The Transtheoretical Model (TTM) was developed in the 1980s as an integrated approach to behavior change drawing from multiple theories. It introduced the stages of change and emphasized motivation. The stages are precontemplation, contemplation, preparation, action, maintenance, and termination. TTM identifies processes of change like consciousness raising and self-reevaluation to progress through stages. Motivational interviewing grew out of TTM and seeks to enhance intrinsic motivation for change. TTM principles emphasize behavior change as a process involving multiple theories and processes of change to prompt adjustments over time.

1. CHAPTER 13
TRANSTHEORETICAL MODEL

2. HISTORY OF TTM
• THE TRANSTHEORETICAL MODEL (TTM) WAS DEVELOPED BY DICLEMENTE AND PROCHASKA
(1982, 1985)
• A REVIEW CONDUCTED BY PROCHASKA IN 1984 SUGGESTED THERE WERE OVER 300
THEORIES INFORMING THE HELPING PROFESSIONS, LEADING TO A FRAGMENTED SYSTEM
OF CARE (PROCHASKA, REDDING, & EVERS, 2013)
• TTM WAS DEVELOPED AS AN INTEGRATED APPROACH, MEANING IT DRAWS ON ELEMENTS
OF MANY THEORIES
• IN ADDITION TO DRAWING FROM SEVERAL THEORIES, TTM INTRODUCES THE STAGES OF
CHANGE AND HIGHLIGHTS MOTIVATION AS FUNDAMENTAL TO THE CHANGE PROCESS
• MOTIVATIONAL INTERVIEWING IS AN EMPIRICALLY SUPPORTED TREATMENT THAT GREW OUT
OF STAGES OF CHANGE AND IS COMMONLY USED IN A VARIETY OF PRACTICE SETTINGS
TODAY

3. THE STAGES OF CHANGE
• PRECONTEMPLATION: PEOPLE ARE NOT INTENDING TO MAKE A CHANGE
• CONTEMPLATION: PEOPLE PLAN TO MAKE A CHANGE SOME TIME IN THE FUTURE,
USUALLY
MEASURED AS WITHIN THE NEXT SIX MONTHS
• PREPARATION: A PERSON IS STARTING TO MAKE THE ADJUSTMENTS
NEEDED TO MAKE A
MORE IMMEDIATE CHANGE
• ACTION: PEOPLE ARE MAKING OBSERVABLE BEHAVIOR CHANGES
• MAINTENANCE: CLIENTS HAVE THE CAPACITY AND WILLINGNESS TO
MAINTAIN BEHAVIOR CHANGE
• TERMINATION: CLIENTS NO LONGER FEEL TEMPTED TO RELAPSE

4. TTM: KEY CONCEPTS
• TRANSTHEORETICAL: DRAWING FROM MULTIPLE THEORETICAL PERSPECTIVES
• PROCESS: CHANGE THAT OCCURS OVER TIME
• DECISIONAL BALANCE: THE PROCESS OF WEIGHING THE BENEFITS AND DISADVANTAGES OF
MAKING
A BEHAVIOR CHANGE
• RELAPSE: A RETURN TO PREVIOUS, UNHEALTHY BEHAVIORS
• SELF-EFFICACY: THE LEVEL OF CONFIDENCE ONE HAS IN HIS OR HER ABILITY
TO MAKE A CHANGE
• PROCESSES OF CHANGE: TEN ACTIVITIES THAT HELP MOVE PEOPLE FROM ONE STAGE
OF CHANGE TO THE
NEXT

5. PROCESSES OF CHANGE
• CONSCIOUSNESS RAISING: INCREASING KNOWLEDGE AND AWARENESS OF
THE IMPACT OF THE PROBLEM BEHAVIOR THROUGH ADVANCED MICROSKILLS
SUCH AS CONFRONTATION, INTERPRETATION, AND INFORMATION SHARING
• DRAMATIC RELIEF: USING TESTIMONIES, MEDIA CAMPAIGNS, OR FEEDBACK
TO FOSTER NEGATIVE EMOTION ABOUT THE PROBLEM BEHAVIOR AND
RECOGNIZE THE REDUCTION IN THESE NEGATIVE FEELINGS ONCE BEHAVIOR
CHANGE OCCURS
• ENVIRONMENTAL REEVALUATION: HELPING THE CLIENTS TO EVALUATE HOW
THE PROBLEM BEHAVIOR NEGATIVELY IMPACTS THEIR SOCIAL ENVIRONMENT

6. PROCESSES OF CHANGE, CONTINUED
• SELF-REEVALUATION: HELPING CLIENTS CONSIDER THEIR SELF-IMAGE WITH
THE PROBLEM BEHAVIOR BEING PRESENT AND AFTER BEHAVIOR CHANGE
• SOCIAL LIBERATION: CREATING OPPORTUNITIES AND RESOURCES THAT
SUPPORT THE CHANGE PROCESS, ESPECIALLY FOR OPPRESSED OR
VULNERABLE GROUPS
• REINFORCEMENT MANAGEMENT: REINFORCING POSITIVE BEHAVIOR CHANGE
AND RECOGNIZING OR CREATING CONSEQUENCES FOR CONTINUING THE
PROBLEM BEHAVIOR
• HELPING RELATIONSHIPS: FOSTERING AND MAINTAINING BEHAVIOR CHANGE
THROUGH SUPPORTIVE PROFESSIONAL AND NATURALLY OCCURRING
RELATIONSHIPS

