Mastering the Stages of Change

1
Mastering the Stages of Change

• In the provision of services for
• Substance Abuse
• Mental Illness
• Co-occurring Disorders

2
The Stages of Change Model

• Developed through studies with dental care and
  smoking cessation by Prochaska and DiClemente
• Examined how the process of change works.
• Broadly applicable to any process of change.

3
The Five Stages of Change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

4
Precontemplation

• Person shows no intent to change a problem or
  behavior.
• Person is either unaware of the problem or
  unwilling to change.
• Individual sees more positive about the behavior
  than negative.
• Person sees behavior as under control or
  manageable.
• Any attempt to suggest that change is necessary
  is likely to be met with immediate resistance.

5
Contemplation

• Person is willing to consider changing.
• Person will engage in weighing pros and cons of
  change.
• Person shows some discomfort/distress with the
  ongoing behavior.
• Person is still strongly ambivalent and can still
  easily move back into a resistance mode if
  defenses are triggered.

6
Preparation

• Person is getting ready to make the change.
• Person clearly intends to change soon.
• There can be some evidence of actual change
  beginning, such as cutting down.
• Ambivalence is not apparent.
• Defenses are not triggered when professional is
  supporting the need to change.

7
Action

• The change process has begun.
• The behaviors and attitudes in question are
  actively being changed.
• The individual is learning and practicing the
  skills necessary to be successful.
• This stage may last for months or even years in
  persons with co-occurring conditions.

8
Maintenance

• Person continues to sustain and strengthen
  change.
• Continues to practice skills to avoid a return to
  old habits or ways of thinking.
• Continues to receive encouragement and support to
  solidify change process.

9
Some important assumptions in the use of the
model

• Change is domain specific. The individual may be
  at different stages for different aspects of
  their problem and lives.
• The model was developed around voluntary change
  processes.
• Each stage is a time period during which
  essential tasks must be completed.
• The process is not linear!

10
Moving from precontemplation to contemplation

• Person must acknowledge a behavior, attitude or
  issue they wish to change.
• This implies that they recognize that their
  behavior has resulted in negative consequences.
• Person starts to develop some self-efficacy
  around change in this realm.
• They may still be ambivalent and can easily slip
  back towards resistance.

11
Contemplation to preparation

• A clear decision to change is made.
• Preliminary steps towards action are taken.
• Ambivalence is resolve.
• Resistance is negligible.
• Professionals role shifts from neutrality and
  transparency to more actively coaching.

12
Preparation to action

• Clear goals for the change should be established.
• These should be incorporated into an action plan.
• Preliminary steps are taken.
• The behavior may not yet change at all until
  action stage is reached.

13
Action to maintenance

• Person must actively meet their goal.
• This change should be sustained for at least 6
  months.
• They continue to learn and practice skills and to
  develop and demonstrate self-efficacy.

14
Cycling is normal!

• People often move from more advanced stages back
  to earlier ones.
• Relapse is a normal part of any recovery
  process and should be framed appropriately.
• Regression all the way back to contemplation is
  rare.

15
Important principles to follow in applying the
model

• Always meet the person where they are.
• Use Empathy, Acceptance, and a Non-judgmental
  style.
• Less confrontation, more support.
• Do not focus on denial or resistance.
• Understand that the stages will be cyclical.

16
Assessing for Stage of Change

• Ask questions in a direct, but non-judgmental,
  non-confrontational manner.
• Ask open-ended questions.
• Use motivational interviewing/Rogerian
  client-centered therapy techniques such as
  reflection and gentle reframing.
• Remember domain specificity. Inquire about the
  various dimensions of targeted areas.

17
Assessing (cont.)

• Remember clients sometimes tell us what they
  think we want to hear. Gently probe below the
  surface.
• Different aspects of the same behavior/recovery
  process can be distinctly different stage of
  change domains.

18
Coerced/Mandated Treatment

• Often these persons are required to be at action
  stage, even though they may still be at
  pre-contemplation or contemplation.
• Joining must occur at the stage they are at, not
  the stage they are required to be at.
• The process must gradually more them to where
  their motivation (internal locus of control)
  matches that of the external locus of control.