Friday, December 10, 2010

Helping others create lasting, significant behavior changes

As a service provider, I usually am trying to help people make a significant change in their lives. The client wants some aspect of his or her life to change, and I am there to help find a path that will lead to that change. It sounds easy enough, but lasting, significant changes are hard to come by.

I often hear service providers complain that their clients are not motivated. On the surface, many clients do not seem motivated. I have had clients miss appointments, not follow through with my suggestions, keep me waiting, tell me nothing will work, and actively sabotage my attempts to help. Yet I still feel that most of them really did want a change, but were perhaps not ready to work on it.

I have found the Stages of Change (DiClemente & Prochaska, 1998) incredibly helpful for understanding the process my clients were going through, and helping me to meet my clients where they are at. Here's a quick summary of the stages a person goes through when making a behavioral change:

1. Precontemplation - is when the person does not feel there is a problem, and therefore does not intend to change his or her behavior. I find as a service provider, if a person is at this stage, I have to question whether this is really an issue for the client or if I am trying to impose my values on the client.

2. Contemplation - is when the peron is thinks he or she might want to make a change at some point in the future.  The person is open to discussing the pros and cons of the behavior.

3. Preparation - is when the person is ready to start planning the behavior change, and set a date in the near future to make that change.

4. Action - is when the person is in the process of making the change.

5. Maintenance - is when the person has made the change but continues to work on maintaining the lifestyle changes to support the new behavior.

Some people suggest that Relapse is the next step and should be planned for, as is tends to occur several times prior to any kind of permanent behavior change.

What bothers me is when service providers use the Stages of Change as an excuse for inaction. They think if the client is not at the preparation or action stage, they do not have a role. I believe our role is to help a person move through the stages, and waiting around usually does not help a person progress.

Sometimes, working in mental health, it can feel like very little progress is made. What helped me to recognize the progress my clients were making, was when a colleague suggested that our role is to help people move to the next Stage of Change, not necessarily to help them move through all of the Stages.

Targeting interventions to the Stage of Change the client is at dramatically increases effectiveness. Diclemente and Prochaska (1998) also describe 10 processes for facilitating movement through the Stages of Change that I have not found as helpful. The Motivational Interviewing framework is often discussed in connection with the Stages of Change, in terms of helping people progress through the Stages, and I will discuss it in a future blog.


DiClemente, C. & Prochaska, J. (1998). Toward a comprehensive transtheoretical model of change. In W. R. Miller & N. Healther (Eds.), Treating addictive behaviors (pp. 3-24). New York: Plenum Press.

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