7. PROCESSES OF CHANGE, CONTINUED
• COUNTERCONDITIONING: SUBSTITUTING NEW HEALTHY BEHAVIORS SUCH AS
MINDFULNESS PRACTICES OR NICOTINE REPLACEMENT TO REPLACE
UNHEALTHY BEHAVIORS
• STIMULUS CONTROL: AVOID EXPERIENCES THAT MAY TRIGGER RELAPSE, AND
REPLACE THE TRIGGERS WITH PROMPTS FOR HEALTHY CHOICES
• SELF-LIBERATION: FOSTERING A COMMITMENT TOWARD MAINTAINING
BEHAVIOR CHANGE SUCH AS THROUGH PUBLIC COMMITMENTS

8. TTM PRINCIPLES
• PRINCIPLE 1: BEHAVIOR CHANGE IS A PROCESS
• PRINCIPLE 2: DRAWING FROM MULTIPLE THEORIES IS THE BEST
APPROACH WHEN
SEEKING BEHAVIOR CHANGE
• PRINCIPLE 3: PROCESSES OF CHANGE ARE USED TO PROMPT
ADJUSTMENTS TO
BEHAVIOR

9. MOTIVATIONAL INTERVIEWING
• IT IS CLIENT-CENTERED, BUT DIRECTIVE
• SEEKS TO ENHANCE INTRINSIC MOTIVATION TOWARD CHANGE
• MILLER AND ROLLNICK (2002, P. 36) SUGGEST PRACTITIONERS MUST:
• DEMONSTRATE EMPATHY,
• DEVELOP DISCREPANCY,
• EXPECT AND ACCEPT RESISTANCE, AND
• FOSTER SELF-EFFICACY.

10. SOCIAL WORK PRACTICE
• ENGAGEMENT ACCORDING TO TTM USES A RESPECTFUL, PROFESSIONAL
RELATIONSHIP TO FOSTER THE CHANGE PROCESS
• ASSESSMENT ACCORDING TO TTM WOULD ASSESS WHICH STAGE OF CHANGE
CLIENTS FIND THEMSELVES AT AND ADAPT THE STYLE OF INTERVIEWING TO
MATCH THEIR CURRENT LEVEL OF MOTIVATION
• INTERVENTION ACCORDING TO TTM WOULD USE THE 10 PROCESSES OF CHANGE
AND MOTIVATIONAL INTERVIEWING TO MOVE CLIENTS FORWARD IN THE PROCESS
OF CHANGE
• EVALUATION FROM THIS PERSPECTIVE WOULD LINK PROGRESS TO SPECIFIC
GOALS THE CLIENTS SET FOR THEMSELVES

11. CASE EXAMPLE DISCUSSION QUESTIONS
• ENGAGING IN THE SPIRIT OF MOTIVATIONAL INTERVIEWING INVOLVES A
DIRECTIVE, YET EMPATHIC STYLE OF INTERVIEWING. WHAT DID CLAY DO THAT
APPEARED CONSISTENT WITH THIS STYLE OF INTERVIEWING?
• CLAY WORKED WITH MATT ON DECISIONAL BALANCE BY CREATING LIST OF
PROS AND CONS OF BEHAVIOR CHANGE. WHAT WAS MATT WORRIED ABOUT AS
HE CONSIDERED STOPPING DRINKING? WHAT DID HE SEE AS THE BENEFIT OF
BEHAVIOR CHANGE?
• THE CONCEPT OF SELF-EFFICACY IS AN IMPORTANT PART OF MOTIVATIONAL
INTERVIEWING. HOW DID SELF-EFFICACY COME UP IN MATT’S STORY?

12. STRENGTHS AND LIMITATIONS OF TTM AND
MOTIVATIONAL INTERVIEWING
• STRENGTHS
• STRONG EMPIRICAL SUPPORT FOR THIS APPROACH
• CAN FIT FOR A VARIETY OF BEHAVIOR PROBLEMS AND FOR A VARIETY OF SETTINGS
• LIMITATIONS
• THE TIME FRAMES TO DISCERN THE STAGES OF CHANGES FAIL TO ACKNOWLEDGE
THE COMPLEXITY OF THE CHANGE PROCESS
• ALTHOUGH MOTIVATION IS IMPORTANT, IT MAY NOT BE THE ONLY THING TO EXPLAIN
BARRIERS TO BEHAVIOR CHANGE (WHAT ABOUT SOMEONE WHO WANTS TO
CHANGE BUT JUST CAN’T?)