Stages of Change

Every Sunday, I look up healthy recipes and I go to the store and buy fruits, vegetables, and lean meats.  I meal plan and divide this food into Tupperware for the week.  And on Monday and Tuesday, I follow my plan.  I am motivated and I feel good.  By Wednesday, I find myself eating candy at the office because, why not?  I am halfway through the week.  Thursday is Happy Hour so chips, queso and margaritas it is!  And by Friday, I am eating out and loving it!

Ok, this is a silly example that I poke fun about, but helps me to highlight that even in every day life’s ins and outs, it can be hard to make lasting changes.  Over the years as a therapist I have often heard people say things like, “People don’t change.”  And, in some cases, I agree.  But when people come in to work in therapy, what is the point of my job if I don’t think people can make changes? 

Over the last 25 years as a social worker, I have worked primarily in the field of trauma, mainly related to family violence.  I have watched the most courageous humans who have been violated and harmed in the worst ways create HUGE changes in their lives. 

The perspective that is most helpful for me, day in and day out in this work, regardless of client or modality, is the consistency and necessity of conceptualizing a client’s process through the Transtheoretical Model of Change (Stages of Change for short!).  

I first learned about this conceptually as a baby therapist working at Genesis Women’s Shelter and Support. DiClemente and Prochaska developed this concept regarding behavior change in 1983 while studying smoking cessation. 

As the Director of Clinical and Professional Services at Genesis, I felt very motivated to provide the very best and most efficient services to women and children who were affected by domestic violence because their lives were often at stake.  As I learned more about these 5 (unofficially 6 stages), we began defining them for women in domestic violence situations in order to provide the best practice interventions to ultimately provide support for women to become safer. 

The phases are as follows:

·       Stage 1 – Pre-Contemplation

·       Stage 2 – Contemplation

·       Stage 3 – Preparation

·       Stage 4 – Action

·       Stage 5 – Maintenance

·       Stage 6 – Relapse

I am going to use a client in a domestic violence relationship as an example, but think of an example in your own life where you are trying to make changes and just notice (not judge) how these stages might apply.

In stage one of Pre-Contemplation, this is a woman that we most likely will not see in our office because she does not think that there is a problem in her marriage.  It may be that a concerned friend or family member has told her to come see us, but she did not initiate services.  The “intervention” for all of us in this case is simply listening, being empathic and accepting resistance rather than opposing it.  Often it is the simple reflection of the words that she is saying to you and reflected back to her that allow her, over time, to begin to see the issue.  In any stage, if she feels pressure it backfires as she feels like she cannot share with other people because they are going to tell her what to do. This often leads her back into the arms of the abusive partner even further.

In stage two of Contemplation, she may be seeking services for support on her own.  She is not calling the abuse, “abuse,” but rather saying things like, “We fight a lot.”  She feels uncertain and often conflicted in this stage.  She is ambivalent about the relationship.  It is important to support her by asking her about her beliefs and what she needs and feels.  This is counter to what the abusive partner does and she begins to recognize that she matters.  It is ok to ask about barriers in this stage and possibility think about the pros and cons about the relationship. 

In stage three, Preparation, the person is willing to take small steps forward.  She may be talking about change in this stage.  Having small goals may be helpful as you support her.  She may also begin talking about a larger plan for making changes.  During this stage with domestic violence, it is important to have an expert like The Haven Wellness Center or Genesis Women’s Shelter and Support begin safety planning with her.   Other safety planning information can be found at the National Domestic Violence Hotline at https://www.thehotline.org/plan-for-safety/

In stage four of Action, she has a clear plan for making changes and is implementing it.  She has goals and is moving toward them.  This is a time for general encouragement and support and in a domestic violence situation, ongoing safety planning as leaving is the most dangerous time for a woman.  Advice is given only as needed. 

In stage five of Maintenance, she has adopted this change for at least six months.  In domestic violence, it means that she has assigned responsibly to the abusive partners and has made changes to keep herself and her children safe.  She has a support system and positive coping skills.  After five years in this stage, the fears about relapse decrease. 

And, let’s talk about that word relapse.  Relapse is the sixth and unofficial stage of change.  Relapse is part of change.  It would be so wonderful if each one of us could simply decide to make a change and sail through each of the stages with no issue, but this is not reality.  Remember back to my silly example in the beginning?  I “relapse” every week.  These stages are not linear.  Relapse often has a negative connotation and yet, I think relapse is just part of this.  We should assume relapse.  So normalize this for her.  Let her know that relapsing back is normal and she should not be ashamed.  If this occurs, we just back up a little. Where is she is now?  Contemplative?  Preparation? Move forward from there. 

Generally, the concept of Stages of Change can be applied to any change any of us make.  It is helpful to understand these stages in order to have patience and understanding with ourselves and others. We know that change is a process, not an event. 

If you want to hear more about this, you can hear more from me on the Radical Sacred podcast here: Radical Sacred

Until we see you,
Kelly & The Haven Team