Employing the Employing the Transtheorectical Model Transtheorectical Model to Transform Behavior:to Transform Behavior:

A Tool Box for Change Agents

ObjectivesObjectives

• Understand the usefulness of the Understand the usefulness of the stages of change as a change agent.stages of change as a change agent.

• Understanding the process of change Understanding the process of change involved for each stage of change.involved for each stage of change.

• Practical applications or techniques Practical applications or techniques of the processes involved in the of the processes involved in the stages of change.stages of change.

Stages of ChangeStages of Change

Theory of how change takes placeTheory of how change takes place

Asserts that for change to occur people will go through Asserts that for change to occur people will go through defineddefined

stages and that these stages are common to everyone. stages and that these stages are common to everyone. ThisThis

theory purports to underlie all other psychological theoriestheory purports to underlie all other psychological theories

in explaining how people change. It is not a in explaining how people change. It is not a developmental ordevelopmental or

psychological theory. It is how change takes place in psychological theory. It is how change takes place in peoplepeople

once our personalities are formed. once our personalities are formed.

Brief Review of the Five Brief Review of the Five StagesStages

• Stage 1: Pre-contemplation: Acknowledging the Stage 1: Pre-contemplation: Acknowledging the ProblemProblem

• Stage II: Contemplation Resolving Ambivalence; the Stage II: Contemplation Resolving Ambivalence; the desire to change vs. the desire to stay the same.desire to change vs. the desire to stay the same.

• Stage III: Preparing to Change; Strengthening the willStage III: Preparing to Change; Strengthening the will

• Stage IV: Action Stage of Change; Making It HappenStage IV: Action Stage of Change; Making It Happen

• Stage V: Maintenance; Maintaining vigilenceStage V: Maintenance; Maintaining vigilence

Stage I: Pre-Contemplation Stage I: Pre-Contemplation Acknowledging problemAcknowledging problem

• Active resistanceActive resistance

• Given upGiven up

• DemoralizedDemoralized

• AvoidanceAvoidance

• DenialDenial

• Lack information Lack information

• HopelessHopeless

• FatedFated

• Responsibility out of their controlResponsibility out of their control

AttitudesAttitudes

Mind your own BusinessMind your own Business

Avoidance of learningAvoidance of learning

Avoid taking responsibilityAvoid taking responsibility

Paradox: How do you help people to Paradox: How do you help people to change who do not intend to change? change who do not intend to change?

To the Pre-contemplatorTo the Pre-contemplator

• Change does not = actionChange does not = action

• Nagging = or creates anger Nagging = or creates anger

• Apathy or giving up = approvalApathy or giving up = approval

• Minimizing or softening the damage Minimizing or softening the damage of behavior = enabling of behavior = enabling

Major Processes at Work: Major Processes at Work: Consciousness RaisingConsciousness Raising

• Raises the level of awarenessRaises the level of awareness

• Gain insight into thoughts and feelingsGain insight into thoughts and feelings

• Develop a real conviction around the Develop a real conviction around the valuevalue

of changeof change

• Increases informationIncreases information

Consciousness Raising Consciousness Raising TechniquesTechniques

Ask Powerful QuestionsAsk Powerful Questions

• Questions that raise clients awarenessQuestions that raise clients awareness

• Questions that gauge clients emotional Questions that gauge clients emotional

reactionsreactions

• Gauge your client’s perception of their Gauge your client’s perception of their loved one’s reactionloved one’s reaction

Consciousness Raising Consciousness Raising TechniquesTechniques

Educate on DefensesEducate on Defenses

• Denial and minimizationDenial and minimization

• RationalizationRationalization

• Projection and displacementProjection and displacement

• InternalizationInternalization

Stage II: Contemplation: Stage II: Contemplation: Resolving AmbivalenceResolving Ambivalence

The desire to change vs. the desire to The desire to change vs. the desire to stay the same.stay the same.

• Substitute thinking for action Substitute thinking for action • ““Someday Promise”: suspension of Someday Promise”: suspension of

conflictconflict• Educate themselves on the subjectEducate themselves on the subject• Need a greater understandingNeed a greater understanding

Remaining unaware of ones ambivalence can keep one can Remaining unaware of ones ambivalence can keep one can trapped in this stage for a long time.trapped in this stage for a long time.

