Behavioral Change: The Four Stages Of Change In Psychology

Stages of Change There are six stages of behavior change that individual’s progress through when experiencing addiction. The first stage of change is Precontemplation, which is when individuals are defensive and in denial about addiction (Van Wormer & Davis, 2013). The second stage of change is contemplation, which is where an individual becomes aware of addiction, but does not see the need for change (Van Wormer & Davis, 2013). The third stage is preparation, which is when the individual comes to terms with the realization of the addiction and sees the need for change (Van Wormer & Davis, 2013). The fourth stage is action, which is when an individual takes control and begins changing. The fifth stage is maintenance, where an individual will
work towards preventing future relapse (Van Wormer & Davis, 2013). The final stage is relapse, which is a part of behavior change, however relapse does not necessary have to occur (Van Wormer & Davis, 2013). This paper will discuss how to determine which stage a client is working, harm reduction psychotherapy, and motivational interviewing.
Determining Stage Changes
Counselors must understand the stage of change each client is in, in order for treatment to be successful. A counselor cannot begin treatment, when a client is still in the beginning stages and is in denial about the addiction. One way to identify the client’s stage of change they are currently in is by paying attention to their immediate concerns (Van Wormer & Davis, 2013). For example, if the client is worrying about getting out of treatment as fast as possible, without a care of overcoming addiction, then the counselor can place the client in stage one, Precontemplation. Another way to determine which stage a client is in, is by using the URICA self report questionnaire (Drapalski, Bennett & Bellack, 2011). The counselor can calculate the self-report to see exactly where the client is about their addiction (Drapalski et al., 2011). Once the stage of change is identified, a counselor can use harm reduction psychotherapy to move the client through the stages (Van Wormer & Davis, 2013).
Harm Reduction Psychotherapy
Harm reduction psychotherapy will guide clients through the stages of behavior change in small steps (Van Wormer & Davis, 2013).
Counselor use harm reduction for its practical and realistic treatment approach (Van Wormer & Davis, 2013). Harm reduction psychotherapy has been shown to significantly impact addict’s lives, by meeting them at their level of behavior (Tatarsky, 2003). For example, if a client is in the Precontemplation or contemplation stage, the counselor should not push the client to change themselves when they are not ready to do so. The counselor needs to meet the client at the stage the client is in to ensure they are not implementing harm and creating inconsistent goals. A technique used in harm reduction psychotherapy is motivational interviewing (MI). Often times clients are in either stage one or two and do not see change as relevant, which is where MI comes into play (Van Wormer & Davis, 2013). MI is a client-centered approach used to influence the client’s motivation and help them move through the stages of change (Van Wormer & Davis, 2013). By using MI, counselors can express empathy, develop discrepancy, avoid argumentation with clients, roll with resistance, and support self efficacy (Van Wormer & Davis,
2013).
Motivational Interviewing In The Stages of Change
MI interviewing can be used within all six stages of change. Along with intervening MI into the stages of change, challenges do present themselves. In the Precontemplation stage, MI can be used to understand the client and their problem (Van Wormer & Davis, 2013). The counselor can build rapport with the client and develop a therapeutic alliance (Tatarsky, 2003). A challenge the counselor will face in this stage is understanding the client may not desire to stop the addictive behaviors (Tatarsky, 2003). In the second stage of contemplation, the counselor can use MI to show the client how critical change is (Van Wormer & Davis, 2013). The client could either see the need for change and move to the preparation stage or continue to be uncertain about addiction and behavior change (Van Wormer & Davis, 2013). In the preparation stage, MI is used to help the client prepare for change (Van Wormer & Davis, 2013). The challenge a counselor may face is the client not having enough hope to move on with treatment. During the action stage, the counselor will use MI to form goals and plan for treatment (Tatarsky, 2003). The challenge in this stage is whether or not the client is ready to begin changing. The Maintenance stage will use MI to reinforce relapse prevention and create a plan for when relapse occurs (Van Wormer & Davis, 2013). The final stage, depending if it occurs is relapse. If a client relapses, the counselor will use MI and implement positive strategies for positive change (Tatarsky, 2003). MI can help clients tremendously, even with the challenges that come along.
Conclusion
The six stages of change are critical in the treatment process of addictions.
By using reduction harm psychotherapy, a counselor can move along the side of the client in the different stages. MI can be a successful treatment intervention to encourage clients to change for the better. In each stage of change, MI can be implemented. There will always be challenges counselors will need to face when treatment approaches do not always go as plan. It is essential to stay with the client as they move through the stages of
change.