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The Adjustment Process

Adjustment: What does it mean? The Oxford dictionary defines adjustment as: 1. To adapt or harmonize or 2. to regulate. Tabor's medical dictionary defines the word as: 1. Adaptation to a different environment or 2. A change made to improve the function or condition.

Adjustment models of counselling typically look at the process in five stages: 1. Shock; 2. Denial; 3. Anger; 4. Acceptance ; 5. Reintegration.

These steps have been referred to by many names, and more recently include this fifth stage of reintegration. Older models focus on Acceptance as the goal. I have walked with many patients and their families through this process.

Acceptance is a psychological goal. How to integrate new circumstances into life is a new challenge that requires learning and reflection. Life will continue to throw us curveballs, but we are responsible for how we choose to react to change.

I encourage patients and families to complete inventories of available strengths and resources, both internally and externally. Identify areas or gaps, and build on these areas. If you are solely dependent on family for social functioning, this might be a good time to take the risk of meeting new friends, joining a community group or activity centre. If you are strengthened primarily by your work and vocational pursuits, now might be a good time to regroup with your family and friends or develop some leisure activities.

I use a series of concentric circles for people to visually be able to assess their social supports. These supports are fluid and can move back and forth between the rings. You will be in the centre of your ring. An example of a fluid support in your life might be your doctor. My work in acute care sees this all the time. In times of wellness, the doctor often resides in one of the outer rings as an available resource, but in times of acute need, the doctor often moves towards the centre with you.

The other area I focus on is realistic goal setting. If you are blind or severely vision-impaired, and your goal is to read a printed book, you might have to seriously reconsider your intent until you master alternative techniques of blindness. If you have just been discharged from hospital, a realistic goal for the first day might be to get up, shower and eat breakfast.

We are faced with setting goals and making choices daily. I recommend breaking goals into manageable pieces. If you are a student writing a term paper, and your goal is to complete it by the end of term, I would suggest an outline be drawn up with "mini sub-goals" along the way. Within the next two weeks, you could research your topic, the following week develop a structure, etc. By breaking goals into manageable pieces and reviewing your resources along the way, you are less likely to become overwhelmed and paralyzed by seemingly daunting tasks.

I work with patients and families who are coping with anxiety, bipolar disease, Psychosis, schizophrenia and depression. These patients are challenged to adapt to new and unexpected limitations. I find these techniques of resource inventories and realistic goal setting very effective tools.

Adjustment is a process we experience daily. We do not graduate from it. It is not a goal we achieve and then rest on our laurels. Adjustment, realistic goal setting and assessing internal and external resources are integral parts of day-to-day lives. We can not control what life presents to us or takes away. We can exercise control through the choices we make everyday. We can choose how we react to changing life circumstances.