Stages of Change & Treatment

The stages of change model is transtheoretical in nature, and can be used to describe one’s process of behavior change that includes the stages of precontemplation, contemplation, preparation, action, maintenance, and termination, and it is not viewed as a linear model but instead a spiral pattern (Prochaska et al., 2013). I would like to share my viewpoints in regards to the stages of change theory by sharing a personal story, and to describe my philosophy on how people change. I will also explain how receiving counseling and treatment plans can help individuals facilitate positive change.

A significant behavior change I made was when I decided to abstain from alcohol because my use was hindering my interpersonal relationships, affecting my health, and creating disaccord at work. This was not something that occurred overnight; my behavior change took place over the course of a decade. My recovery story is probably unlike most, in that I never received help for my alcohol use. When I was ready to change, I possessed a very all-or-nothing type of behavior, where I would quit cold turkey but would then relapse soon after.

I remember dwelling in the precontemplation stage, where looking back into my early twenties, I had believed that my excessive drinking patterns were normal for my age. I disregarded that I would often black out and blank on what I had said or done while I was drinking. In reflecting, I feel I was rationalizing my actions to continue to allow what I was doing and deem it acceptable. It took over five years for me to realize that my behavior was not only severely unhealthy, but also dangerous due to mixing substances. After I realized the harm I was imposing on myself, I sat in the contemplation stage for a long while. I understood what I was doing was immoral, toxic even, but at that time, I never sincerely held any intent on ceasing my alcohol intake. I received much judgment and stigma from family and “friends” for my actions, that I was simply complacent where I was in my life for many years as an alcoholic.

I have no recollection of a preparation stage because my actions were very swift and typically impulsive. I never sought treatment or external help, and was determined to get better on my own terms, which meant quitting in a fit of guilt and shame. Then, I would frequently relapse as a means to self-medicate my depression. There was no preparation for getting better because I would simply try and fail. The action stage of quitting did not last long or feel good because I believed that the rules of abstinence did not apply to me. When I finally knew internally that I wanted to quit for good, all of my emotions began to sink in. I had worn myself out both physically and mentally to the point I was ready to adhere to the action stage. I had lost family and friends and felt I did not have much else to lose at this point, so I gave sobriety one last shot. Many action changes were made at this time, which included refraining from going out, cutting ties with certain acquaintances, and avoiding liquor stores.

After countless failed attempts to sober up, I ultimately achieved the maintenance phase. For me, the maintenance and termination phase occurred simultaneously. I had reached the point where I had outgrown my past self-destructive behaviors. From that point on, I have not craved alcohol and am proud of myself for how far I have progressed in my recovery. Although I did not experience every stage of this theory, I find that the model is a concrete process, from which I have been able to apply to my own life in retrospect. I have also seen it with my own eyes in a clinical treatment setting, and viewed clients shift from precontemplation to contemplation to preparation.

Reasons for change can be internal or external, but I feel that long-lasting change is due to an internal desire to better oneself for oneself. I agree very much with DiClemente et al.’s (2008) view that motivation and intentions related to the change of addictive actions play a vital role in one’s recovery. My philosophy on how people change is that internal motivation is absolutely key, in order to maintain and sustain long-standing desirable behaviors. An individual’s drive and yearning for change has the potential to create it. I do not believe that ultimatums or legal consequences are enough to generate healthy choices that stand the test of time. It takes conscious effort to make a positive change in our lives, and I feel that people do so when they are ready. I think that support and community networking can also help to promote the idea of progress, but ultimately, the choice resides within the individual.

In my situation, my soul was quite literally exhausted with the vicious cycle of drinking and the physical consequences became unbearable. I had to get clean for myself, and not because someone told me to. Thinking back to when people expressed concern for my drinking, that was not enough, and so I had to go on my own journey to find recovery. I feel this applies with the general population. For example, I have spoken with many individuals who have said they were in treatment multiple times prior, but that it did not work because they did not have the internal desire to stop using. Numerous studies have demonstrated a positive relationship between motivation for treatment and motivation for change related to substance use treatment (DiClemente et al., 2008).

Receiving treatment can help provide valuable support for the client to make healthier choices, where the client may not have support otherwise. Looking back, I feel that seeking counseling may have had the potential to speed up my recovery process, seeing as I was missing that support from family and friends. The stages of change model is a helpful tool to gauge where clients are at, and helps to individualize the treatment and approach when interacting and caring for them. I think counselors need to be aware of which stages their client is in, so that they are able to personalize and provide appropriate care and techniques that can foster further change within their client. I find that seeking support can inspire change, especially in group counseling where there may be individuals who are in the action or maintenance stage, and others who are still in the precontemplation or contemplation stage can see how positive change can be.

Treatment plans also inspire change because they are heavily focused on goal setting. The treatment plan should be based on setting goals for the client that reflect a motivation for a better future and an ability to create a vision of health and wellness (Adams & Grieder, 2014). Working together with clients and tracking their progress within their treatment plan is a form of teamwork, which I feel can motivate the client to maintain progress. I have seen this in my own personal counseling because I make sure to do the work outside of the sessions, so that I can report back with improvement. Of course, life is tough and there may be times when people can become or feel stagnant in recovery, but working with mental health professionals is a helpful tool to continue setting goals so that they can keep leveling up.

In reflection of my recovery, I believe my personal stages of change were due to an internal motivation that I feel is a necessary component for stable recovery. Change will look different for everyone, but the stages of change theory can help demonstrate where clients are, in regards to their recovery, which aids counselors in creating appropriate treatment plans that will fit the needs of the client. Treatment plans are also a valuable instrument that clinicians can apply in treatment, as a means to facilitate change with individuals who experience a substance use disorder.

References

Adams, N., & Grieder, D. M. (2014). Treatment planning for person-centered care: Shared

decision making for whole health (2nd ed.). Academic Press.

DiClemente, C. C., Nidecker, M., & Bellack, A. S. (2008). Motivation and the stages of change

among individuals with severe mental illness and substance abuse disorders. Journal of

Substance Abuse Treatment, 24, 25-35. https://doi.org.10.1016/j.jsat.2006.12.034

Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (2013). Applying the stages of change.

Psychotherapy in Australia, 19(2), 10-15. https://search.informit.org/doi/abs/10.3316/INFORMIT.254435778545597