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|Change:||Introduction to Personal Change | Facilitating Change | Selfhelp Books on Change|
Mona Krishan, M.S.
by the Office of Women's
Health, Illinois Department of Public Health
Women From the Focus Groups Speak
Why This Guide?
Midlife and older women today probably have more opportunities to lead long, healthy, productive and fulfilling lives than ever before in history. This is the good news.
The challenge is that in order to have these long, healthy and fulfilling lives we must deal effectively with change. Changes are often imposed externally; the choice becomes how to manage the change ? to make lemonade from the lemons handed us by life. But many changes occur because we want to improve. These self-initiated changes may have a great deal to contribute to the gratifying quality of life that we seek.
Public health persons are interested in facilitating personal change because of the overwhelming evidence that morbidity and mortality are influenced by life style choices. Any program which can help people to make daily decisions which contribute to better health will improve the health of the population overall and reduce health care costs.
This is a very brief summary of what we have learned from our work helping women change. Our perspectives come from decades of studying about and working with women who are confronting changes, and from a recent special project in which we documented that even a modest Workshop can, in fact, help women change.
Learning About Personal Change
We have learned a good deal from a project funded by the Illinois Department of Public Health Office of Women?s Health: ?Promoting Mental Health Among Midlife and Older Women Using a Stages of Change Model.? That project was based in part upon an interesting model of how people change that has been developed by researchers studying how individuals deal with a variety of problematic behaviors (such as smoking, poor diet, inadequate exercise, negative thoughts). The model became known as the Transtheoretical or Stages of Change model because individuals seem to go through a similar series or stages of thoughts and actions in the process of making and sustaining personal change. The model and the guidelines for using it to direct personal change are summarized in a very useful book, Changing for Good by James Prochaska, Ph.D., John Norcross, Ph.D., and Carlo DiClemente, Ph.D. (1994).
As part of this project we met with eleven groups of diverse midlife and older women in focus groups to discuss what personal changes they would like to make, and what they had learned from past experiences about what helps them change and what makes it difficult to change. We drew on their insights to help us design a series of ?Changing for Good? workshops. We held eight workshops with diverse groups, and measured how they felt about the workshops and whether they used the experiences to help them change.
In our focus groups and workshops we found that many midlife and older women are open to personal change.
- Some women describe bad habits they wish to change. The ?habits? included a wide range of behaviors: grabbing a brownie instead of a peach; exercising the remote control rather than the feet; automatically thinking ?she won?t want to go with me? rather than calling an acquaintance to go for a walk or to a movie; thinking up excuses why one should remain in a dehumanizing job or relationship rather than exploring ways to alter the situation or find an alternative; automatically thinking ?I can?t do that? when invited to experience something novel and enticing, or when asked to consider personal change; being unable to straighten up or clear out the clutter in the closet or on the desk. The common theme is that the ?bad habits? contribute to a diminished sense of self-control and self-efficacy, which many women associate with growing older. Unfortunately, this psychological loss of the sense of possibility and control may contribute as much to poor self-care and lowered immune system functioning as the health-risky behavior. It is probably impossible to separate the habits of the body (e.g. exercise, nutrition, check ups) from those of the mind and spirit.
These are the women who are most likely to be helped by programs currently designed on the basis of the Stages of Change model. Most of the research on this model has been done with people who have identified specific problematic behaviors that they wish to modify.
Other women feel they are ok as they are ? but they can envision a way of being which brings them closer to feeling whole, empowered, fulfilled, and connected to the larger purpose of life. They do not come to a group promising personal change to focus on particular habits, but to address their concerns about their life direction in general. The change they seek is transformational. Most of the popular self-help books directed at midlife women deal with such desires.
We found that many women are able to use even brief group experiences to help them change, but that continued support would be more beneficial.
Over half of the women who attended one ?Changing for Good? workshop, lasting from 2-3 hours, were able to make progress toward the personal change goal they set for themselves at the end of the workshop. We measured progress using qualitative ratings and responses to a standardized measure (the Personal Change Questionnaire); the assessments from both measures showed substantial agreement.
Most of the women recommended that a good support program for personal change should extend beyond one session. They cited personal experiences with other, more extended programs, and their own sense that their progress would be strengthened and sustained if they could maintain the supportive connections begun in the workshop. This makes very good sense in terms of the evidence: initiating change is often a long and complex process ? but sustaining change is even more challenging. A single-session workshop can help women at any point, but no single experience will be enough.
