When clients first come to therapy, they often wonder: “What do I want to gain from this? How can I get help if I don’t even understand what’s bothering me?”.
Maybe they tried therapy before and it “didn’t click” or they lost motivation, or simply couldn’t find time to commit to weekly sessions. What they DO know is they need help, they just need to find out what to do.
These feelings are very common when facing a big step such as going to therapy. The understanding of our motivation is one of the essential parts of getting better – not only knowing what the issue is – also the knowing why I want to change.
What to expect from the process of change?
How fast can I move forward?
What if I fail?
Being prepared will make us more confident and less anxious about the changes and will let us navigate the process in a more mindful way.
The Stages of Change or The Transtheoretical Model of Change is a clinical theory developed in the 1970’s by James Prochaska of the University of Rhode Island and Carlo Di Clemente.
The stages can be best explained as interrelated steps we go through with our thoughts and emotions when we are confronted with a difficult situation that needs changing.
The concept can be applied to anything from quitting drinking to breaking up an unhealthy relationship to healing from grief after losing a loved one. The stages follow an order and each of them has a purpose in creating change. They also occur gradually – from initial resistance and denial, a commitment and progression is created, and relapse is an expected part of the process.
I love to talk to my clients about the Stages of Change, because it provides tremendous help in creating a deeper understanding of the process they are going through and prepares them to set realistic expectations for the next steps. It is like a map of progress that they fill in with their own details to use in moving forward the therapy path.
Important elements to consider in a change process are:
Readiness to change: having the resources and knowledge to make a lasting change successfully (e.g. believing that therapy is helpful or knowing where to find information on AA support meetings).
Barriers to change: if and what is preventing you from changing (e.g. not having time, finances to dedicate to treatment, not having reliable transportation to drive to group meetings.)
Likelihood of relapse: triggers to returning to a former behavior (e.g. living with a person who is using drugs when attempting to stay sober.)
According to the theory, stages follow the order:
Stage 1: Precontemplation (“I don’t need to change.”)
Clients in this stage do not see change as something wanted, needed, or possible and have no intention of changing the behavior. For example, “I have no intention of taking up a sport or going running.”
The client may be lacking awareness, insight or information about the issue, may have tried to address it and failed and feels discouraged. Since the situation is already usually impacting client’s life in a serious manner, we try to help the client consider the need for behavioral change. We want to educate and discuss the risks regarding current behavior.
Stage 2: Contemplation (“I think I want to change.”)
Clients are in procrastination and plan to make the change within next months. They are aware of the pros and cons of making the change. For example, “I know I need to lose weight for my health, but I enjoy fast food.” Important to consider is working with ambivalence – mixed and contradictory feelings, identifying barriers and committing to changes in the present.
Stage 3: Preparation (“Ok, so how do I start?”)
Clients are committed to changing their behavior, they want to work on an action plan, they are organizing resources and support, writing down goals, developing strategies to make the changes happen and implementing first preparatory actions (e.g., getting a gym membership.)
Stage 4: Action (“I’m doing it!”)
The change behavior began, and a new pattern of behavior is forming. Clients have made some progress and modified their lifestyle over the last six months, for example, “I go to the gym on Mondays, Wednesdays, and Fridays every week, and I am following a plan set out by my trainer.” What’s important now is to keep the positive change and motivation going, reward progress behaviors, and monitor for relapse and obstacles.
Stage 5: Maintenance (“I’ve changed.”)
Clients in this stage have been following the new pattern for a certain amount of time and it is now part of their lifestyle. They become confident they can continue their new way of life. It can last between six months and five years (Prochaska & Velicer, 1997). Relapse is now less likely to happen. for example, “I am confident I can make healthy eating choices at home, work, or when I go out.” Now we want our clients to sustain the new behavior for the long term, avoid relapse and develop coping strategies.
Stage 6: Relapse (“I’ve done it again.”)
Clients returned to their old habits or behaviors and regressed to an earlier stage. It is not considered a stage, but a failure to maintain the change, either by the wrong activity (e.g., beginning smoking again) or inactivity (e.g., stopping going to gym.) As disappointing as it feels, relapse is typical for behavioral changes, yet not inevitable. We want clients in this stage to focus on identifying the triggers linked to relapse, to reaffirm them in their commitment and help them process through the stages again.
Stage 7: Termination (“I permanently changed.”)
The behavior is extinguished now and there is no need or craving to return to old behaviors. Client is now integrated with the change because the unhealthy habit is no longer a part of their way of coping. The new, healthier behavior is part of the person’s identity and lifestyle and has persisted for a long time, for example, “I have been keeping up with physical exercise for some years now, and even after recovering from a long-term injury, I continue to do so.”
Another view is that termination is never reached and a risk of relapse into unhealthy ways is always present. In this perspective, the client always remains in the maintenance stage. In some cases, individuals who do not participate in therapy are usually in a contemplation or preparation stage of change, sometimes even in an action stage.
From there we work together on creating new habits and learning to accept the change as a wonderful part of life!
If any of this information feels right to you, please feel free to contact our office for more information.
-Zuzanna Gromulska, MS, LPC-Associate Supervised by Guillermo A. Castañeda, LPC-S
Prochaska, J. O., & Velicer, W. F. The transtheoretical model of health behavior change (1997). American Journal of Health Promotion, 12(1).