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Lesson 1: Abnormal Behavior
Stages of Change
Mental health practitioners obviously want their clients to improve, and a major goal of psychotherapy is for the client to progress to a higher stage of change in the model engendered by Prochaska and DiClemente (1983), with the ultimate goal being the client not needing treatment anymore. Clients progress and regress (as relapse is part of the process and change is rarely linear) through the following six stages:
Precontemplation
In precontemplation, the client is in denial or uninterested in changing. This stage is very common among court-mandated clients and others who do not want to be in therapy, and clients in this stage can be resistant and difficult to work with. However, there are ways to help clients progress through this stage, such as the empirically supported technique known as motivational interviewing (Miller & Rollnick, 1991).
This “stages of change” model can be used for many things and not just psychotherapy, so I’m going to use the example of losing weight and getting in better shape as we go through the stages. If someone is in precontemplation then they think they’re fine and they are not interested in changing.
“I’m fine – I don’t need to lose weight”
Contemplation
In this stage, the person is aware of the problem (or they move past denial to admit that they have a problem) and they have thoughts about changing. Essentially, they’re starting to think about change but they don’t have a concrete plan yet.
“Maybe I need to start exercising and losing weight”
Preparation
In the preparation stage the individual has an actual, concrete plan to change – but they haven’t implemented it yet.
“Next week I’m going to get a gym membership and I’m going to start a diet program.”
Action
This is where you want clients to be; the individual is implementing the plan(s) from the previous stage and is doing what they need to do to change.
“I’m going to the gym several times per week and I’m actively engaged in a diet program.”
Maintenance
As the name implies, this stage is about sustaining the change and progress from the action stage; essentially, the maintenance stage is about preventing relapse.
“I renewed my gym membership, I still go several times per week, and I’m sticking with my diet.”
Termination
This is when the client no longer needs treatment. In psychotherapy, termination typically involves wrapping up treatment and coming up with strategies for maintaining progress after treatment is over.
A caveat to this last stage regards drug and alcohol treatment: when it comes to addiction, nobody is ever considered to be “fully recovered”. People prefer to use the term “in recovery” because someone can be clean for 20 years but still relapse. Thus, if you’re treating someone for addiction then there is no termination stage per se and the client just stays in maintenance long term.
Self-Check
The most difficult state to transition into is...
We’ve taken a sidebar journey to peek behind the curtain and examine the inner workings of psychotherapy, but now let’s get back to the major focus of this lesson:
Brainstorm Ideas
Think about this question as you generate thoughts and ideas in preparation for the Lesson 1 Discussion Forum questions found at the end of the lesson.
- What are some potential resons why it is so hard for people to go from preparation to action?