What are the Stages of Change and How Can They Help Me?
Therapists use a wide range of tools and theoretical orientations to help them better understand and help their progress toward their mental health goals. However, patients are often in the dark about the theoretical orientations their therapist may be using to conceptualize their symptoms and treatment plan. A quick Google search will likely show you articles related to CBT, EMDR, ACT, and other evidenced-based treatment modalities. Admittedly, it is likely that your therapist is using at least one of these theoretical orientations to guide your treatment. However, your therapist may also use the Transtheoretical Model of Change (TTM), commonly called the “stages of change,” to help understand your symptoms and cognitive perceptions.
The TTM was initially developed by James Prochaska and Carlo Di Clemente in 1977 (Sutton, 2020). Generally, they are defined as stages that patients often move through as they work to change their behaviors. Further, these stages give providers insights on how to best support individuals as they progress through treatment (Sutton, 2020). The TTM applies to a broad range of symptoms and problems including substance abuse/addiction, weight control, smoking, anxiety, depression, and many more (Raihan & Cogburn, 2023).
Aasheim (2012) notes that these stages are not linear in nature and it is not necessary for individuals to work through these stages “in order.” Furthermore, it is not uncommon for individuals to cycle through the various stages multiple times before experiencing consistent and long-lasting change (Aasheim, 2012). Finally, while your provider may be working from primarily a CBT-based orientation, it is also likely that your provider is using the TTM to guide interventions and treatment goals (Aasheim, 2012).
Prochaska and Di Clemente’s TTM model includes 6 stages:
Pre-contemplation: Individuals in this stage are not going to take any
action to change their behaviors as they generally do not believe that
there is a problem. When working with individuals who are in the pre-
contemplation stage, providers will likely work to increase awareness of
a problem and the risks associated with continuing the current
behaviors (Sutton, 2020).
Contemplation: In this stage, individuals are becoming aware that
there is a problem and may be developing the intention to begin
changing behaviors (Sutton, 2020). However, it is also common for
individuals in this stage to experience conflicting emotions about their
behaviors and the potential for change (Cherry, 2022). Providers will
often encourage patients in this stage to create pros/cons lists about
their current behaviors and changing their behaviors (Sutton, 2020).
Preparation: At this stage, a decision has been made to pursue change
and individuals are establishing goals and developing a plan (Sutton,
2020). Additionally, individuals are likely experimenting small changes
to collect information about their behaviors and changes they would
like to make (Cherry, 2022).
Action: This stage involves the implementation of a plan to change
one’s behaviors. Additionally, as individuals are implementing their
plans, they are observing the results, rewarding successes, and make
revisions to further promote change (Sutton, 2020). Typically,
individuals spend a minim of 6 months in the action stage to change
their behaviors (Raihan & Cogburn, 2023).
Maintenance: Individuals in this stage are focused on maintaining
their changed behaviors and continued progress toward their goals.
Additionally, providers work with patients to identify obstacles and
develop coping strategies to manage these obstacles and maintain
progress (Sutton, 2020).
Termination: This stage occurs when individuals have maintained their
changed behaviors for 6 months or longer. At this point, the behavior
has become integrated into the individual’s daily routine and has
become a habit (Sutton, 2020).
In addition to considering what stage of change you may be in, your provider is also considering other aspects that contribute to changing behaviors. For example, your provider has likely worked with you to more fully understand the perceptions and beliefs that you may hold about the changes you are attempting to implement. Specifically, if you do not think that the benefits outweigh the drawbacks of implementing change, then you are unlikely to follow through with the steps necessary to implement and maintain long-lasting change (Sutton, 2020). Additionally, it is vitally important that you believe in yourself and your ability to overcome obstacles inhibiting your efforts to change (Sutton, 2020). Your therapist will also work with you to identify strategies to manage barriers to change and ultimately prevent relapse in the future (Cherry, 2022).
The decision to change your behavior is often not an easy or simple one to make. There are a number of factors that both help and inhibit your ability to make long-lasting and positive changes within your life. Prochaska and Di Clemente’s TTM model can help both you and your therapist assess your readiness for change and set you up for long-lasting success.
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
Capuzzi, D., Stauffer, M. D., & Aasheim, L. (2012). Motivational Interviewing. In Foundations of Addictions Counseling. essay, Pearson.
Cherry, K. (2022, December 19). The 6 stages of behavior change. Verywell Mind. https://www.verywellmind.com/the-stages-of-change-2794868
Raihan, N., & Cogburn, M. (2023, March 6). Stages of change theory - statpearls - NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK556005/
Sutton, J. (2023, February 8). The 6 stages of change: Worksheets for helping your clients. PositivePsychology.com. https://positivepsychology.com/stages-of-change-worksheets/