The document summarizes the Trans-theoretical Model of Change proposed by psychologists James Prochaska and Carlo DiClemente. The model outlines five stages of change that people progress through when trying to change an addictive behavior: pre-contemplation, contemplation, preparation, action, and maintenance. It also includes the possibility of relapse. The model can be used by therapists and coaches to assess what stage a client is at and determine appropriate strategies to help them progress to the next stage of change.
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The Stages of Change The stages of change are Preconte.docxjoshua2345678
The Stages of Change
The stages of change are:
Precontemplation (Not yet acknowledging that there is a problem behavior that needs to
be changed)
Contemplation (Acknowledging that there is a problem but not yet ready or sure of
wanting to make a change)
Preparation/Determination (Getting ready to change)
Action/Willpower (Changing behavior)
Maintenance (Maintaining the behavior change) and
Relapse (Returning to older behaviors and abandoning the new changes)
Stage One: Precontemplation
In the precontemplation stage, people are not thinking seriously about changing and are not
interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do
not feel it is a problem. They may be defensive in the face of other people’s efforts to pressure
them to quit.
They do not focus their attention on quitting and tend not to discuss their bad habit with others. In
AA, this stage is called “denial,” but at Addiction Alternatives, we do not like to use that term.
Rather, we like to think that in this stage people just do not yet see themselves as having a
problem.
Are you in the precontemplation stage? No, because the fact that you are reading this shows that
you are already ready to consider that you may have a problem with one or more bad habits.
(Of course, you may be reading this because you have a loved one who is still in the pre-
contemplation stage. If this is the case, keep reading for suggestions about how you can help
others progress through their stages of change)
Stage Two: Contemplation
In the contemplation stage people are more aware of the personal consequences of their bad
habit and they spend time thinking about their problem. Although they are able to consider the
possibility of changing, they tend to be ambivalent about it.
In this stage, people are on a teeter-totter, weighing the pros and cons of quitting or modifying
their behavior. Although they think about the negative aspects of their bad habit and the positives
associated with giving it up (or reducing), they may doubt that the long-term benefits associated
with quitting will outweigh the short-term costs.
It might take as little as a couple weeks or as long as a lifetime to get through the contemplation
stage. (In fact, some people think and think and think about giving up their bad habit and may die
never having gotten beyond this stage)
On the plus side, people are more open to receiving information about their bad habit, and more
likely to actually use educational interventions and reflect on their own feelings and thoughts
concerning their bad habit.
Stage Three: Preparation/Determination
In the preparation/determination stage, people have made a commitment to make a change.
Their motivation for changing is reflected by statements such as: “I’ve got to do something about
this — this is serious. Something has to change. What can I do?”
This is sort of a .
One of the best-known approaches to Behavior change is known as the "Stages of Change" model, which was introduced in the late 1970's by researchers James Prochaska and Carlo DiClemente who were studying ways to help people quit smoking.
The Stages of Change Model has been found to be an effective aid in understanding how people go through a change in behavior.
Practical hints and tips for assessing readiness to change - Dr Bronwen BonfieldMS Trust
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To have increased awareness of the factors that affect an individuals readiness to change.
To explore the theoretical models that underpin change behaviour
To develop awareness of skills and strategies to support individuals and their families.
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5/STAGES AND PROCEsSES OF HEALTH BEHAVIOR CHANGE 113
intervention should increase the effectiveness, assist the client in progress-ing to the next SOC because of enhanced motivation and readiness, and reduce the likelihood of dropping out of treatment because the intervention was not appropriate.
Stages of Change
Change is not viewed as a single event, such as "I will eat less sodium start ing today,
"
but as an unfolding process over time requiring more than one
attempt. The model in Table5-1 shows the how, not the why, people change either with counseling or without it on their own. To make changes, people progress through six identified stages. The tasks at each stage vary, and
movement through the stages represents personal progress for the client.
Precontemplation
In stage 1, Precontemplation, a person is unaware or underaware that a
health problem exists, denies that there is a problem, or has no intention
to take action to change. Thus, the individual has no plans, for example, to modify eating practices to lose weight or start exercising in the next
6 months.34 The person may have tried a change previously and failed,
such as to lose weight, and may be resistant to the health professional's efforts to suggest possible changes. Perhaps a visit to the doctor initiated
a referral to see the nutrition and dietetics counselor for weight loss, even
if the patient was not concerned with his or her weight.
Because these clients are unaware, uninformed, or unconcerned about the
health problem, the counselor needs to assess the client's views on making
a change and address the reasons for not wanting to change rather than
providing dietary information. Educating the client about food changes
not appropriate at this stage. To identify this stage, the counselor may
asAre you seriously intending to change (name the problem behavior)
in the next 6 months?"
1. Precontemplation
No intention of changing in the next 6 mno.
2. Contemplation
Intending to change, but not soon.
