Mental Health Matters: Stages of change

Each January, millions of people think about setting one or more goals to accomplish in the new year. Reaching these goals usually requires some sort of behavior change, if not a series of changes, meaning it is helpful to be knowledgeable about how we undertake and progress through the process of change before setting goals.

In 1998, DiClemente and Prochaska published a chapter about a transtheoretical model of change in the book, "Treating addictive behaviors," 2nd edition, edited by Miller and Heather. This model, which was originally applied to addictions, is now widely used to explain and assist with any type of change people want to make.

DiClemente and Prochaska’s model of change actually starts with no change. They call it the Precontemplation stage, which means you have not even begun to think about making a change. And yet, change is still a possibility. When you are in precontemplation, even much-needed changes can be completely outside your awareness.

The second stage is Contemplation. At this point, you have become aware that a change is needed or desired. Perhaps your doctor tells you your blood pressure is getting high or you start to think it would be nice to be a bit stronger. When you are in Contemplation, change is not yet occurring, though you may make some stabs at it without much direction or commitment.

The third stage, Preparation, is where more meaningful movement toward change occurs. Unfortunately, it can also be a much-overlooked stage of change. Taking the time to think through and research your goal can make the difference between success and giving up due to frustration and lack of resources. For instance, losing weight can be a healthy goal, but it will be hard to achieve if you do not shop for healthy food or decrease how often you eat out. Thinking about potential obstacles ahead of time will give you more confidence as well as increase your chances of success.

It is not until the fourth stage that DiClemente and Prochaska’s model gets to Action. The Action stage of change is where you put together the thoughts about change with the preparations for change and begin to do things differently. If your goal is to knit a sweater, then Action begins when you have learned some basic knitting; found a pattern, yarn and knitting needles; and set aside time to knit. A diet may go into the Action stage after a diet plan is chosen; groceries have been purchased; thought has gone into how and when you will prepare food; and you have a plan for refusing food that does not fit into your diet plan.

Maintaining your new behaviors is the fifth stage. This is when the Action stage has been going for long enough that you have seen positive changes toward your goal and those changes are feeling more normal. In other words, the change you made is now the new behavior. For example, a year ago, it may have been really hard to get up 30 minutes early to exercise, write, paint, cook, etc., but today, it is simply your routine.

One of the important aspects of DeClemente and Prochaska’s model is the inclusion of a sixth stage called Relapse. A relapse or lapse is a recurrence of unwanted behavior and/or cessation of desired behavior. Because lapses are likely to happen, a plan to deal with them should be made in the Preparation stage. Having a plan for a lapse will get you back on track that much sooner. Because not everything can be planned for, the most important thing is to remember that a lapse is not the end of your goals. In fact, it can be helpful to view lapses as opportunities to learn about yourself and the process of change. Plans can look great on paper, but it may be you were not realistic or did not have enough information and need to make adjustments to improve your chances of success. This is a much healthier approach than assuming nothing will go wrong or demanding perfection.

Rather than “good luck," I will close by wishing you good Preparation and Action stages of change so that you may reach the Maintenance stage and realize your dreams.

Nora Sinclair is a licensed professional counselor and national certified counselor based in Lexington, S.C.