The Stages of Change

If not now, when? – Maimonides

Evidently, your relationship with an incentive has led you to the point where you are reading about how to change it. Coincidentally, the text says that individuals who seek to escape their addictive relationship go through a predictable sequence of stages, including one in which they gather information about how to change their ways by reading texts such as this.

In fact, much can be learned by observing how incentive use disorders play out over time.  The Stages of Change model * emerged from this kind of knowledge.  Individuals who develop a self-injurious relationship with an incentive tend to progress through a sequence of stages, which are listed below. Those who fail to prevent relapse are condemned to repeat the sequence. 

  • Pre-contemplation – The stage at which there is no intention to change. Your incentive use produces more benefits than costs and you intend to continue using it as you have. You are unaware or under-aware of a problem. It isn’t that you can’t see the solution; it’s that you can’t see the problem.

  • Contemplation– The stage of ambivalence; you are aware of the problem and would like to give up the costs but are reluctant to give up the benefits.

  • The Decision– When it is clear that the costs of incentive use far outweigh the benefits, you may decide to do what it takes to change course. You make the decision with the understanding that you may encounter local conditions that would motivate lapsing, and so the promise that you will adhere to your decision, despite the influence of local factors, is implied.

  • Action– The stage at which you develop the plan to change your life’s course and begin to implement it.

  • Relapse Prevention – During this stage, which hopefully lasts the rest of your life, you do what it takes to prevent relapse.  If you relapse, you will cycle back to the contemplation stage and at some point in the future go through these stages again.

A Path Through the Stages

The passage from childhood to adulthood includes many transitions, each one subtle and each provoking its own set of challenges.  Likewise, the passage from dependence to self-determination is complex and as you progress from one stage to the next you will face a sequence of challenges, each requiring something different of you.  

Unlike physical maturity, which unfolds all by itself, the development of psychological maturity is up to you.  This developmental passage requires that you take responsibility for its planning and execution.    You play both the role of the change agent [the entity responsible for planning and executing the treatment that will produce the intended change] and of the patient [the entity who is to change as a result of the treatment].

In your role as agent of change, you will have to select the tactics best matched with your current situation.  First some don'ts:

Do not rely on change processes appropriate for the contemplation stage (e.g., costs-benefits analysis) when you are in fact in the action stage. Trying to modify behaviors by becoming more aware of why you should change is not effective. Insight alone does not bring about behavior change.

Do not rely on change processes appropriate for the action stage until you are genuinely motivated to do what needs to be done. Action without insight produces short-term change.

Synopsis of recommendations for each stage

Contemplation Stage: Most people are vulnerable to local sources of motivation, because they have never decided upon what they really want out of life, or if they have, they have forgotten it. Such individuals are easily corrupted because their motivation is always state-dependent—that is, there is no core motivation to compete with local sources of motivation.

The purpose of your life is not ending your relationship with the incentive.  What do you really want for this one precious life you have to live?  If you are unsure about core motivational issues, please work with the contemplation exercises in the next chapter: Contemplation.

Once you appreciate your core motivation, you can perform a realistic costs-benefits analysis regarding incentive use by completing the Decision Matrix, which follows the contemplation exercises. The objective of the contemplation stage is to resolve your ambivalence about your relationship with the incentive, so you can make your decision.

The Decision: The climax of your relationship with a pathogenic incentive is your decision to change it. You must appreciate that once you make a commitment your behavior can no longer be state-dependent. If you commit to quit drinking, you cannot permit a drink just because you feel like it at the moment. You make a commitment with the understanding that you will go to any lengths to adhere to its terms. Be aware that unlike a goal, a commitment is a promise. If you make one and fail to honor it, it would have been better to have declined it and avoided the loss of belief in the power of your word. If you are not yet ready to make such a commitment, then return to the contemplation stage exercises. If you are ready to proceed, be aware that whatever you decide during the action stage implies a No Exceptions Clause such as, “I agree to permit no exceptions to the contingencies stated here—regardless of how reasonable a violation of its terms may seem at the time.”

Action Stage: Once you appreciate your core motivation, and have decided upon your intentions, you will have to act in the objective world.  Misbehavior does not mean you are a bad person; nevertheless, it cannot be undone.  The initial part of the journey requires that you pay attention to following your intended course, so you will need a plan specifying your intended course. The action stage includes developing your plan and the first few days or weeks of following it, and lasts until the initial excitement of the new project wears off. Then the most important stage begins.

Relapse Prevention Stage: Research shows that most people who achieved good long-term outcome did so only after several trips through the sequence of stages. Do not be discouraged if you have relapsed in the past; instead, learn from your expensive education. In the beginning, most people are highly motivated to do what it takes to be free of their problem. After this initial “whoopee effect” has passed, the real battle begins. As long as you perform well, time is on your side, and you will get better with practice. However, some people become sloppy as the salience of their original commitment dissipates with the passage of time. Good long-term outcome requires that your motivation to adhere to your plan is always greater than the forces that would pull you back into relapse. Your task during the Relapse Prevention Stage is to respond as intended during the high-risk situations that lie ahead until your intended reactions become the default. The chapters of this section follow the order suggested by the stages of change model, but users are encouraged to focus on the content best matched with their current stage.

So let's begin with your core motivation:

  • What is most important to you?
  • What are you willing to sacrifice for?


* Prochaska, J, DiClemente, Carlo & Norcross, J - In search of  how people change:   Applications to addictive Behavior.   Amer Psychol, 1992,47, 1102- 1114

 

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