Stages of Change

The Stages Defined

Intentional behavior change is integral to healing and recovery from mental health challenges. Change follows clear patterns, identified in the transtheoretical approach known as the Stages of Change.

Prochaska and Norcross (2001) defined the Stages of Change as follows:

“Precontemplation is the stage in which there is no intention to change behavior in the foreseeable future.” Prochaska and Norcross wrote that most people who are in this phase do not know they have a challenge that must be addressed. Approximately 40% of people seeking outpatient treatment are in this stage of change, with exceptions being those who are struggling with chronic discomforts (e.g., chronic pain, regular panic attacks).

“Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action.” Approximately 40% of people seeking outpatient treatment are in this stage of change.

“Preparation is a stage that combines intention and behavioral criteria. Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year.”

“Action is the stage in which individuals modify their behavior, experiences, and environment in order to overcome their problems.” Approximately 20% of people seeking outpatient treatment are in this stage of change. What many do not realize is that action plans for change need to last for three to six months so that new habits have a chance to take root and become routine.

“Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action.” People in this stage of change rarely present to outpatient treatment, but many still may not realize that relapse from a successful change is a normal experience. As the diagram at the top of this entry shows, repetition of successful change processes usually occurs multiple times before life challenges are fully resolved.

“Termination is the stage in which people have completed the change process and no longer have to work to prevent relapse. Termination is defined as total confidence or self-efficacy across all high-risk situations and zero temptation to relapse.” Closure is the gift we give ourselves. Too often, we live without knowing that the answers we need for our lives are always present in our own actions and desires.

The Stages Applied

Mental health treatment can seem insurmountable through the perspectives offered by culture and mass media. However, therapy is more discretely episodic, with sequels to initial steps furthering stories of healing and growth. All treatment begins with listening. Even for those in the Precontemplation stage of change, listening to others offers opportunities for new awareness. In the Contemplation stage, therapy becomes clarifying and specifying, so that Preparation is grounded in commitment. When an action plan begins, therapy looks like strategizing for high-risk situations. Through the phases, the therapist acts to support different needs, shifting from source of insight to a collaborator. The word “therapist” comes from the Greek word for attendant, or one who goes along with another. Regardless of the stage any person may begin from at the start of treatment, therapist and client create a partnership for successful change.

References

Prochaska, J.O., & Norcross, J.C. (2001). Stages of change. Psychotherapy, 38, 4, 443-448.