MOTIVATING POSITIVE CHANGE

Patients coming to a physician or other health care professional for help, especially in the areas of prevention and health promotion, often come to get new information and ideas. Once those have been transmitted, however, the next, and often harder step, is putting these ideas into action.

We have all heard the expression that “The road to Hell is paved with good intentions.” This phrase also points to the gap between ideas and action. So we can start with good intentions – what gets us side-tracked?

Inner Children

In the 1960’s and 1970’s, some people conscious of their health and wanting to heal old wounds began to speak of one’s “Inner Child”, the part of oneself that was small, weak, innocent, hurt, and in need of comfort. It’s a powerful idea that can provide great motivation to change.

Let me give you a personal example I have often shared with my patients. For years as a child and young adult, my dental health was nothing to write home about. And for years, my dentist had told me, over and over again, to take better care of my teeth. She may or may not have given me any details on how to do this, but if she did, I wasn’t listening.

Then, one day, I went to a dentist in another city, and spent some time with his assistant. She asked me if I knew how to floss, and I said “I think so.” She then asked me to show her how I did it, so I did. She watched my technique, and then, with excitement said “Oh! There’s something I can show you to help you! Would you like me to?” I said yes, and then she proceeded to show me how to floss properly. It had been the first time I can recall that anyone had done that.

As the months went by, I started to floss more and more regularly, and somehow, it didn’t seem like a duty or a burden. I used to “treat” myself at times by going to bed without flossing, but I grew to realize that treating myself by harming my health was no treat at all! I started to think of flossing as an act of caring for myself, as an act of self-love. And I have no doubt that the change started with that dental assistant who was able to relate to me in a playful, non-judgmental, and enthusiastic way. Anyone who has spent time with small children knows that this approach is a less stressful way to guide them into making appropriate choices than coercion and control.

Other Inner Beings

There is another resident of all of our psyches that needs mentioning. He or she is called the Shouldmonster. I think of her/him as being like a well-intentioned, pushy, bigger older sibling whose heart is in the right place, but who is clumsy and bullying in their approach. The Shouldmonster says “You should eat better. You should exercise more. You shouldn’t yell so much. You should turn off the TV.” And what happens? In the majority of cases, little to no lasting change in behaviour occurs, past a few guilty and sullen stabs at something new that are quickly abandoned.

Why doesn’t this work? I can share with you a conversation that I had with a recovering alcoholic patient of mine about exercise:

MD: So what about exercise? Are you managing to do any these days?
Patient: Well, I keep pushing myself to do some.
MD: And what happens?
Patient: Well, sometimes I do a little, but then I stop not too long after.
MD: Do you have any idea why that I might be?
Patient: No.
MD: Can you tell me what happens when someone else, like for example your wife, pushes you to do something?
Patient: I dig in my heels and get stubborn!
MD: So when someone pushes you to do something, you resist.
Patient: Yes.
MD: Would you consider that you are pushing yourself to exercise, and when you’re pushed, you resist? You’re resisting yourself!

Why is the Shouldmonster there?

I believe that there are several cultural reasons at work. In my work with addicted patients, I have come to believe that our culture has a very poor understanding of compulsion in everyday life. By compulsion, I mean the reality that all of us at times do something we wish we hadn’t after the fact, where we lost our power of choice in doing more than we had planned. Almost everyone can relate to, at times, doing one of more of the following: eating too much; drinking too much alcohol; staying in that relationship too long; staying up too late; losing more money than planned at the casino. The usual response of people to this is to invoke willpower, to “pull oneself up by your bootstraps,” to try harder. But if this worked for most people, we would have almost no compulsive behaviour in our culture, since determination is something that generally, most of my patients have.

Vicious Cycles

Another reason why this approach rarely works is that it sets up a vicious cycle: I do something I shouldn’t, I feel bad about it, I resolve to do better, I push myself to change, it doesn’t work too well, I feel even more bad about it, I feel hopeless, and I give up trying to change. Often, what’s at the base of this hopelessness is a feeling of shame, the sense that I am somehow unworthy of care and love, even from the self. In this state, people feel disempowered, and in my experience, disempowered people are rarely able to bring about positive change.

So what works?

One principle of addiction recovery that can work for anyone, addict and non-addict alike, is that of surrender. If someone is fighting a losing battle, over and over again, then to continue to fight is to continue to lose. In this situation, the only way to win is to surrender. This doesn’t mean giving up in hopelessness; but it does mean accepting that what has been tried hasn’t worked, and something new needs to happen. It implies a gentleness towards the self, a more forgiving attitude that accepts that we all lose our power of choice at times, and that, often, it’s not really that big a deal. If a person accepts that they, for instance, overeat at times, rather than trying to control the behaviour (and likely not succeeding), they can accept in a non-judgmental way that at times, this happens. Then, they can calmly look at the circumstances in which they lose their power of choice over food. Often this happens when someone is upset, or celebrating, or nervous in social situations, or trying to fit in. By accepting that the behaviour happened, it is far easier to get at the root cause of it, and, through greater self-awareness, start to learn to choose gentler and healthier options. Again, it’s far easier to describe this process than to put it into action, but as with any human skill, it does get easier with practice.

So what about the Shouldmonster?

What works on the Shouldmonster best is laughter and play. A Shouldmonster is a serious sort, whose currency is anger, coercion, and pushiness. Unfortunately, getting angry at your own Inner Shouldmonster only makes them stronger and pushier. You push, they push back, and you become the battleground! Often, what a Shouldmonster needs more than anything is to relax and have healthy fun, which means fun without a hangover, whether it be physical or emotional. Perhaps you could take your Shouldmonster for a slow walk around the neighbourhood, or play with a child, or a pet. In my personal and professional experience, a calm acceptance of the Shouldmonster’s presence, a light attitude, and a willingness to stop fighting with it can help people to approach their lives in a less serious way that is both more fun and far healthier.

Conrad Sichler MD, CCFP

close article