3. Preparation
Small changes are made, intending to change in 30 d.
4. Action
Changes are made in food choices regularly.
5. Maintenance
Behavior changes maintained for 6 mo.
6. Termination
Occurs only if changes are maintained for a year or more.
Tahl
2/COUNSELING
FOR HEALTH
BEHAViOR CHANGE
-fat diet ande Cotoa
114
less fat (or more fruits and vegetables) in the near futur2DOUl e
Droblem andi
a person with a heart problem may need to know the health benelits
this.
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For people ignoring the relationship between a high-fat :
ght about eatin
heart disease, for example, one may ask: "Have you tho
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At this stag
change as well as the risks of not addressing the problem Denef
ofene
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idensith
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Prochaska and DiClemente's Trans-theoretical Model of Change. By Theresa Lowry-Lehnen. Lecturer of Psychology
1. Theresa Lowry-Lehnen
RGN, BSc (Hon’s) Nursing Science, PGCC, Dip Counselling, Dip Psychotherapy,
BSc (Hon’s) Clinical Science, PGCE (QTS), H. Dip. Ed, MEd
PhD student Health Psychology
2. Trans-theoretical Model of Change
The Transtheoretical Model /Wheel of Change; proposed by the
psychologists James Prochaska and Carlo Di-Clemente helps
people make changes and considers how it can be used for
structuring coaching/ therapy intervention.
The model is particularly helpful in situations where a client is
trying to break a habitual/ addictive behaviour which is
creating repeated problems for them.
It can be applied to a range of habitual problems, including:
Smoking
Misuse of alcohol/ drugs
Eating problems
Other addictive behaviours
5. Trans-theoretical Model of Change
Prochaska and Di Clemente’s model has
been set out in a number of different ways
to illustrate the stages that a person often
goes through on the path to change.
One possible way of listing these stages is as
follows:
6. Trans-theoretical Model of Change
Pre-Contemplation:
Client is not thinking
at all about changing
their behaviour.
After PreContemplation, at
some point the client
then moves into Stage 1
of the model.
7. Trans-theoretical Model of Change
Stage 1 –
Contemplation:
Here the client is in
ambivalence – i.e.
they can see some
benefits in changing
but also are aware of
or experiencing the
benefits of not
changing, so as yet
they haven’t started to
change and are a stage
of indecision.
8. Trans-theoretical Model of Change
Stage 2 – Decision:
The client makes a decision
to change.
Usually this occurs after some
specific triggering
event, which increases their
motivation to change – for
example, if smoking
cigarettes / abusing alcohol is
the problem behaviour, then
an event such as a relative or
friend experiencing serious
health problems from
smoking /drinking might
trigger the client to decide to
cut down their own smoking/
drinking.
9. Trans-theoretical Model of Change
Stage 3- Action: The
client now begins to
act.
This may be by
stopping the problem
behaviour altogether
(e.g. by ceasing
smoking/ drinking
alcohol) or by reducing
it (e.g. not giving up
smoking /drinking
altogether, but
reducing it).
10. Trans-theoretical Model of Change
Stage 4 –
Maintenance: If things
are going well, then the
client maintains their
progress in stopping or
cutting down the
problem/ addictive
behaviour.
11. Trans-theoretical Model of Change
Permanent Exit – If the client is able permanently to avoid
returning to the problem behaviour then they can be said to
have permanently exited from the cycle.
Usually they may be said to be controlling or managing the
problem rather than that it has disappeared.
For example, they might still get cravings to smoke/ drink
alcohol, but so long as they avoid actually smoking / drinking
in practice they will avoid the harmful physical effects
associated with smoking/ alcohol
However, in most cases before they achieve permanent
exit, the client will experience Stage 5:
12. Trans-theoretical Model of Change
Stage 5: Lapse:
The client slips back
temporarily into the
problem behaviour (e.g.
perhaps they are
particularly stressed one
night and they have a
cigarette/ drink
alcohol).
13. Trans-theoretical Model of Change
Prochaska and DiClemente represent the stages 1-5 as a
wheel or cycle which people generally go round several times
before they are able to exit permanently.
The model is therefore sometimes referred to as "The Wheel
of Change", but should not be confused with the ‘Wheel of
Life’, with which most coaches are familiar as a common tool
for initial assessment of different areas of a person’s life!
14. Trans-theoretical Model of Change
The 'lapse' stage in Prochaska and DiClemente’s model is
sometimes called 'relapse'. This distinction can therefore be
used to highlight to the client that if they have a slip-up or
lapse, they have a choice – they can either:
Get back on track, recognise their progress and try to learn
from the experience of lapsing as to what they might do
differently the next time to avoid lapsing again in a similar
situation
OR
Lose heart and see the lapse as a sign that they will never
achieve change in which case the lapse may become a
permanent relapse.