Creating a Successful Workshop Experience
Our expert in creating successful workshop experiences is Jean Ellzey ? since she has been doing that for several decades, and led all of the workshops for our project. While our project was the first time she had tried systematically to apply a Stages of Change approach to her work, she found that the basic ingredients remained the same. Most of the women in our groups were in the early stages of change ? wondering whether they even wanted to change, contemplating what they would have to give up to change, and struggling to form a clear image of what they and life might be like if they managed to change.
Developing a good group for women who want to change is a lot like making a cake. You need the right container to start with: an atmosphere conducive to building trust. You need a good recipe, one that calls for ingredients that mix well together and produce a nutritious, satisfying resource of soul food. What are the best ingredients?
The following are some important factors I consider to be important in a guide to facilitating change in midlife and older women.
ATMOSPHERE. Size is important, five to ten women. Regular attendance is important to building trust, if more than one meeting. Time allotted for all to share, but silence is okay too, if preferred. Presentation of an object at first time together, so that a little self-disclosure can both introduce them and hopefully build a little trust and security in sharing. In this project we used a selection of Beanie Babies (small stuffed animals), with an instruction to select one and share with others how this creature represented something about them. In other sessions we have used stones, pictures, or other symbols. Underneath all is the meaning of education, "educere", to "lead out," rather than fill them with more words.
ASSESSMENT. Reflection time is important to help members see where they're starting from on their journey in this workshop. Where are they now in terms of their own reality? ("The facts, Ma?m, just the facts.") What is, is (Kasl, 1992). William Bridges (1980), an expert on the subject of transition, might say, "Look at what is ending for you right now." Some women might say marriage, some my job, my child-bearing years, my Mother just died, etc. Other pieces of their reality might be attitudes or patterns they want to change, like ?I don't want to be so negative, I want to be more accepting of others and more able to love,? etc. There are all kinds of endings and desired outcomes for midlife and older women in a group on change.
ACKNOWLEDGMENT of this reality, or clarifying and putting it into words. This is necessary before any change or action can take place. It could be written or shared with a partner. This is a good place to discuss The Serenity Prayer, used by 12-step groups.
BRAINSTORMING with the group considering the various effects of change or transition on them personally --the feelings, lostness, thoughts, awarenesses, etc. The Leader can use direct questions to them, or a "mind-map" with word transition in middle circle, or a sentence completion upon which to reflect. Hearing more of the feelings of the group often helps them realize their own feelings, helps them with self-reevaluation, and can make them feel less alone with their own problems.
SELECT A CHANGE GOAL. In looking at their Reality Now, take time to narrow down goals, or choose a measurable, realistic change they'd like to work on.
INFORMATION ON CHANGE THEORY. What tools (processes) can help them accomplish their chosen change? What relationships could help support them? What stage are they in, on the way to actual action? Are they open and ready to risk the unknown outcome, or to face their fears? Are they able yet to commit themselves to this possible change, no matter how small or large it is? This is not judgmental, but is to help them see the steps in making change work for them, the strategy of the process. They need to realize the process is lengthy, not short.
PREPARATION. Discuss the strategy that might help them accomplish this goal. A form can be useful here: list the goal, set a date for action, identify the motivators for achieving it, identify the obstacles to doing it, identify their resources. This allows a plan or strategy to form in their mind (and on paper) that often becomes an unconscious motivator.
CLOSURE. Toward ending of session, let them share their goal, and one or two things about it, like: What do I intend to work toward? What short-term action step will I take?
Other Tools to Facilitate Change
- BOOKS. Self-help books are also powerful tools for many women. Because of the experiences of women leading and participating in our focus groups and workshops, we have developed a very selective list of books that have been helpful to midlife and older women in their own efforts to change negative habits or seek self fulfillment. Because we are interested in the Stages of Change model, based in a great deal of empirical research, we evaluated the books in terms of this model. Most of the books reviewed are good for the early stages of change; few deal with Action or Maintenance stages.
