Five Stages of Change

Many moons ago, I was incredibly frustrated with a client who kept getting in trouble for the same behaviors.

He never was rearrested, but his drug use got him into problems with school, his family, and his inability to follow through on anything we had agreed to. His family was even more frustrated because  he did nothing: He didn’t go to school; he didn’t complete any assignments; he didn’t follow through with his responsibilities at home; he didn’t want to go to treatment, and his drug use was occasional enough that he wasn’t really an addict.  The main thing was that he just didn’t really do anything.

When we would meet, he put on a great show of how he had goals, he wanted people to see how much he’d been doing, how he had been working hard, and how he was caught in a viscous cycle whereby his past behaviors meant his parents would never trust him unless he was perfect – which he had no desire to be.   In his mind, they had a problem of too high of expectations and he was acting like a normal teenager.

During one of our legal team / social work team meetings, I listened patiently as the social workers explained that there was nothing they could do. I believe my quote (which still has been brought up time and time again to tease me) was, “That’s not a good enough answer, [expletive]. I want you to fix him!”

And that’s why I personally need to work with social workers.

Realizing what they were working with, the social work team were nice enough to do a presentation and training on the Transtheoretical Model of Change. Essentially, you don’t just get to “fix” people – they have to work through five stages of change:

  1. Precontemplation – there is no intent to change their behavior in the foreseeable future; the person is unaware of their problems.
  2. Contemplation – the person is aware that a problem exists and is thinking about addressing it, but nothing has been done to address the problem.
  3. Preparation – when a person intends to take action.
  4. Action – where the work actually begins.
  5. Maintenance – relapse and setbacks are inevitable; this is being cognizant of that reality and keeping a plan in place to address shortcomings.

When the social work team said that there was nothing they could do, they were dead right: this client was in the precontemplation stage. No amount of plan or program would make a difference. If he didn’t see that there was a problem, there’s no reason to change.

Even now I reflect on behaviors that I want to change (like working out before taking the kids to school) and how the self-rationalizations kill everything before action begins. I can prepare, I can contemplate – but when I tell myself “you ran a marathon a few years ago – you’re in great shape” I put myself back in the precontemplation stage and hit the snooze button again.

The challenge for us (and parents) is to help with the precontemplation stage, and like most good things in life, it’s something that the person has to experience and understand and feel for themselves. No amount of nagging, lecturing, or explaining will move somebody out of the precontemplation stage.

I should know – I spent the first 10 years of my practice trying.

(image via flickr.)

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