Video: Stages of Change
[See video clip on Stages of Change about 2/3 of the way through the series of clips.]
Transcript: ‘Stages of Change’ was developed by Prochaska & DiClemente. It basically was based in research about cigarette smoking literature, and it helps cognitive behavior therapists, in particular, understand the motivation of an individual who’s coming in for treatment.
The first stage in the ‘Stages of Change’ is called precontemplation, meaning the client just says, “Well, I don’t really think I have a problem.” In the twelve steps of the disease model, we call that denial. “I don’t really have a problem. You think I have a problem, then that’s your problem.”
The next stage is contemplation. Contemplation is, “Yeah, I’ve got a problem, but I don’t know if I want to do anything about it.” That’s often the case. Lots of people come in and say, or they say to their spouse, “I know I have a problem, but I don’t know if I really want to go through all the misery, or all that stuff to stop.” Some people stay in the contemplation phase for years. Sometimes they even go to the grave in the contemplation; they never even evolve out of it.
Then the next stage, if that balance beam of the contemplation phase eventually tips it up, is that they’ll then go into the preparation. In other words, they’ll pick up a self-help book, or they’ll maybe go to a therapist and start to learn about the resources that are available to discontinue this behavior.
If that’s successful, they’ll move on to what’s called the action phase, with action being doing something. They stop gambling. They stop Internet surfing. They stop something. That’s generally a short phase. From that we can either go to a maintenance phase, where they sustain the change in the behavior, or there’s a relapse. If there’s a relapse in the ‘Stages of Change Model’, we try to bring them back around to not going back to the precontemplation phase, but actively into the preparation phase, and start the cycle all over again.
The idea is that we bring to bear certain strategies at certain stages. Most treatment centers assume that the individual is ready for the action phase when they walk in the door, and that’s not the case. Rarely does a client, whatever the addiction is, walk in and say “I’m ready to stop.”
They have to hit bottom; they have to do a variety of different things to get to that place. That’s why so many treatments go awry, because there’s a false assumption about the motivation of the individual with the addiction.