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Motivation to Change Treatment at The Center for Eating Disorders


Motivation to Change

Ambivalence and resistance towards recovery are common among those with eating disorders even when faced with the negative, and sometimes dangerous, consequences of their illness.  Particularly at the beginning of treatment, individuals may find comfort in their symptoms, and thus may not be significantly disturbed by nor have any desire to change their behavior.  Some people are particularly reluctant to commit to the goal of weight gain while others may be ambivalent about relinquishing the ideal of thinness or the protective functions of other symptoms, such as binge eating and purging.  Because of this, a key ingredient in the initial phase of CED treatment is developing motivation for change.

Understanding Motivation

Scientifically proven stages of change, developed initially for understanding changes in addictive behavior, have been shown to be applicable to eating disorders. These stages of motivation are used to classify patients according to their “readiness” to make therapeutic changes. 

The Stages of Change

  • Precontemplation (no intention to change),
  • Contemplation (thinking about change, but not committed),
  • Preparation (intending to take action, but have not done so),
  • Action (modifying behavior),
  • Maintenance (relapse prevention). 

Research has shown that when therapeutic intervention is matched to a patient’s stage of change and the therapy is conducted within that stage, a more positive and long-lasting result is more likely. At the CED, therapists work to identify each patient’s readiness for change. Unless medical risks dictate otherwise, therapy begins with support, education, and other efforts to increase motivation. The overall goal is to move each patient from denial of their illness and resistance to treatment toward acceptance and readiness for change.

How is Motivation Developed?

At the Center for Eating Disorders, motivation for treatment is enlisted by therapists during group and individual psychotherapy. At every level of care, a combination of cognitive and behavioral strategies is applied in order to facilitate movement to the next stage of change. During this process, education about the stages of change is provided, obstacles to change are discussed, disadvantages of the eating disorder are identified, and specific goals for action are established.  At each stage of change, specific strategies are used to help move the patient to the next stage. For example:

  • During the precontemplation stage, the pros and cons of the eating disorder are discussed.  Ambivalence is created and an awareness of a problem is developed.
  • In the contemplation stage, all efforts are directed at establishing a commitment to making changes. 
  • At the preparation stage, obstacles to change are identified and problem-solving skills are boosted so that the patient may begin taking action.
  • During the action phase, efforts are directed at behavioral change. 
  • And, finally, during the maintenance phase, work is focused on the preservation of motivational gains.

Throughout this process, each patient learns to identify their current stage of change and recognize their own resistance, which will help facilitate treatment of their eating disorder overall. 

Maintaining Motivation:

It is expected that for most patients, motivation will ebb and flow during the course of treatment.  Even during the action phase, patients will experience indecision and ambivalence. Because of this fluctuation, it is essential that work on motivation continues, even after behavioral goals are achieved. Understanding this process is important in reducing discouragement and increasing long-term success.

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