15. Trans-theoretical Model of Change
If the client does relapse, then the therapist/
coach can encourage them to respond to the
situation practically.
Rather than see the lapse as a sign of failure of
will power, just see it as a natural stage in the
process of change and encourage the client to see
that they have a choice about whether to get back
on track.
17. Trans-theoretical Model of Change
How can a therapist/ coach use Prochaska and
DiClemente’s Model?
A coach/therapist can use the model when working with a
client either by sharing it with the client or else as a
framework to work to behind the scenes.
The client can be shown the model of change, asked to locate
what stage they feel they are at currently and what stages
they have moved through, and to elaborate on circumstances
and their thoughts about this.
18. Trans-theoretical Model of Change
Often, seeing the model of change and the stages, enables a
client to feel that their perceived problem is not so
extraordinary as they may initially think and that they are
actually following quite normal stages in working through
their problem.
Explaining to a client that a relapse is normal and doesn’t
have to lead to failure, can assist the client in dealing with
potential feelings of guilt, shame or inadequacy at not
progressing faster.
19. Trans-theoretical Model of Change
Seeing the stages of the model set out and explained
clearly can also help a client to feel that the situation is
not hopeless or beyond their control.
Instead, it is a situation where they can progress if they
are patient, set realistic achievable goals and don’t panic
when they lapse, but try to adopt a mentality of learning
from experience without judging themselves.
20. Trans-theoretical Model of Change
The model also takes the pressure off the
therapist / coach to solve all the client’s problems
immediately.
Instead they have a clear framework within which
they can encourage the client to locate their
problem behaviour and select strategies.
21. Trans-theoretical Model of Change
At any stage in the coaching process where the
client appears to be blocked or faltering in
progress, the therapist/ coach can go back to the
model and reassess with the client what stage
they are at and what may be appropriate
strategies for them therefore to adopt.
Different strategies are appropriate for different
stages of the model.
22. Stage
Appropriate
Strategies
Pre-Contemplation:
Client not considering trying to
achieve change
For someone at this stage, appropriate information
as to why change may be helpful for the client,
provided in a non authoritarian manner by way of
simple information, may be of use.
Stage 1 - Contemplation:
Client sees some benefits in
changing but is also experiencing or
aware of benefits in not changing
Encourage the client to:
1. Analyse the arguments for and against change (e.g.
to complete a list highlighting and weighing up both
the advantages and the disadvantages of making the
changes they are thinking about)
2. Reflect on different options for change and the
likely effect of them.
3. Consider whether there are any very small ways
they could begin to take steps in the direction of
change, which seem reasonable and achievable to
them.
23. Stage
Appropriate Strategies
Stage 2 Deciding to try to
achieve change
Encourage client to:
1. Plan change carefully rather than make a rush decision.
2. Break the plan down into achievable goals.
3. Write down commitment to change.
4. Think about where they can get support for following their
plans.
Stage 3 - Acting
to achieve change
Encourage client to:
1. Follow their plan, monitor and review progress.
2. Reward and congratulate themselves on successes (even small
successes).
3. Remind themselves of the benefits that will ensue if they
achieve goals and acknowledge & identify those benefits as they
happen (even if only partially achieved)
4. Pace themselves at a level where they will be able to sustain
motivation & if possible allow themselves some time to relax
when they are not focusing on their plan – Recognise they have a
life outside the plan.
5. Learn from things which don’t turn out as they expect.
6. Make use of appropriate support.
7. If they lapse, try not to return back to where they started from
but instead recognise the progress they have made, revise their
24. Stage
Appropriate Strategies
Stage 4 Maintaining
change
Encourage client to:
1. Recognise that development is an
ongoing process.
2. Maintain and review plans
until absolutely sure they are no longer
required.
3. Again, if they lapse, try not to return
back to where they started from but
instead recognise the progress they have
made and implement a new plan, learning
from the lapse.
4. Think about whether there is a way they
can help others make positive changes in
the light of their experience.
25.
26. References
Prochaska, J.O. & DiClemente, C. C. (1982) “Transtheoretical
therapy: Toward a more integrative model of change” from
'Psychotherapy: Theory, Research, and Practice', 19, 276-288.
Prochaska, JO; Norcross, JC; DiClemente, CC (1994) Changing for
good: the revolutionary program that explains the six stages of
change and teaches you how to free yourself from bad habits. New
York: W. Morrow;. ISBN 0-688-11263-3
Prochaska, JO.; DiClemente, CC (2005) The transtheoretical
approach. In: Norcross, JC; Goldfried, MR. (eds.) Handbook of
psychotherapy integration. 2nd ed. New York: Oxford University
Press; p. 147–171. ISBN 0-19-516579-9
Prochaska, JO. & Norcross, JC (2010)Systems of psychotherapy: a
transtheoretical analysis. 7th edition Brooks & Cole, CA