When considering a change in one’s life, it can be useful to think of the process as a series of stages. In psychotherapy, the “Stages of Change” model (Prochaska & Norcross, 2001) is a highly valued and utilized construct that helps us understand how people change.
The most important factor in changing one’s behavior is motivation. And the stages of change are a useful tool for determining how motivated one is to change. Motivation to change is best viewed as a combination of intention to change and holding behavioral goals specific to change. For example, cessation and abstinence, or reduction and moderation, could be specific goals for substance use. Establishing a consistent workout routine could be a goal for weight loss. Setting boundaries could be a goal for interpersonal relationships. Whatever the type of change desired, it is important to set specific goals.
Once one is motivated to change, one must be ready to change. Readiness to change can be viewed as the degree of importance the change holds for the individual (Is it a vague wish or, is it a matter of life and death?) and the amount of confidence one has in their ability to perform the tasks necessary to make the change. The tasks required to move from one stage to the next often take a great deal of energy and effort for which one must be prepared. Further, the tasks of one stage often interact with those of the next stage of change and prepare one to progress toward the goal. An example of a task could be identifying the situations and emotions that trigger the unhealthy behavior and substitute alternates that do not. Or conversely, developing methods to cope with behavioral triggers that are unavoidable in one’s current situation. The tasks must be personalized to the individual and their goals for change.
There are typically five stages that individuals go through in the process of change (six if one includes termination as a stage); These are precontemplation, contemplation, preparation, action, and maintenance.
In the Precontemplation stage, one may have a vague notion that things are not right, often because of input from others, but does not have a desire to change one’s behavior or have any sense of immediacy regarding it. Some reasons for this may be: They think the problem is not their own but that of those who pester them to change. They rationalize the problematic behavior as unavoidable or a matter of right. They rebel against the idea of change altogether. In this stage, they may engage in therapy only because of external reasons, to satisfy others or because of legal issues, and the most helpful role of the therapist is to help the client become aware of the potential negative consequences of their behaviors.
In the Contemplation stage, one is aware that a behavior is problematic and may have a genuine desire to change. They may feel in some way endangered by their behavior but helpless to change it alone. Often, people in this stage have already made unsuccessful attempts to change. There is no plan of action in this stage and a great deal of ambivalence toward changing the behavior is present. In this stage, it is important to focus on the benefits of change versus the detriment of continuing the harmful behavior. A therapist can be most helpful in this stage by helping the client see their past attempts to change as small successes rather than failures. In this stage, motivation can begin to develop by identifying personal reasons for changing and the steps necessary to initiate the change process.
In the Preparation stage, one is committed to change and is outlining the behavioral criteria that would constitute successful change. Although some ambivalence may remain, in this stage they begin to plan a course of action and identify the specific steps that will be necessary to achieve their goals. During this stage some small successes will be discernable. It is important at this stage for one to set goals that are reasonable, identify obstacles to change and how to overcome them.
In the Action stage, one begins to exert a great deal of effort in successfully performing the tasks necessary to change the problematic behavior. In this stage, behavior begins to be truly modified. Although slips and setbacks are common in this stage, the effort and commitment remains. It is most helpful in this stage for the client to feel confident in their ability to change and flexible with regard to setbacks and strategic changes in tact that may be required.
In the Maintenance stage, one is focused on preventing relapse into the problematic behavior. They have successfully coped with situations and phenomena that in the past acted as a trigger for relapse and begin to fully appreciate their successes. They can identify temptations and resists them. At this point the therapist becomes more of a consultant and often does not see the client on a regular basis.
In Termination, the client is confident in their ability to avoid relapse and considers themselves to have successfully changed their behavior for the better. At which point they can look back and appreciate how far they have come, which in itself builds more confidence.
One will often cycle through the stages of change more than once, and go over aspects of some more than others. Certain tasks will be easier to complete than others and task modifications may be necessary depending upon the individual. During the process of change, aspects of one stage may be present in another and ambivalence will do battle with confidence on many levels. Nevertheless, the stages of change constitute a useful guide for both therapist and client as they work together toward a desired goal. They can work together to bring about an awareness that builds the motivation necessary to change.
Reference
Prochaska, J. O. & Norcross, J. C. (2001). Stages of Change. Psychotherapy, 38, 4, 443-448.