The 5 Stages of the Cycle of Change

Why is change so difficult? Maybe we believe it has already cost us a lot to get this far so why risk everything. We are also creatures of habit. We form our habits, then our habits form us.

Change also makes us feel insecure. We feel that maybe we don't have what it takes to succeed. But change is here to stay! We could argue that when we stop changing, we stop growing.

In 1982 James Prochaska and Carlo DiClemente developed a useful model describing how people change. The model was based on self-help change, but research has shown it to underpin all types of change related to behaviours such as addictions, eating disorders and it could probably be applied to changing your job or moving house as well.

The Cycle of Change (Transtheoretical Theory of Change, is its clinical name), unifies a whole range of theories about how people change. It assists us in understanding where our clients may be in the cycle and how to engage and work with them depending on the stage they are in. In a self-help community it is important for clients to understand where they are.

The Cycle of Change is not like a carousel, where you get on, then go around, and get off when it stops. There are entry and exit points; change can take a number of attempts.

Some people can move rapidly through the cycle. Those recovering from drug addiction may take up to two years to maintain a drug free lifestyle.

Here are the 5 stages of the cycle:-

1. Pre-Contemplation

Pre-contemplation is the stage in which people are not intending to take action in the next six months. The people in this stage may be unaware of the consequences of their behaviour. When confronted they are likely to respond with a surprised "Who me?" They could be termed as "happy users".

There are others in this stage who may have tried to change a number of times without success. They have become demoralised by the whole process. They will generally avoid reading, talking or even thinking about their behaviour, and will come up with a number of defenses, possibly saying things like "I don't have a problem" or "If you had a job like mine, you would drink" (dealt with in a separate article on "Denial")

This person will not respond positively to being forced into treatment either by peer pressure or as part of a court order. At the time of writing this article, the UK Government is contemplating (no pun intended) withdrawing state benefits to encourage alcoholics into treatment. Many drug/alcohol professionals will have doubts about the efficacy of such a programme. Firstly the system which is already under-funded, is not designed to take on a sudden influx of reluctant recovering alcoholics.

The Cycle of Change would argue against a successful outcome. The fact is traditional health programs are often not designed for people at this stage as they are not matched to their needs.

2. Contemplation

Contemplation is the stage in which people intend to change in the next six months. They are aware of the benefits of change but are also aware of the costs . This balance between the costs and benefits of changing can keep people stuck in this stage for long periods of time. They will say things like "I may take drugs, but my friends take more. I'm not an addict, I can quit when I want to." They may waiver between contemplation and pre-contemplation.

This stage may take a couple of weeks or it could take a lifetime. There is much procrastination. But it can be a time of anticipation, anxiety, action and excitement. The people at this stage are not ready for a recovery programme.

3. Preparation or Determination

Preparation is the stage where people intend to take action in the next month. They would have taken small steps towards quitting in the past year. They have a plan of action, they have checked out what strategies or resources are available to them, consulting a counsellor, buying a self-help book or relying on a self-change approach. They are motivated to change, they will say "I have a problem, something must change. What can I do, how can I change?

Those who try to skip this stage and go straight to the Action stage, often fall flat on their faces. They know at this stage that they need a major lifestyle change. They are ready for Action.

4. Action

Action is the stage where people have made particular changes in their life-styles within the past six months. They believe they have the ability to change their behaviour and are doing things to make a change. This is the stage where they are more likely to seek the support of others. Action is measurable, it is not just about a change in behaviour (which is often seen as the action). But Action is only one of five stages.

Not all changes to behaviour count as action in this model. For example a smoker may have cut down, or switched to a low tar cigarette. But he must raise his game, at this stage, only total abstinence counts. There can be no half measures with alcohol or drugs.

In the Action stage he may be saying, "Getting in to this rehab has saved my life". The Action stage is also the stage where complacency can set in, when it is vital to maintain focus, because here is the greatest risk of relapse.

5. Maintenance

The goal of the maintenance stage is to maintain the new status quo. There are not so many changes to be made as in previous stages. People at this stage tend to remind themselves of how much progress they have made.

Maintenance is the stage in which people maintain a drug free lifestyle. They may be back in work, relationships reconciled, and even helping others. They are less tempted to relapse and growing in the confidence that they can continue their change. They are able to anticipate the situations in which relapse could occur and prepare coping strategies in advance.

People in the Maintenance stage constantly reformulate the rules of their lives and acquire new skills to deal with life and avoid relapse. They remain aware that what they are striving for is personally worthwhile and meaningful so that they can stay on track.

Relapse

Relapse is not a stage of the cycle of change as such. But it is an important aspect of it. Relapse is returning to the old behaviour and abandoning the new changes. It sometimes leads a recovering person to revert to an earlier stage of change. But frequently, a relapse means going back to square one, back in pre-contemplation, especially for a recovering drug addict or alcoholic. Smokers may get away more lightly where a relapse may take them back to Contemplation or Preparation.

There are different ways of helping people through each stage. But that's the subject of another article.