It’s not my intention to give full information or an extensive discussion on every theory. This website is intended to be a starting point and the main difference with other websites is the visual representation of the theory, which I hope will help get to grips with the theory. There are also links it the bottom to get your further research started.

Stages of Change Model

Prochaska and DiClemente – 1983

 

 

Definition

In 1982 – 1983 James Prochaska and Carlo DiClimente formulated the steps clients go through when they implement changes in their life, irrespective of the nature of those changes. If you explore the links at the bottom of this page, you’ll see a small selection of issues this can apply to. Career planning and management invariably will involve voluntary or compulsory change.

The Stages of Change Model, also called the Transtheoretical Model, describes the 5, or 6 if there is relapse, stages clients go through to implement change. If all is well, a client will reach the maintenance stage and then leave the circle. However, a lot of clients will relapse and will have to start the circle again. This doesn’t mean that they are back where they started. They will have reached a different place from where they will re-enter the contemplation stage after going through a phase of denial or precontemplation. This means that, in time clients will move through the upward spiral of the different stages several times as they learn from each and every relapse, until they are in a place from where they can leave through the maintenance stage.

This model will at first sight be self-explanatory and simple to understand. Would you find it easy to recognise these stages in a client however? And would you find it easy to find techniques to work with the client so they can access or move on to the next stage in the model?

 

The Stages of Change Model in practice

I hope you’ve noticed this is called a model, rather than a theory, which indicates its possible use in our practice. Like some other models of change, this model too can be used to assess where the client is in the cycle and what still needs to be put in place. It offers a route map for the practitioner through which to guide the client to successful change. Each stage will have its own characteristics and techniques to help you work with the client towards entering the next stage.

Let’s have a look at the different stages and offer or suggest some examples of actions we can take to facilitate the client’s progress:

Precontemplation – could include:

  • Reluctance to see that change needs to happen – creating dissonance in the client or ‘magic thinking’ – “imagine what life would be like if… “.
  • Being overwhelmed and being in denial change needs to happen – breaking the client’s present situation down in small parts which are easier to manage.
  • Being resigned to the state the client is in at the moment – challenging the client in thinking that things can change and the present situation doesn’t need to be forever.
  • Rebellion or agressive behaviour or refusal to act – agreeing with the client and then gradually introducing the thought of how it could be different and that it’s in their hands.
  • Rationalising the problem, for instance using rational arguments why change is not needed – debunking false logic and fantasy with evidence, while being careful not to push the client into rebellion.

Contemplation – could include:

  • Frustration -with the present state but not yet committing to change or taking steps to implement change – offering understanding and using good listening skills are key. In my experience it’s not the right stage to offer solutions, if at all. At a later stage allow the client to come up with their own solutions to promote ownership. Very often, they know best as well.
  • Ambivalence – as with many stages in between not realising change needs to happen and a realisation of change is a stage of ambivalence, especially when the client was feeling overwhelmed before – help the client clarify their feelings by asking open questions. Help them weight up the pros and cons of taking action.
  • Contraditictions or the use of paradoxical points or arguments – linked to the previous point made about being ‘in between’ – reassure the client that having conflicted feelings and that there may be arguments which seem to contradict each other is absolutely normal at this stage. Clarification of their contradicting statements may offer support to the client. Contradictions can also be signs of a deeper conflict or feelings.
  • Weighing up of the benefits of change or staying in the present state – help the client explore the pros and cons of their argument. Offer support with clarification. 
  • Procrastination or hesitation because of wavering – help the client accept that procrastination is a normal reaction to being unsure but offer support in helping them take action by exploring the benefits of doing so and the downsides of staying in limbo.
  • Commitment to action and then a retraction because of severe doubt – here too, support the client by confirming that doubt is normal and offer support and a weighing up of the implications of not acting and the benefits of taking action.

Preparation – can include:

  • Elation – because the client has made a commitment – followed by doubt – join the client in their elation (within reason!) but be aware that doubt can follow and anticipate this. See above for some suggestions of techniques to work on this with the client. Try and help the client stay realistic without dampening their spirits to the stage that they fall back to a precontemplation stage.
  • Commitment to action – support the client in moving on to the next stage by asking open questions in how they want to see action take place.
  • Possible remnants of hesitation and/or ambivalence – support the client as in the previous stage.

Action:

  • If all is well, the client takes ownership of the process of change – affirmative and positive support in the client moving forward and in their planning.
  • Client participates in formulating a plan for change – support the client in formulating this without taking over. The professional is a facilitator to allow the client to take full ownership. Set realistic expectations and steps. The client may want to make too big a change that’s difficult to implement and which will increase the chance of a relapse.
  • Identifying and activating of the client’s support network – help the client formulate who their support network is going to be, if appropriate, and what role each of their supporters could play in actioning change but also supporting them when they risk relapsing.
  • The plan is then implemented – agree actions to be taken between to two of you (follow up appointments, checking in, etc…). Also support the client in developing techniques for them to maintain the change.

Maintenance:

This is the stage where the practitioner will start stepping back to allow the client to implement and maintain their changes. You could offer a listening ear and to make sure that the client feels free to come to you for further support without overwhelming them or forcing them. They need to take ownership. Offer to check in with the client now and again or offer a follow up appointment. 

  • The client continues to implement the plan and establishes new habits
  • Setting up and use of maintenance techniques by the client (awareness, reframing, positive thinking, etc…)
  • Client engages with their support network

Exit

  • If the process is successful, the client exits the model – the client also exits the working relationship.
  • If the change is permanent the clients doesn’t need further support

Relapse:

  • The client may relaps into old behaviour or may temporarily forget the plans and techniques you both put in place – you could be supportive, listening to the client and their reasons (realy or imagined) of why they have relapsed into old behaviour. It’s important to listen and not to judge.
  • The client re-enters the precontemplation stage but is in a different place than before. If relapse happens, the client may spend less time in the precontemplations stage and recognition that change needs to happen may come easier to the client – offer support to the client as before, but also confirm that they are in a different place by asking open questions.

 

Critique

I find this a very useful model which is easy to remember. The techniques may require some practice but if you have a basis of client-centred techniques, this should not be overly challenging. I’m hesitant to offer more of my own critique to give you the chance to explore and think about the strenghts and weaknesses of this model more yourself.

  • How powerful is this model for you? It’s sometimes difficult to work with clients who find it challenging to be or stay motivated to implement change.
  • Would you find this easy to implement with a client who needs or wants change? Or have you without realising, used some of this model already?
  • In which circumstances, or with clients, would this model be weaker?
  • Here too, have a look at how this model performs against Brown’s criteria.
  • In what ways is it different to other models of change, especially Schlossberg’s model?
  • How is it different to motivational theories and models?

 

Useful links

More academic resources:

References:

  • Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395
  • Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288