Starting from the question: “What makes people change when they try to change some undesirable or problematic situation?”, and they created a model to try to understand what, how, when and why people change. Through research focused on studying the phenomenon of intentional change, they developed their transtheoretical model, composed of stages, processes and levels.
THE STAGES OF CHANGE
The stages represent the temporal dimension, that is, when people change. When helping someone you must consider the particular moment they are in. It is postulated that to achieve change, a person must go through well-defined and predictable stages, which must be respected to facilitate the process.
To achieve success in change, it is essential to know what stage the person is in in relation to their problem, in order to design specific procedures that suit each subject. In other words, what is sought is the therapeutic relationship and the type of intervention appropriate for each person depending on the stage in which they are located.
1. Precontemplation: It is likely that the patient attends due to external constraint (court order, family members, etc.), expressing denial of the problem and without really considering the change. The risk of abandonment here varies between 40% and 60%, and even 80% in cases related to substance use.
2. Contemplation: The subject recognizes having a problem, is more receptive to information regarding his problem and possible solutions, although he hesitates as to when to initiate the change, still doubting its benefits.
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3. Preparation: At this stage the person is ready for action, having taken some steps towards the objective.
4. Action: refers to the moment when the steps taken to achieve change become more evident. Its duration is 6 months.
5. Maintenance: It follows action and lasts another 6 months, the purpose at this stage lies in sustaining the changes achieved through lifestyle modification and relapse prevention.
6. Completion: The client no longer needs to use any change process in order to prevent relapse or return to the problem.
It is important to note that, when trying to change a problem, a large part of the subjects relapse at least once in the process, but the majority of them usually start it again from the contemplation or preparation stage, and then move on to action. This is why it is said that change does not follow a linear pattern, but rather a spiral one. The majority of subjects incorporate new strategies and knowledge from those experienced in relapses.
It is also essential for the therapist to remember that the stages of change are specific for each problem behavior.
THE PROCESSES OF CHANGE
They refer to the procedural dimension (how people change). In others, they are the tools used by each individual in their purpose of solving certain problems.
The change processes that we can find most frequently are:
1. Awareness: It refers to activities that seek to increase the degree of information that a stimulus brings to the person, so that they can obtain effective responses. The objective is awareness of both cognitive and affective experiences. Any increase in knowledge, from whatever source, also increases awareness. Some therapeutic procedures to increase awareness about the individual or the nature of their problem are: psychoeducation, interpretation and confrontation.
2. Self-reassessment: It is a process triggered by some activities that the person performs after reevaluating cognitive and affective aspects. It consists of reflection on the need to change things or not, the conflict with your value system and the possible benefits and disadvantages. It is common for the subject to feel that, although things would improve with the change, it would have a cost.
3. Self-reassessment social: the individual considers that, if the change happens, his or her environment would be healthier.
4. Self-liberation: After reassessing their situation, the person makes the decision to change the problematic behavior.
5. Social liberation: It consists of activities that help the individual have more alternatives to choose from; Changing the person’s environment can also help others change.
6. Dramatic relief: It is when emotions produced by the negative consequences of the problem behavior are experienced and expressed.
7. Counterconditioning: It is a behavioral process that consists of the modification of a response (whether motor, physiological or cognitive) that is provoked by stimuli conditioned to a specific behavior; With this process, it is possible to promote and develop more behavioral options (an example of this is anxiety control techniques, such as the and exercises).
8. Stimulus check: This technique involves a restructuring of the environment with the objective of reducing the probability that the stimulus will occur.
9. Handling of the eventuality: The central objective of this process is to use a series of activities to change the consequences that follow problematic behavior through a system of reinforcements and punishments. The latter is not only questionable from an ethical point of view but is also not frequently used by therapists and by people who manage to change successfully on their own. A form of reinforcement that is very simple and effective is self-assessment.
10. Helping relationships: It is essential to achieve change and simply refers to the social support that family, friends, etc. can provide.
LEVELS OF CHANGE
These levels constitute the object dimension or what must be changed. And it is represented by several interrelated levels that encompass psychological problems susceptible to treatment, namely:
- Symptom/Situation.
- Maladaptive cognitions.
- Current interpersonal conflicts.
- Family/system conflicts.
- Intrapersonal conflicts.
It is very important that at the time of the intervention, the therapist can define at what level the subject demands help because they tend to vary even in patients who present similar symptoms. Prochaska and Diclemente recommend starting with the first level because:
a) People who try to change alone tend to use it more.
b) It is the level that offers the least resistance and is most accessible to consciousness.
c) Finally, it usually represents the reason for the consultation.
If the change does not materialize, you can resort to the level change strategy. Although if the patient demands from the first interview, to be helped from a certain level, the key level strategy is used. Finally, it may happen that the subject arrives demanding problems at several levels at the same time; the strategy used here is multiple impact.
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Source: Training in therapeutic skills, Carlos Mussi (2006).