not enough to get people to make changes in their lives.One of the most promising theories to help people do so comes from the field of motivational therapy and is known as the transtheoretical model. It was developed by psychologists James Prochaska and Carlo Diclemente in 1982; they sought to understand how and why people change, either on their own or with the help of a therapist.
The model breaks down the process of change into five key stages: precontemplation, contemplation, determination-preparation, action and maintenance. Let’s briefly look at how this model works and how it was useful in helping Rivka.When a person is in the precontemplation stage, he/ she does not even think there is a problem that needs changing. In Rivka’s case, she spent many years not paying any mind to her serious weight problem. Although she wasn’t happy about her obesity, she saw no relationship between her over-indulgence in food and her body weight, low self-esteem and desire to achieve significant goals in her life. Growing up, other children made fun of her because of her weight issue and she always felt on the outside of the social circle; her dating life was now “a zero,” to use her own words.When Rivka turned 25, she realized that many of her friends were either married or in serious relationships.She began to be concerned about her body image and to think she might need to do something about it.Rivka had entered the contemplation stage of change: No longer in denial, she was seriously thinking she had to do something. She started to admit to herself that she had a serious food-addiction problem, and that she had no real control over her binge eating.Rivka felt stuck, so she came to therapy asking for my help. This is called the determination-preparation stage of change; for the therapist, this point is the “window of opportunity” when you see the person is really ready to transform. I helped her start to list reasons why she wanted to lose weight. She was pretty clear about this, but did not feel she could succeed; her self-confidence was very low.My goal here was to help her develop more confidence by increasing her motivation (getting Rivka to identify personal reasons why she wanted to lose weight), addressing her ambivalence and anxiety about starting to make changes in her diet. Rivka was clear that she wanted to look better, attract men and feel good about herself. We also explored the meaning of feeling good about herself, and discussed many factors in her life that may have compromised a more positive self-esteem.Finally, Rivka was fully on board and ready to undertake the necessary adjustments to embark upon her new diet and exercise plan. The action stage follows, and Rivka was able to start her new program. It was during this stage that she really needed a lot of encouragement and empathetic support from this therapist, as well as from her good friends.Of course, making a change is no guarantee that it will be maintained, so as she began to lose weight, I taught Rivka relapse-prevention skills to prevent slips – occasional regressions when trying to keep new and healthier behaviors in place. If and when a slip would occur, Rivka needed the psychological tools to learn from them and understand what went wrong, to get back on track and continue her change process. This stage is called the maintenance stage of change.Motivational counseling is a powerful and useful therapeutic paradigm that has helped motivate many people to get over their psychological inertia and put into action the personal change goals that will enable them to live healthier lives. People seeking transformation have to start somewhere, and admitting there is a problem and contemplating change is the place to begin.To quote political commentator and writer Ben Stein, “So many fail because they don’t get started – they don’t go. They don’t overcome inertia. They don’t begin.” The writer is a marital, child and adult cognitive-behavioral therapist with offices in Jerusalem and Ra’anana; he also provides online videoconferencing psychotherapy. drmikegropper@ gmail.com, www.drmikegropper.weebly.com