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Stage of Change

General Description

In the transtheoretical model of Prochaska and associates, there are six defined Stages of Change involved in clients making changes in their lives.

Precontemplation
The client is not intending to change in the near future (in the next six months).
Contemplation
The client is aware of a problem and would like to change within the next six months, but has not committed to changing.
Preparation
The client intends to change within the next month, and has taken at least some small step toward making a change.
Action
The client is actively making changes that result in improvement.
Maintenance
The client is working to maintain the changes, and to avoid relapse.
Termination
The client has completed his or her change, and does not have to worry about relapse.

Prochaska Suggestions for Matching Treatments to Stage of Change

Prochaska and associates have several suggestions for matching treatments to clients' stage of change, which could be translated to matching clients to therapists. First, they suggest that "experiential processes that produce healthier cognitions, emotions, evaluations, decisions, and commitments" (Prochaska, 2000, p. 244) for people in earlier stages, and to use more behaviorally oriented treatments for people in later stages. Another suggestion is that therapists concentrate on preventing dropping out of therapy for clients in the precontemplation stage, as it was found that these clients were more likely to terminate their therapy prematurely. The implication for matching is that clients in early stages should not be matched to therapists who emphasize taking action, and clients who are in later stages should be matched to these therapists. In addition, clients in very early stages should be matched to therapists who concentrate on preventing premature termination.

Assimilation of Problematic Experiences

In a roughly parallel method of analysis, Stiles and associates have developed a model of therapeutic impacts based on stages of assimilation of problematic experiences by clients. In this model, problematic experiences are somewhere along the assimilation continuum of unassimilated, partially assimilated, assimilated, or applied. Stiles recommends using different types of therapy for clients at different stages. For clients at lower levels of assimilation, Stiles recommends using exploratory therapy types such as interpersonal, psychodynamic, or experiential. For clients further along the assimilation scale Stiles recommends methods of therapy more oriented to actively solving problems, such as cognitive and behavioral therapy.

The Stiles system was combined into the Prochaska system by assessing clients' stages of change, and then matching with therapists using three specific recommendations:

  1. The more action oriented the therapists, the more they should be matched with clients in later stages of change. Action orientation would consist of helping clients to take actions, helping clients to change cognitions, and helping clients to solve problems.
  2. The more therapists usual or preferred methods of therapy involve experiential or exploratory techniques, the more they should be matched with clients in earlier stages of change.
  3. The more the therapists concentrate on preventing premature termination, the more they should be matched with clients in the precontemplation stage of change.

For more information, or to give feedback, email Kenneth Frankel, Ph.D.

References

Brogan, M.M., Prochaska, J. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychotherapy, 36(2), 105-113.

Prochaska, J. O. (2000). How do people change, and how can we change to help many more people. In M. A. Hubble, B. L. Duncan, & S. D. Miller, (Eds.), The heart and soul of change (pp.227-255). Washington, D.C.: American Psychological Association.

Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried, (Eds.), Handbook of psychotherapy integration (pp. 300-334). New York: Basic Books.

Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy, 38(4), 443-448.

Stiles, W. B. (2001). Assimilation of problematic experiences. Psychotherapy, 38(4), 462-465.

Stiles, W. B., Elliot, R., Llewelyn, F. P., Firth-Cozens, J. A., Margison, F. R., Shapiro, D. A., et al. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy, 27, 411-420.