Transtheoretical Model of Change

1
Transtheoretical Model of Change

• Prochaska, J. O., DiClemente, C. C., Norcross,
  J. C. (1992)

2
Transtheoretical Model of Change

• General Information
• Stages of Change
• Processes of Change
• Stage Based Interventions
• Stage Assessment
• Application to Guidance and Counseling Model
• Other Applications and Questions

3
General Information

• The name transtheoretical model of change was
  chosen because it is usable with any counseling
  theory.
• Prochaskas research suggests that steps from one
  stage to the next are taken when someone changes
  whether or not they are in counseling.
• Steps are not followed straight through. There is
  spiral movement.
• The counselor must be in stage with the client in
  order to facilitate movement through the stages.
• Only 3 of clients who do not move from stage 1
  to stage 2 within the first month take action to
  change behavior within the next 6 months.
• 7 of clients who move from stage 1 to stage 2
  within the first month take action to change
  behavior within the next 6 months.
• Pre-treatment stage of change influences chances
  of successful outcomes. Twenty-two percent of
  all precontemplators, 43 of the contemplators,
  and 76 of those in action or prepared for action
  at the start were not smoking six months later
  (p. 1106).
•  

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Stages of Change

• Stage 1 Pre-contemplative Stage
• Client is not aware or is under
  aware that a problem exists
• They may know they have problem but have not
  connected it to their behavior, thoughts,
  feelings and their responsibility for the
  problem.
• There is no intention of change in the
  foreseeable future
• Others see the problem
• Usually will not seek help
• Usually show up by forced referral
• Counselor should not side with the referral
  source this will develop resentment. Must
  establish the relationship first.
• Listen to their side of the issue and help them
  explore the benefits of change

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Stages of Change

• Stage 2 Contemplation
• Yes, but phase
• Can be a prolonged stage
• May have a goal but are not sure it is worth the
  time, energy, effort to achieve it
• Provide a climate where the client can consider
  changing without any pressures
• Pressures may include guilt, blame, and/or
  reasoning. This is usually not effective at this
  point
• Ally with the ambivalence
• Motto when in doubt, dont change
• Weigh pros and cons

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Stages of Change

• Stage 3 Preparation
• This is the how to phase
• The client will try and see how it feels, looks,
  etc. to make the change
• This is when a treatment goal is selected
• Provide client with possibilities let clients
  choose the method

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Stages of Change

• Stage 4 Action
• Clients have a commitment and plan
• They take action
• Stage 5 Maintenance
• Change continues
• Anticipation is the best defense against
  relapse.
• Develop a plan to help them avoid situations that
  may cause relapse
• Develop plans to help them stop the slide if one
  begins (alcoholic call a friend if client takes
  a drink)
• Find someone who is supportive

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Processes of Change

• Consciousness Raising Increasing level of
  awareness and more accurate information
  processing.
• Dramatic Relief Experiencing and releasing
  feelings
• Environmental Reevaluation Affective and
  cognitive reexperiencing of ones environment and
  problems.
• Self-Reevaluation Affective and cognitive
  reexperiencing of oneself with respect to ones
  problems.
• Self-Liberation Belief in ones ability to
  change and commitment to act on that belief.

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Processes of Change

• Helping Relationship A relationship involving
  openness, caring, trust, genuineness, and
  empathy.
• Reinforcement Management Reinforcing more
  positive behaviors and punishing negative ones.
• Stimulus Control Restructuring ones
  environment or experience so that problem stimuli
  are less likely to occur.
• Counter-Conditioning Substituting more positive
  behaviors and experiences for problem ones.
• Social Liberation Noticing social changes that
  support personal changes.

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Stage Based Interventions

• Moving from Pre-Contemplative to Contemplative
• Consciousness Raising (observations,
  confrontations, interpretations, bibliotherapy)
• Dramatic Relief (psychodrama, grieving losses,
  role playing)
• Environmental Reevaluation (empathy training,
  documentaries)
• Moving from Contemplative to Preparation
• Self Reevaluation (value clarification, imagery,
  corrective emotional experience)
• Moving from Preparation to Action 
• Self-Liberation (decision-making therapy, New
  Years resolutions, Logo therapy techniques,
  Commitment enhancing techniques)
• Moving from Action to Maintenance
• Helping Relationships (therapeutic alliances,
  social support, self-help groups)
• Reinforcement Management (Contingency contracts,
  overt and covert reinforcement, self-reward)
• Counter Conditioning (relaxation,
  desensitization, assertion, positive
  self-statements)
• Stimulus Control (restructuring ones
  environment, avoiding high risk cues, fading
  techniques)

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Stage Assessment See University of Rhode Island
Change Assessment Scale (McConnaughy, E. A.,
DiClemnte, C. C., Prochaska, J. O., Velicer, W.
F., 1989)

• Sample Items
• Precontemplative
• As far as Im concerned, I dont have any
  problems that need changing.
• Im not the problem one. It doesnt make
  sense from me to be here.
• Contemplative
• I think I might be ready for some
  self-improvement.
•      It might be worthwhile to work on my
  problem.
• Action
•      I am doing something about the problems
  that had been bothering me.
• I am finally doing some work on my problems.
  
• Maintenance
• It worries me that I might slip back on a
  problem I have already changed, so I am here to
  seek help.

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Application Guidance and Counseling Models

• Guidance Curriculum
• Self-confidence
• Motivation
• Decision making
• Interpersonal effectiveness
• Responsible behavior
• Responsive Services
• Tardiness
• Absences truancy
• Misbehavior
• Drop out prevention
• Substance abuse
• Harassment issues
• School Counselor Roles
• Guidance
• Counseling
• Consultation
• Professionalism
•  

• Responsive Services
• Tardiness
• Absences truancy
• Misbehavior
• Drop out prevention
• Substance abuse
• Harassment issues
• System Support
• Guidance program development
• Parent Education
• Counselors professional development
• System Support
• Guidance program development
• Parent Education
• Counselors professional development
•  

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Other Applications andQuestions

• Does this model fit for systems?
• Does the Dev. Guid. Coun. Model need to change
  in light of counselor student ratios? Where is
  the system on changing? Are administrators ready
  to change in attitude toward counselors? Are
  counselors themselves ready for change?
• Is this applicable across ethnicities/Cultures?
•  
• Is this applicable to counseling with students
  with classroom behavior problems?
• How might group processes be influenced
  by knowledge of the stages? Members in different
  stages of change.
• How would our work be different if we viewed
  clients as being in the pre-contemplative stage
  rather than as resistant, unmotivated, lazy,
  etc.?
• What are the effects of self-efficacy and locus
  of control on the movement from one stage to the
  next?
•  

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Other Applications andQuestions

• Can the school counselor use the time advantage
  they have over agency counselors to help clients
  through the stages?
•  
• What are the most appropriate interventions to
  move from pre-contemplative to contemplative?
•  
• How might couples/family therapy be different if
  the individuals are at different stages of
  change?
•  
• How might this be applied to the supervision of
  counseling students?