Our publication, Self-Guided Change: An Annotated Guide to Books for Midlife and Older Women Evaluated in a Transtheroretical Stages of Change Framework, by Jean Ellzey, M.S., Margaret Huyck, Ph.D., and Lorie Rosenblum, Ph.D., M.S.W. is available from OWL chapters; from the Department of Public Health, Office of Women?s Health; or can be downloaded from http://www.owlillinois.org; or requested from Dr. Margaret Huyck, Institute of Psychology, Illinois Institute of Technology, Chicago 60616.
- WEBSITE RESOURCES. An important resource for information, exhortation (e.g. consciousness-raising), and even support is the internet. Depending on the kind of change envisioned, one can access information about:
1) Health consequences of particular behaviors, or behavioral consequences of health problems ?
Institutes of Health]
[National Women?s Health Resource Center]
Mental health issues]
2) Self-help resources ?
Women?s Health Helpline,
IDPH Office of Women?s Health: 800-522-1282
[Illinois Self-help Coalition]
1) Local community colleges often have courses in personal change
2) Local organizations may facilitate change ? e.g., inanna, a women?s empowerment organization, with a quarterly newsletter and monthly personal growth classes; contact through firstname.lastname@example.org, telephone 630-357-1531.
3) OWL Illinois is a national, grassroots organization dedicated to education, advocacy and mutual support for midlife and older women. They have local chapters in Illinois, and a statewide organization. Call 312-347-0011 for more information than is available on this website.
About the Authors
Jean Ellzey, M.S.
After being a homemaker for 24 years, I decided I needed more mental stimulation and a chance to contribute something outside the home. I didn't know what! After receiving my M.S. in Counseling Psychology in the mid-'70's I was hired to direct the Returning Woman's Program at a community college. I started counseling and teaching women who were primarily homemakers. As the years have gone by, the clientele for courses on women has become women "working outside the home for pay." Some problems they bring are similar; many are different. But the effects of change and transition in their lives are the same, in 2001 as in 1976.
I continue to teach "Women in Transition" part-time at College of DuPage, I facilitate support groups for women, and I do one-to-one consultations, or "Tutorials in Transition." I enjoy giving presentations on the one absolute in life: CHANGE.
Contact me at (708/386-9621) or JeanGLZ@aol.com
Margaret Hellie Huyck, Ph.D.
I began my study of middle and later life at the University of Chicago Committee of Human Development about 40 years ago; adult development was the exciting uncharted territory! I am currently a Professor in the Institute of Psychology at Illinois Institute of Psychology. I have published two books about adult development and aging, and share what I know about family relations, personal development, and related issues with many different groups. My primary research focuses on adult parent-child relations, midlife marriage relationships, and gender identity styles. I also do program evaluation research, currently with programs designed to help families who provide care for older persons. For over a decade I have been an activist with OWL, the organization that serves as ?the voice of midlife and older women.?
Contact information: email MHHuyck@aol.com, Phone: 773-667-3649; Fax: 773-667-1419
.Institute of Psychology, Illinois Institute of Technology, Chicago, IL 60616
Mona Krishan, M.S.
I joined this project because I became fascinated by the dilemmas presented to me by the women working in the Delhi factory where I had persuaded the owner to let me set up an official site as a counselor. While they were initially unwilling to talk with me, I found that when I gained their trust they were able to share their concerns about the complex work and family issues they encountered.
I have heard some of the same concerns in my work with this Change project. My role on the project is as Research Assistant; it has been an important part of my learning as a student in the Ph.D. program in Clinical Psychology at Illinois Institute of Technology. I have learned about the complexities of understanding and measuring personal change.
Lorie Rosenblum, Ph.D., MSW.
I am still working on my transformations. I became a Social Worker at midlife, after my career as an English professor had reached a dead end. I find my second career as challenging and rewarding as the first, and I see remarkable continuities between the two. Instead of reading stories, I listen to them, and build on narrative theory to practice narrative therapy. I?ve taught and written about the power of ?illness stories,? and lectured on various topics, including a slide presentation, ?Women Artists Looking at Women?s Bodies.? I value collaborative writing, and am always on the look-out for a co-author. I am also a founding member of the Hyde Park OWL chapter, and I enjoy turning ?meetings? into ?groups.?
Contact information: email dolrosen @aol.com. Phone: 773-643-4347, home; 708-660-2825, work.
Project Funded by the Illinois Department of Public Health,
Office of Women?s Health