Prochaska and DiClemente's Stages of Change Model for Social Workers

When life requires a change in directions, sometimes it feels frightening. Changing can be uncomfortable and confusing. Even with a clear goal, the path forward may be hazy. The journey is often difficult and slow and sometimes requires professional help. Clinicians understand this and are trained to help their clients reach their goals by carefully navigating the stages of change. However, counselors need to tailor their assistance to their client's needs, so it's crucial to recognize what stage of change clients are in before deciding how to successfully guide them.

Keep reading to learn more about DiClemente and Prochaska's Stages of Change, one of the most widely adopted models for helping clients make lasting behavioral change. Comprehending the change process, assessing a client's readiness to change and proposing effective ways to achieve change are the primary objectives of the Stages of Change model.¹

During a smoking cessation study in 1983, researchers James Prochaska and Carlo DiClemente identified and developed their Stages of Change as one of the three components in their Transtheoretical Model of Behavior Change, also known simply as TTM. TTM describes the process of change, stages of change and methods of measuring change.¹

Five official stages are described in DiClemente and Prochaska's Stages of Change Model, including pre-contemplation, contemplation, preparation, action and maintenance. An unofficial 6th stage, relapse, is popularly included because occasional slips are inevitable in the change process.¹

The Stages of Change Model was originally used to help people overcome addictions and problematic behaviors such as alcohol or drug abuse, overeating and smoking.² However, it is now the "standard-bearer" for change therapy and is also applicable for school bullying, condom use, sunscreen use, exercise adoption and other preventative health measures such as cancer screening and mammography.³

Social workers, counselors and other clinicians approach DiClemente and Prochaska's Stages of Change with an understanding that change takes time, varying from one client to another. However, all clients achieve similar stage-specific goals before moving on to the next stage.¹ Through each stage, unconditional acceptance and support are offered, together with interventions personalized to a client's unique situation.³

The following paragraphs explore each of the 6 stages of change. Assessment clues are provided, as well as some effective interventions appropriate to each stage.

In the pre-contemplation stage, clients may not recognize the consequences of their actions. Some clients may have been court-ordered or otherwise pressured into treatment. In any case, clients in this stage are typically not considering changing their behavior. Assessment clues include ignorance or denial of problems.^1,4

Intervention strategies include listening actively, expressing empathy and accepting the client's resistance rather than opposing it. Personalized tasks may include asking clients to reconsider their behavior by analyzing the risks of their actions and identifying any benefits of changing.^3,4

Clients acknowledge their problem in the contemplation stage but may not have the confidence to take a step forward. Clues to recognizing clients in this stage include uncertainty, conflicted emotions or ambivalence about changing.^1,4

Instilling hope in the client's ability to proceed is a crucial form of support in this stage.¹ Effective interventions may include asking about a client's beliefs to help gain a deeper understanding of their behavior.³ Asking about possible barriers to change may also be helpful. Clients may gain a stronger sense of purpose by asking them to weigh the pros and cons of present behavior as well as the pros and cons of changing.^2,4

In the preparation stage, clients are willing to take small steps forward. Evidence of this stage may include statements confirming a client's commitment to change and a willingness to prepare a plan of action.^1,3

Setting small, achievable goals is critical for clients in this stage. Strategic tasks may include identifying resources, supports and skills the client may draw on and then help the client create a plan to attain them. Encourage the client's self-efficacy and commitment to change.¹ Clients also need help realistically assessing their level of difficulty during this stage. Considering potential problems and pitfalls can help clients determine solutions and prepare for difficulties ahead of time.²

Clients in the action stage have developed clear plans for change and are implementing them. They are easily identified by their direct actions towards accomplishing their goals.^1,4

As clients become more active, clinicians take on less active roles. The intervention strategies in this stage include periodic reviews of client motivations, resources, progress and enthusiastically praising success. Then, as clients gain greater confidence and ability, counselors provide additional support, advice and guidance only as needed.^1,3

Clients enter the maintenance stage after adopting their new change for at least six months. Other identifying factors are unwavering commitment to their change and conscious actions to avoid temptation. They are prepared for potential pitfalls, with well-developed coping skills and support systems.^1,3,4

Continuing more as a consultant, the counselor provides advice, guidance and support to clients in the maintenance stage only as needed. People typically remain in this stage for up to 5 years as confidence in sustaining their new lifestyle increases and fear of relapse decreases.³ Interventions during this stage may include helping clients recognize how overconfidence sometimes leads to relapse. It's also important to promote the mindset that a potential relapse is only a minor setback, not a devastating failure.¹

The unofficial 6th stage of change is relapse. Although termination or completion is the ultimate goal of DiClemente and Prochaska's Stages of Change model, relapses are common in the process of making lifelong changes.^3,4 Clients in this stage have lapsed back to old behavior and are easily recognized by their frustration, disappointment or feelings of failure.⁴

Intervention strategies and tasks include de-stigmatizing and normalizing the notion of relapse, helping the client identify the cause and devising a plan to avoid this trigger in the future. Rebuilding the client's confidence may require restarting the process of change at an earlier stage, such as contemplation, preparation or action.⁴

The keys to success in the relapse stage are helping clients reassess their supports and skills and reaffirm their commitment to their goals. The learning opportunity gained by a relapse very often strengthens a client's resolve and improves the chances for a lifelong change.^2,4

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<sup>1. Retrieved on April 22, 2021, from socialworkpodcast.blogspot.com/2009/10/prochaska-and-diclementes-stages-of.html
2. Retrieved on April 22, 2021, from psychcentral.com/lib/stages-of-change
3. Retrieved on April 22, 2021, from ncbi.nlm.nih.gov/books/NBK556005/
4. Retrieved on April 22, 2021, from verywellmind.com/the-stages-of-change-2794868</sup>