The Center for Brain/Mind Medicine > Support & Education
Stages of Change for Caregivers
Changing With Our Person
Becoming a caregiver for someone with dementia means you have to change your own behaviors as the disease progresses. This is a lot to ask, especially if you’ve been in a relationship with the person with dementia for a long time.
The Stages of Change Model is one way to break these changes into manageable steps. Originally developed by psychologist James Prochaska and colleagues to help people quit smoking, we now know this model can be useful in changing other behavior patterns. The five stages of change in this model are precontemplation, contemplation, preparation, action, and maintenance.
Let’s see how this model can help you modify your behaviors as a caregiver to make life easier for yourself and your person. For example, how do you respond when your person says things that are not true, don’t make sense, or are incorrect? In the old days (pre-diagnosis), you may have corrected the person or politely disagreed. Now, however, this leads to a tug-of-war you’ll never, ever “win.” Your person will feel hurt and angry; you’ll feel frustrated and guilty.
You might consider changing this dynamic by framing it in stages. By now, you’re probably past the precontemplation stage. You know you need to change your behavior, since your person can’t change. You’ve already moved one stage ahead into contemplation—you’re thinking about changing how you react.
Now you can move into the next step: preparation. You may feel some grief—you’ve lost the way things used to be between you and your person, back when you could share the same reality. You may need to learn what you can say to preserve your own reality, yet not upset your person. Perhaps you’ll set a conscious intention to pause before responding the next time your person says something untrue. You might also share your intention with a trusted friend so they can cheer you on.
Next comes the action stage. This is where the rubber meets the road—trying the new way and practicing it. If your person says, “That house over there is new” and you know it’s been there for years, you could try just nodding, saying “Hmmm…” or responding, “It does look new, doesn’t it?” If your person says they used to live in Paris (not true), you could try smiling and not commenting at all. If your person accuses you of hiding their wallet, try responding with, “I didn’t mean to misplace it. Let me help you find it.”
There’s no fool-proof way, no one-size-fits-all strategy. Experiment to see what works best for you and your person.
Consider keeping track of how many times a day you manage to avoid correcting or contradicting your person, and rewarding yourself for your improvement over time. Change is hard. You‘re replacing old habits with new ones. It’s okay that you won’t always respond perfectly. It’s also okay to pat yourself on the back for simply trying. Finally, support is particularly important during the action stage of change. A caregiver support group can be invaluable.
We all know how easy it is to backslide. That’s where the maintenance stage comes in. The more you practice, the more automatic the behavior will become, the less effort it will take and the easier and more natural it will feel. After a while the new behavior replaces the old and becomes the norm.
But, guess what? As soon as you change one behavior, your person will move on to another stage requiring you to change in different ways. It will help you to anticipate what might be ahead by learning about the types of changes your person may go through as they move from stage to stage. You might also find it helpful to learn about what skills you can acquire to best manage during each phase. That way, when the time comes, you’ll already be past precontemplation and contemplation and into preparation.
The Important Takeaway
Change takes time and grace. You can do it!