Stages of Change
By J. Lynn Holsman, PRS
Health & Recovery Content Specialist
Edited for Medical Content by Dr. Pennington, NP
Stages Of Change
There is a saying amongst twelve-step groups (AA, Al-Anon etc.) that states, “When the pain is great enough, the change will occur”, which basically means that a person will be willing to change her behavior only once it has become unbearable to stay the same. This is precisely what the Stages Of Change Model attempts to explain. It focuses on the decision-making process of someone who is looking to make an intentional change. For the purposes of this article, we will use Jane as an example to walk you through each of the stages of change. Jane is a woman with a drinking problem. We will follow her through the Stages of Change in deciding to act and get help for her drinking.
Precontemplation
The very first stage of change is Precontemplation. In this stage, the individual does not see a problem with their behavior, but everyone around them can see there is a problem. People are resistant to the idea of change in the Precontemplation stage. If we look at our example of Jane, her situation will look like the following: Jane does not think she has a problem with drinking. She has had a few consequences from her drinking, but she does not see that the consequences and her drinking are related. For instance, she may have missed some days of work due to her drinking and partying… so much so that her job is on the line. In this first phase of change, Jane blames her work problems on her boss, finding any excuse to take the focus off herself. “My boss just doesn’t like me,” is an example of some justification she might try to use.
Contemplation
The next stage is Contemplation. Here, an individual begins to acknowledge that they have a problem and how to go about fixing it. In the Contemplation phase, an individual will weigh both the pros and cons of changing their behavior. There will still be some ambivalence about wanting to take all the necessary steps for change, but the behavior change will take place within the next six months. If we look at Jane in this stage, she has admitted that her drinking is problematic. She knows that something needs to change, but she doesn’t necessarily know-how. She is not ready to take full responsibility for all her reckless behavior, but she does agree that change needs to take place.
Preparation
After Contemplation comes the Preparation Stage. In this stage, individuals will make a change in their behavior within the next 30 days. They will begin to see how making a change can positively affect their lives and begin making some small shifts to prepare themselves for making a major life change. By now, a person has fully accepted that change is coming, and they are willing to put forth the effort. Looking at Jane and her problem drinking, in this Preparation Stage, she might have a bed promised to her at a treatment center, and she’s just waiting for the bed to become available. If Jane has a child to care for, in this stage she would be looking for alternative childcare before heading to treatment, but she has fully admitted that her drinking is problematic and is willing to make the necessary changes to become a healthier person.
Action
The Action Stage is the next Stage of Change. When someone is in the Action Stage, they have begun to change their behavior within the last six months. They plan to continue moving forward with the changed behavior. In the case of Jane, she would be in treatment at this point, and actively working her chosen program of recovery. Every day, she is making small changes to meet her long-term goal of not drinking.
Maintenance
Next, we have the Maintenance Stage. In this stage of change, the changed behavior has been sustained for at least six months or more. Individuals intend to maintain their changed behaviors. During this stage, people are actively working to not relapse to earlier stages. With Jane, by the time she was in the Maintenance Stage, she would have at least six months of sobriety, working to maintain the longevity of her sobriety. She is continuing to work her program of recovery and has no desire to return to drinking. Although she may have fleeting thoughts or even urges, her authentic self wants to stay sober, and she works toward maintaining that goal daily. We finally end at the termination of the problematic behavior, but most people will remain in the maintenance phase so as not to return to the behavior they were trying to change.
Change is never easy. Relapse may happen. A slip may occur in any of the stages. If that happens, the individual begins the process over again. We can see how Jane’s mindset changes throughout the stages. At first, she doesn’t believe she has a problem at all, then changes to ambivalence, and eventually turns into determination. It is important to take these stages into consideration when looking at any behaviors in our own lives that we may want to change. Understanding these stages can help set you up for success!