The Transtheoretical Model of Change by Janet Oakes February 2005

James Prochaska, Ph.D. and Carlo DiClemente, Ph.D developed the Transtheoretical Model of Change. It evolved out of Prochaska's comparative analysis of 18 major theories of psychotherapy and behavior change. He identified nine process that can produce a change in behavior: consciousness raising, social liberation, emotional arousal, self-evaluation, commitment, counter conditioning, environmental control, reward, and helping relationships. 

In further studying these processes with Dr. DiClemente in 1982 they noticed 6 stages of change, or phases individuals go through to change their problematic behavior. These stages of change are the aspects of the Transtheoretical Model that we have discussed more extensively in class. These stages are:

1. Precontemplation (no intention to take action in the next six months)
2. Contemplation (intends to take action in the next six months) 
3. Preparation (intends to take action in the next 30 days with some behavioral steps in this direction) 
4. Action (has changed overt behavior for less than six months) 
5. Maintenance (has changed behavior for more than six months) 
6. Termination (behavior will never return, there is confidence that there will be no relapse) 

These stages of change are often diagramed on a circle showing where a client might enter treatment, relapse, and come back into treatment of complete treatment. 

I feel the model is very useful for helping to identify what stage a person and therefore what interventions would be most appropriate and potentially helpful. It is a model that can assist us as counselors in our task of meeting the client where they are. Recognizing that a client is at the precontempaltive stage allows for a more compassionate and accepting understanding of the client than labeling them as being in denial or unwilling. And with this understanding we can choose interventions that may help the person move to the contemplative stage. 

For example, we could use consciousness raising by providing information about the nature and risk of their behavior and the value and drawbacks of safer behavioral alternatives. In other words providing education can be helpful at this stage of change whereas trying to put together a plan of action would not be helpful and may in fact be destructive, driving the person away and discouraging them from seeking treatment in the future. 

Motivational Interviewing involves a variety of therapeutic techniques and principles that work hand in hand with the Transtheoretical Model of Change. Many of these techniques are especially helpful to clients in the contemplative stage of change as they identify and intensify the ambivalence the client feels about the pros and cons of continuing their substance use or finding alternative options. The discomfort of the discrepancies the person is experiencing at this stage can be used to help motivate them to move to the Preparation and Action Stages.

Awareness about the stresses that may threaten clients after they have stopped their substance using behavior when they are at the maintenance stage is very helpful in working with clients to prevent relapse. 

12 Step programs can be very useful in providing a sense of community and belonging or 'helping relationships' so well as learning and strengthen the new non using behaviors by teaching and helping others or 'social liberation' in the language of the model. 

Awareness of the "stages of change" can help us to be open and flexible in our thinking, truly client centered, paying attention to the client allows the flexibility to be able to see / understand clients at different stages that they move trough not as fixed in one place, willing or nor willing, good or bad. So I do see the model as useful. It is only as useful as the person using it, can also become rigid if one starts to listen more to the model than to the client. 

We need to focus on the client so that if they are ready to skip a stage and go to the action stage we can be right there with them and not miss opportunities to help clients or get in the way because we expect things to go in a particular order at a particular pace.