Psychology
A STEP
TOO FAR?
Have we been right
to embrace the
‘cycle of change’,
asks Natalie Davies
hen Bill Wilson, who went on to co-found
Alcoholics Anonymous, was hospitalised for the
fourth time for alcohol detoxification, he cried, ‘If
there is a God, let Him show Himself!’. As AA’s
story goes, ‘the room became ablaze with light
and Wilson was overwhelmed by a Presence and a
vision of being at the summit of a mountain
where a spirit wind blew through him, leaving the
thought, “You are a free man”. Wilson never took another drink.’
Though Wilson’s story is spectacular – so much so that we might be inclined to
think it a ‘fable’ rather than a blueprint for what might actually happen – it’s not
unusual to hear about ‘revelatory moments’ or moments in which someone
suddenly or spontaneously discards a substance that up to that point they had
depended on. An example is the smoker who suddenly becomes disgusted with
their smoking, spits out the cigarette half way through, dumps the remnants of
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the packet in a bin, and never turns back, as if something had overtaken them.
But another important narrative, and perhaps one more pertinent to the
conversations between practitioner and client, is of the ‘longer road to recovery’ –
of a process of change rather than a one-off event; of an experience mixed with
conflict, ambivalence, vacillation, regret, and often relapse. And it’s this process
that Prochaska and DiClemente’s ubiquitous ‘five stages of change’ model
endeavours to describe.
The ‘five stages’ plot the journey from Point A (‘no acknowledged problem’) to
Point B (‘no problem now’) – each marker along the way representing a shift in
motivation, intention, and capacity to change. Dealing frankly with the possibility
of relapse, the popular depiction of the five stages as a ‘cycle of change’ (see the
illustration opposite) shows the continued work that people can do or redo until
the day they successfully achieve what is known as a ‘lasting exit’ to recovery. The
cycle shows the progression or evolution through the stages of pre-contemplation,
contemplation, preparation, action, and maintenance, and how this can come full
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