Maybe You Should Talk to Someon - Lori Gottlieb Page 0,123
eat. We can’t convince an alcoholic not to drink. We can’t convince people not to be self-destructive, because for now, the self-destruction serves them. What we can do is try to help them understand themselves better and show them how to ask themselves the right questions until something happens—either internally or externally—that leads them to do their own persuading.
It was Charlotte’s car accident and DUI that moved her into the next stage, contemplation.
Contemplation is rife with ambivalence. If pre-contemplation is denial, contemplation might be likened to resistance. Here, the person recognizes the problem, is willing to talk about it, and isn’t opposed (in theory) to taking action but just can’t seem to get herself to do it. So while Charlotte was concerned by her DUI and the subsequent mandate to participate in an addiction program—which she grudgingly attended and only after failing to take the course in time and having to hire a lawyer (at great expense) to get her deadline extended—she wasn’t ready to make any changes to her drinking.
People often start therapy during the contemplation stage. A woman in a long-distance relationship says that her boyfriend keeps delaying his planned move to her city, and she acknowledges that he’s probably not coming—but she won’t break up with him. A man knows that his wife has been having an affair, but when we talk about it, he comes up with excuses for where she might be when she’s not answering her texts so that he doesn’t have to confront her. Here people procrastinate or self-sabotage as a way to stave off change—even positive change—because they’re reluctant to give something up without knowing what they’ll get in its place. The hiccup at this stage is that change involves the loss of the old and the anxiety of the new. Although often maddening for friends and partners to witness, this hamster wheel is part of the process; people need to do the same thing over and over a seemingly ridiculous number of times before they’re ready to change.
Charlotte talked about trying to “cut back” on her drinking, about having two glasses of wine each night instead of three or skipping cocktails at brunch if she would be drinking again at dinner (and, of course, after dinner). She could acknowledge the role that alcohol was playing in her life, its anxiety-muting effects, but she couldn’t find an alternative way to manage her feelings, even with medication prescribed by a psychiatrist.
To help with her anxiety, we decided to add a second therapy session each week. During this time, she drank less, and for a while she believed that this would be enough to control her drinking. But coming twice a week created its own problems—Charlotte was once again convinced that she was addicted to me—so she went back to the once-a-week schedule. When, in an opportune moment (say, after she’d mentioned getting drunk on a date), I’d bring up the idea of an outpatient treatment program, she’d shake her head. No way.
“Those programs make you stop completely,” she’d say. “I want to be able to have a drink at dinner. It’s socially awkward not to drink when everyone else is.”
“It’s socially awkward getting drunk too,” I’d say, to which she’d reply, “Yeah, but I’m cutting back.” And by then it was true; she was cutting back. And she was reading up on addiction online, landing her in stage three, preparation. For Charlotte, it was hard to concede the lifelong fight she’d been in with her parents: “I won’t change, Mom and Dad, until you treat me the way I want to be treated.” She’d made a subconscious bargain that she’d change her habits only if her parents changed theirs, a lose-lose pact if there ever was one. In fact, her relationship with her parents couldn’t change until she had something new to bring to it.
Two months later, Charlotte waltzed in, unpacked the contents of her bag onto the arms of her throne, and said, “So, I have a question.” Did I know of any good outpatient alcohol-treatment programs? She had entered stage four, action.
In the action stage, Charlotte dutifully spent three nights per week in an addiction-treatment program, using the group as a substitute for the wine drinking she used to do at that time. She stopped drinking entirely.
The goal, of course, is to get to the final stage, maintenance, which means that the person has maintained the change for a significant period. That’s not to say that people don’t backslide, like in