I recently read an article written by Mark S. Gold, MD, and he spoke about how change happens. Just as there are stages of grief, there are stages of change. In the beginning of his article, Mark notes that almost 20 years ago, two well-known alcoholism researchers, Carlo C. DiClemente and J. O. Prochaska, introduced a six-stage model of change to help professionals understand their clients with addiction problems and motivate them to change. Their model is based on their personal observations of how people went about modifying problem behaviors such as smoking, overeating and problem drinking.
As a Marriage and Family Therapist, Master NLP Practitioner, Certified Hypnotherapist, and Sports Psychology Consultant, I’ve used this six-stage model of change to help my clients assess where they are in terms of their readiness to stop all kinds of behaviors that keep them feeling stuck and out of integrity with their own values and out of alignment with their higher selves. In addition, I’ve used this six-stage model to help my clients find and maintain the motivation to stop whatever self-destructive habits, patterns, or behaviors are getting in their way and precluding them from realizing their full potential and leading healthy and fulfilling lives. In addition to using this six-stage model to help my clients with addiction issues, I’ve used this model to help couples decide if they’re sincerely interested in salvaging their marriage or not, men and women with anxiety and depression decide if they’re willing to take medication to address chemical imbalances in their brain, athletes decide if they truly want to make the sacrifices that will be required of them to become professional athletes and/or champions, men and women decide if they’re sincerely ready to give up extramarital affairs, codependent relationships, criminal behavior, etc.
The six stages of the model are:
As a Marriage and Family Therapist, Master NLP Practitioner, Hypnotherapist, and Sports Psychology Consultant, it’s been incredibly helpful for me and my clients to understand their readiness to change by being familiar with the six-stage model of change. With this knowledge in hand, I can help my clients make decisions that that truly resonate with them in light of what stage of change they’re at. Understanding where they are in terms of their readiness to stop self-destructive habits and behaviors helps me to tailor how I approach our change work together, and it helps me to think of ways to motivate them to move away from what is familiar to what will serve their highest good.
Individuals in the precontemplation stage of change are not even thinking about changing their self-destructive behaviors or freeing themselves from the quicksand that is making it feel impossible for them to make empowering decisions for their lives. They may not see their behaviors as problems, or they may think that others who point out their problems or paralysis are exaggerating.
There are many reasons to be in precontemplation, and Dr. DiClemente has referred to them as “the Four Rs” —reluctance, rebellion, resignation and rationalization:
- Reluctant precontemplators are those who, through lack of knowledge or inertia, do not want to consider change. The impact of the problem has not become fully conscious.
- Rebellious precontemplators have a heavy investment in their self-destructive behaviors, and they are are hell bent on making their own decisions. They are resistant to being told what to do.
- Resigned precontemplators have given up hope about the possibility of change and seem overwhelmed by the problem. Many have made many attempts already to change their behaviors to no avail. In turn, they feel defeated and destined to engage in their behaviors for the rest of their lives.
- Rationalizing precontemplators have all the answers; they have plenty of reasons why their behaviors are not a problem, or why their behaviors may be a problem for others but not for them.
Individuals in this stage of change are willing to consider the possibility that they have a problem or internal conflict, and the possibility offers hope for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a commitment; it is not a decision to change. People at this stage are often quite interested in learning about change and transformation and what steps they must take to achieve them. They know that whatever habits and patterns they engage in are causing them problems, and they often have a mental list of all the reasons that sticking with behaviors that are self-destructive or stop them from moving forward or in a different direction is bad for them. But even with all these negatives, they still cannot make a decision to change.
In the contemplation stage, often with the help of a treatment professional like a Marriage and Family Therapist, life coach, Hypnotherapist, Master NLP Practitioner, or Sports Psychologist, these people make a risk-reward analysis. They consider the pros and cons of their behavior, and the pros and cons of change. They think about the previous attempts they have made to stop whatever behavior is keeping them stuck, and what has caused them failure in the past.
Determination: Commitment to Action
Deciding to stop self-destructive habits, patterns, and behaviors are the hallmark of this stage of change. All the weighing of pros and cons, all the risk-reward analysis, finally tips the balance in favor of change. Not all ambivalence has been resolved, but ambivalence no longer represents an insurmountable barrier to change. Most individuals in this stage will make a serious attempt to stop their self-destructive behaviors in the near future. Individuals in this stage appear to be ready and committed to action.
This stage represents preparation as much as determination. The next step in this stage is to make a realistic plan. Commitment to change without appropriate skills and activities can create a fragile and incomplete action plan. As a Marriage and Family Therapist, I will help these individuals make a realistic assessment of the level of difficulty involved in making new decisions and incorporating new behaviors into their lives. They will begin to mentally, emotionally, and even spiritually prepare for potential problems and pitfalls down the road, and they will come up with concrete strategies, resources, and solutions that will keep them moving forward toward achieving their goals.
Action: Implementing the Plan
Individuals in this stage of change put their plan into action. This stage typically involves making some form of public commitment to change their behavior or move toward their stated goal in order to get external confirmation of the plan. If they have not done so already, individuals in this stage may enter individual counseling, marital counseling, group therapy, outpatient treatment, attend AA meetings, or tell their family members and friends about their decision—or all of the above.
Making such public commitments not only helps people obtain the support they need to change, but it creates external monitors. People often find it very helpful to know that others are watching and cheering them on. In addition, such public commitments makes them accountable to those they’ve shared their intentions and goals with.
Nothing succeeds like success. A person who has implemented a good plan begins to see it work and experiences it working over time, making adjustments along the way. They reclaim sacred parts of their lives, and they develop hope and self-confidence as they continue to show up in ways that align with their highest selves.
Maintenance, Relapse and Recycling
The action stage normally takes three to six months to complete. Change requires building a new pattern of behavior and thinking over time. The real test of change is long-term sustained change over many years. This stage of successful change is called “maintenance.” In this stage, a new way of being with oneself, others, and the world is firmly being established, and the threat of a return to old patterns becomes less intense and less frequent.
Individuals who have engaged in self-destructive patterns or paralysis by analysis may experience a strong temptation to fall back into old patterns from time to time. Sometimes relaxing their guard or “testing” themselves begins a slide back. I do my very best to successfully arm my clients at this stage of change with a variety of relapse prevention skills. They know where to find me, and they know where to get the support and resources they need elsewhere too.
People who relapse back into old self-destructive behaviors learn from the relapse. The experience of relapsing and returning to new, healthier patterns of thinking and behaving often strengthens a person’s determination and resolve to take right action in their lives going forward.
The ultimate goal in the change process is termination. At this stage, my clients no longer find that old, self-destructive behaviors tempt them; he has complete confidence that he can thrive without fear of relapse.
Thank you for taking the time to read my article. I hope that you have found it illuminating and helpful!!
John Boesky, LMFT/MNLP/CHT/Sports Psychology Consultant