Resolving Ambivalence Resolving Ambivalence EssentialEssential

Contemplation Traps: Delay tacticsContemplation Traps: Delay tactics

• Search for absolute certaintySearch for absolute certainty

• Waiting for the Magic MomentWaiting for the Magic Moment

• Wishful thinkingWishful thinking

• Pre-mature actionPre-mature action

Major Processes at Work: Major Processes at Work: Emotional ArousalEmotional Arousal

Drama regarding the negative troubling Drama regarding the negative troubling consequences of ones behaviorconsequences of ones behavior

• Increases awareness Increases awareness

• Increases depth of feelingIncreases depth of feeling

• Moves towards actionMoves towards action

• FilmsFilms

• Psychodrama Psychodrama

• Other fear-arousing methodsOther fear-arousing methods

Process: Emotional ArousalProcess: Emotional Arousal

Ask Powerful QuestionsAsk Powerful Questions

That address advantages andThat address advantages and

disadvantages of changedisadvantages of change

That address optimism and pessimism aboutThat address optimism and pessimism about

change change

That address intention or lack of intention toThat address intention or lack of intention to

change change

Emotional Arousal Emotional Arousal TechniquesTechniques

•MoviesMovies

•WebsitesWebsites

•PropagandaPropaganda

•ContractsContracts

Continue with consciousness raising by asking the right Continue with consciousness raising by asking the right questions inquestions in

search of the right answers.search of the right answers.

Process: Self Re-evaluationProcess: Self Re-evaluation

• Taking stockTaking stock

• Reveals essential values are in conflictReveals essential values are in conflict

• Feeling, thinking, and believing Life Feeling, thinking, and believing Life would be improvedwould be improved

• Requires the contemplator to abandon Requires the contemplator to abandon all hope that change is effortlessall hope that change is effortless

Process: Self Re-evaluationProcess: Self Re-evaluation

Ask Powerful Questions that address:Ask Powerful Questions that address:

• How can one feel good about themselvesHow can one feel good about themselveswhile continuing the behavior: essential valueswhile continuing the behavior: essential values

• How they would feel if the did not have theHow they would feel if the did not have thebehavior: lines up with values & positive behavior: lines up with values & positive

feelingsfeelings

• Cost of change: giving up the belief that Cost of change: giving up the belief that change is easychange is easy

Re-evaluation techniquesRe-evaluation techniques

• Think before you actThink before you act

• Create a new self imageCreate a new self image

• Make a decision: evaluate the pro’s Make a decision: evaluate the pro’s and cons’and cons’

• Solicit Input Solicit Input

End of ContemplationEnd of Contemplation

Ambivalence that undermines Ambivalence that undermines determinationdetermination

has been resolved. Change is necessary,has been resolved. Change is necessary,Change is not effortless.Change is not effortless.

Ready to start making plans to changeReady to start making plans to change

Dangers: contemplation traps or premature actionDangers: contemplation traps or premature action

Stage III: PreparationStage III: Preparation

Hopeful Vision of themselvesHopeful Vision of themselves

• Stronger commitment develops Stronger commitment develops

• Feel more confidentFeel more confident

• Small steps toward actionSmall steps toward action

• Focus is on the futureFocus is on the future

• Focus is on the positive aspects of Focus is on the positive aspects of change change

• Focus is on alternativesFocus is on alternatives

Process: CommitmentProcess: Commitment

• Strengthening and encouraging the willStrengthening and encouraging the will

• Pledge to yourselfPledge to yourself

• Pledge to behavior changePledge to behavior change

• Pledge to just and reasonable cause: Pledge to just and reasonable cause: life instead of deathlife instead of death

Process: CommitmentProcess: Commitment

Ask Powerful Questions that address:Ask Powerful Questions that address:

• AnxietyAnxiety

• ObstaclesObstacles

• OptionsOptions

• ResourcesResources

Ask Powerful QuestionsAsk Powerful Questions

• What have you heard others say about what has worked for them?What have you heard others say about what has worked for them?

• What have you considered doing? What have you considered doing?

• What have you tried in the past?What have you tried in the past?

• What worked?What worked?

• What are your options?What are your options?

• What your life will be like when you change your behavior? What your life will be like when you change your behavior?

• How will your life be enhanced? How will your life be enhanced?

• What will it free me up to become? List the benefits and keep it before What will it free me up to become? List the benefits and keep it before you.you.

