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This lesson goes over the five stages of change model, explaining who created the model, defining each of the five stages, and explaining the sixth stage that may occur.

Five Stages of Change Model

Set up: How many therapists does it take to change a lightbulb?Punchline: One, but the lightbulb has to want to change.The old joke above refers to the second stage of the five stages of change model, which was created by a pair of researchers interested in treating alcoholics in the 1980s.

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Carlo C. DiClemente and J. O.

Prochaska each had years of experience in helping people stop problem behaviors, and their experience led them to collaborate on a model that explained the natural progression of changing an unwanted behavior. They published their work in 1983 and included the following steps in the model they created:

  1. Pre-contemplation
  2. Contemplation
  3. Determination
  4. Action
  5. Maintenance

Breakdown of the Stages

The pre-contemplation stage literally means ‘before thinking.’ People in this stage are not thinking about making any changes to their behaviors and are not yet ready to make any changes. According to the model, these reasons can be summed up in four words starting with the letter ‘R’: reluctance, rebellion, resignation, and rationalization. These people may not have realized the problem exists, are in denial about it, lack motivation to do anything to change it, or might just be rebelling against anyone else telling them what to do.

The second stage is contemplation, where individuals start to think that maybe they do have a problem and might want to change. The four Rs from the previous stage are still exerting influence over their behaviors, so the problem behavior continues. At this point, they are not really sure they have a problem, but are starting to become open to the possibility. Although this doesn’t sound like much, this openness is a crucial part of the change process. This fact is also at the root of the joke that started this lesson off.

During the third stage, determination, the person has admitted to themselves that they have a behavior that they want to change, and they are determined to make a change. They have thought about all the pros and cons of both the behavior and how difficult it will be to change. This stage includes researching ways to make a change, looking up information on getting professional help, or making a plan to change on their own. For some people, this planning is much less scary than actually taking the first step to changing a problem behavior.

For others, the time lapse between planning and action is so small it’s barely noticeable.The next to last stage is the action stage, where the person wanting to change a problem behavior has made the plans to change and is putting those plans into action to change the behavior. Prior to this stage, the person with the problem behavior may not have admitted to anyone else that they had a problem. That often changes at this stage in the change process: professional help is often contacted, and thoughts on the problem behaviors are shared with friends and family.

This is the stage when visible changes actually start to happen. According to the model, this stage takes 90 to 180 days for most people to complete.The last stage is maintenance, where the person changing the problem behavior works to maintain the changes they have implemented so far. Stopping a problem behavior in the long term is more difficult than stopping it in the short term. Situations and temptations will naturally come up in the person’s life that will test their resolve at sticking with the changes they’ve made. Sometimes these events are one-time events and the person gets back on their newly chosen path. They may even have a plan in place to help prevent relapses from occurring.

Other times, a small slip-up can lead to a much larger slide back into old behaviors and the cycle has to start all over again. The good news for these people is that subsequent cycles are often easier work through than the first time.We’ve gone over all five stages of the change model, but from the point of view of a therapist-patient relationship there is one more stage: termination. In this stage, the person making the change has demonstrated that they have the ability to make the change long term, has fewer temptations to return to old behaviors, and deals with those temptations more easily than before. At this point, the patient can continue the maintenance stage on their own, and there is no further need for professional assistance. In other words, the therapist-patient relationship terminates.

Lesson Summary

The five stages of change model describes a series of changes that people go through to change a problem behavior into maintaining a healthy behavior. The five stages are: pre-contemplation, contemplation, determination, action, and maintenance. If the person has employed professional help in making the change there is also a sixth stage where the therapist-patient relationship ends, called termination.

During the pre-contemplation stage, there is no thought about the problem behavior or the need to make a change. While in this stage, the person going through it has to deal with the four Rs: rationalization, rebellion, reluctance, and resignation. The contemplation stage starts with the possibility that there might be a problem that needs changing, but the idea is not yet solidified at this stage. The determination stage solidifies the need to make a change and starts the planning process. The action stage puts those plans into place. The maintenance stage strengthens and keeps the changes that have been made.

If there is a therapist-patient relationship, it terminates when the long-term maintenance of the change seems strong enough that the professional support is no longer needed.

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