TIP and ACTIVITY: Stages of Change

Erin Flynn with BTS asked me to post a deeper dive into the Stage of Change.  Thank you for that request, and here it is:

The stages of change theory was put together by Prochaska, DiClemente and Norcross. They researched, among many different behaviors, smoking cessation and weight loss, and found that people progress naturally toward changing their behaviors. As they do so, they go through certain stages, namely precontemplation, contemplation, preparation, action, and maintenance. From the action or maintenance stages, a person can relapse. In the table below, a version of which can also be found in the Interlock Enhancement Counseling manual that I published with Dr. David Timken, I describe each stage, what the goal is, what the client needs to do, and what we as counselors could do to facilitate their movement to the next stage of change.

A few things to remember. A client can be in one stage of change for one behavior, a totally different stage of change for a different behavior. So, it is behavior-specific, not client-specific. For the very same behavior, a client’s behavior could be in the action stage but their thinking could be in the precontemplation stage. For example, a client could be sober and providing clean UAs (action stage), however they might be saying that once they are off paper, they will be right back to using (precontemplation stage). So, it is important to both support their behavior in action, and challenge their precontemplation thinking.

I have posted a few activities on using stages of change. They can be found here:

Stage of Change Goal Client tasks Counselor tasks
Precontemplation To raise doubt that has an emotional component. The discrepancy needs to be bothersome.

Problem recognition

Examination of behavior

Logging behavior (e.g., thought logs, mood charts, drinking logs, interlock logs)

Education / Information

Normative feedback

Assign logging exercises

Resist the righting reflex

Contemplation To explore ambivalence

Impact exploration

Examination of benefits and consequences of behavior to self and other(s)

Examination of benefits and consequences of changing the behavior to self and other(s)

Conduct decisional balance exercise to examine the impact

Help the client develop and deepen the discrepancy between intention and impact

Clarify what change may look like

Begin to elicit change talk

Preparation To experiment

To develop a plan

Decision to change

Clarification of what the goal is

Expression of resolve and commitment

Participate in plan development

Elicit commitment language

Develop a plan that highlights the goal, the obstacles, steps to manage the obstacles and dates to reevaluate

Develop skills needed to execute the plan

Incorporate contingency management

Action To remove obstacles

To support positive movement

Act of change

Taking steps based on the plan developed

Monitors additional obstacles that arise

Provide support

Highlight unexpected benefits from changing

Develop skills for relapse prevention

Provide incentives for success

Maintenance To develop a long-term plan

To discuss changes in lifestyle

Evaluation of change

Examination of new behavior

Examination of impact of new behavior

Provide support

Provide incentives for success

Process through plan modifications as needed

Relapse Assessment and re-evaluation Exploration of what led to the relapse Explore the relapse, what worked about the previous plan, what didn’t

Reassess the client to see what stage of change they are in now.

 

2 thoughts on “TIP and ACTIVITY: Stages of Change

  1. Thanks Anjali! This deeper dive is helpful for me explore and support the stages of change with my clients in a more effective way. I appreciate you adding more to my understanding of the stages & all you do to help me make my groups FUN!

    Like

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