Are you ready for change?

One of the things I miss about practicing psychotherapy is the challenge of helping people make change.  Unlike other health care providers, counselors and therapists are not in the business of telling people what to do. Instead, we have the opportunity to help people discover their readiness for change, explore their options and make empowered choices.

Hmm…that sounds a lot like a being a Migraine Advocate.
It’s a good thing the skills transfer!

When people think about making a change, it is tempting to jump right into the “I know I should so I’ll just force myself” phase. Most of the time, despite good intentions and enthusiasm, the change doesn’t last. Rarely do people ask themselves if they are ready to change, if they want to change, if they know what it takes to change, or what might keep them from changing. So we all go through lots and lots of failures in an attempt to make a change.

Here at we meet a wide variety of people who represent what mental health professionals call Stages of Change. These stages are part of an intervention style called Motivational Interviewing (MI). It’s a pretty simple concept and certainly doesn’t take an advanced degree to understand. MI is a way to help people make positive change without persuasion, threats, ultimatums, or intimidation. This counseling style recognizes that change is only made when a person is ready. Permanent change can’t be forced, mandated, or legislated. MI counselors acknowledge that people only change when they are ready, despite the attempts of others reward, reinforce, or punish.

Take a look at the list of stages below. Can you find yourself in this list? Keep in mind that everyone goes through all of these stages multiple times before successfully making a change. Seeing yourself in one stage isn’t positive or negative. It just helps you understand better why you might not be successful at making a change just yet. All change follows a predictable course. Only the timetable varies.

“I’m just fine.”

The technical term is Precontemplation which is just a fancy word for saying, “I haven’t thought about and don’t see the need to.” People at this stage may not even know they are having migraine attacks. If they have been diagnosed, they often believe one of three things:

  • Their migraines really aren’t that bad.
  • There isn’t anything that can be done to help.
  • They’ve already found a solution that works for them.

Even though these beliefs may not be true, patients at this stage cannot be persuaded otherwise. No amount of encouragement, bribing, threatening, etc. will convince them. Patients can also return to this phase after a particularly rough treatment failure. In this case, they are discouraged, frustrated, and skeptical of the benefits of trying again. The more people try to convince them, the more resistant they become.

I remember a time when I was in this stage. My doctor really wanted me to try Topamax. He had high hopes that it would finally get my attacks under control. He gently brought it up at every appointment for almost two years. Every time I refused his offer. The side effects scared me, making it impossible for me to even consider all the positive studies on its effectiveness as a migraine preventive. I had to get to a place of readiness all on my own.

“I wonder if…”

In this Contemplation stage, patients admit there is a problem and imagine the possibilities. Maybe they read an article, talk to a friend, or just get tired of too many attacks. They don’t make any commitment to action. Instead, they are ambivalent, fear failing, and focus exclusively on the possibility of negative outcomes.

“What if it worked?”

Patients begin to think seriously about what it would take to make the change. They begin to prepare by talking to others who have made similar changes. They will solicit other’s opinions about experiences with various treatments. We read a lot of posts that start out, “Has anybody tried…?” That type of question is a hallmark of this Preparation stage.

“Let’s do this!”

Most doctors (and even therapists) like to work with patients at this stage because patients are already convinced to make the change. They are ready to get started and take active steps toward change. Frankly, professionals have it easy by this phase. We like to think this is when we finally get to do our jobs and get our egos stroked by the success of our patients. Hey, we’re only human.

A migraine patient in the Action stage is often keeping a diary, asking about treatment options, watching his or her triggers. They are informed and involved, looking for an expert partner to help them make a permanent change.

“Rock-n-roll, baby”

At this stage, patients are building the skills that maintain change. When it comes to migraine, Maintenance behaviors involve faithful use of a diary, taking medications on schedule, keeping appointments, actively avoiding triggers and choosing migraine-friendly lifestyle habits. The phase looks different depending on what change is being made. Patients (and their providers) have a positive outlook in this phase. It can be tempting to feel as though change is finished, that the achievement has been made.


Inevitably, we all fall off our own “wagon”. Relapse is a natural part of the change process.  We get tired of taking medicines, treatments fail, and patients get worn out. When the initial enthusiasm is met with harsh reality, it is only natural to feel like giving up. It starts slow. We forget to take our preventives one day. We delay taking our abortive at the first sign of an attack. We miss our favorite snack – the one guaranteed to trigger an attack. Holidays, vacation, and illness disrupt that delicate balance we’ve been maintaining. That initial cynicism returns and we lose hope once again.

This pattern will recycle over and over again until change is fully established.

Next up:Motivational Interviewing in action

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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