Countering AnxietyCountering Anxiety

Do something concreteDo something concrete

• Take small steps to reduce anxiety Take small steps to reduce anxiety

• Set a dateSet a date

• Have courage and go public Have courage and go public

• Prepare for major surgeryPrepare for major surgery

• Create a plan of action that your Create a plan of action that your client buys into client buys into

Plan of ActionPlan of Action

Setting GoalsSetting Goals• Set concrete goalsSet concrete goals• Make goals realistic Make goals realistic • State them positively State them positively • Make them measurable Make them measurable

Create the specific steps you will take to reachCreate the specific steps you will take to reachthose goals. those goals.

Now that Now that theythey have created a detailed, have created a detailed,

specificspecific, , realisticrealistic and concrete plan of and concrete plan of

action, it is time to action, it is time to movemove into the into the fourthfourth

stage of change, stage of change, actionaction..

Stage IV Action: Making It Stage IV Action: Making It HappenHappen

This is where one pulls it all together. This is This is where one pulls it all together. This is where the all the work of going through the stages where the all the work of going through the stages starts to pay off in action and in results. starts to pay off in action and in results. Theoretically this is where one follows through Theoretically this is where one follows through and takes action. They involve others for support and takes action. They involve others for support and accountability, they engage in change and and accountability, they engage in change and move forward. move forward.

Stage IV Action: Making It Stage IV Action: Making It HappenHappen

PitfallsPitfalls

Poor preparationPoor preparation

Cheap changeCheap change

No simple solutionsNo simple solutions

Same ole, same oleSame ole, same ole

Ask Powerful QuestionsAsk Powerful Questions

• What could you do instead?What could you do instead?

• What has worked in the past?What has worked in the past?

• What do you think will work in the future?What do you think will work in the future?

• What moves you to change? What moves you to change?

• What were your original reasons to make a change? What were your original reasons to make a change?

• What would help you take action? What would help you take action?

• Is there some concrete reminder of where you want to be in the future? Is there some concrete reminder of where you want to be in the future?

• Is there some concrete reminder of where you don’t want to be in the Is there some concrete reminder of where you don’t want to be in the future? future?

Process: CounteringProcess: Countering

Substituting healthy behaviors forSubstituting healthy behaviors for

problematic onesproblematic ones

If you do not provide a different If you do not provide a different behavior one is likely to return to old behavior one is likely to return to old

behaviorsbehaviors

Countering TechniquesCountering Techniques

• Active DiversionActive Diversion

• ExerciseExercise

• RelaxationRelaxation

• Counter ThinkingCounter Thinking

• AssertivenessAssertiveness

Process: Environment Process: Environment ControlControl

The process of restructuring your The process of restructuring your environment to remove as much as environment to remove as much as possible the likely occurrence of the possible the likely occurrence of the

problem behaviorproblem behavior

Environment Control Environment Control TechniquesTechniques

• AvoidanceAvoidance

• Cue exposureCue exposure

• RemindersReminders

Process: RewardProcess: Reward

““Environment control modifies the Environment control modifies the cuescues

that precede and trigger problem that precede and trigger problem behavior;behavior;

reward modifies the consequences reward modifies the consequences thatthat

follow and reinforce it.” follow and reinforce it.”

Reward TechniquesReward Techniques

• Covert managementCovert management

• ContractingContracting

• ShapingShaping

Using helpful relationshipsUsing helpful relationships

Identify your helpersIdentify your helpers

• Exercise togetherExercise together

• Have a buddyHave a buddy

• Use your familyUse your family

Stage V: MaintenanceStage V: Maintenance

Keeping what you got….by far the mostKeeping what you got….by far the most

difficult of the stages. This is becausedifficult of the stages. This is because

success is measured in years and decadessuccess is measured in years and decades

and lifetimes. and lifetimes.

Combating the erosion of Combating the erosion of commitmentcommitment

Process: All of the aboveProcess: All of the above

• Don’t forgetDon’t forget

• Keep your distanceKeep your distance

• Create a new lifestyleCreate a new lifestyle

• Be aware of your thinkingBe aware of your thinking

• Use your support Use your support

• Guard against backslidingGuard against backsliding

ResourcesResources

• Changing for Good: A Revolutionary Six-Stage Program for Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. Overcoming Bad Habits and Moving Your Life Positively Forward. James O. Prochaska, John Norcross, Carlo, DiClemente n. 1994.James O. Prochaska, John Norcross, Carlo, DiClemente n. 1994.

• Miller (1999). Miller (1999). Enhancing Motivation for Change in Substance Enhancing Motivation for Change in Substance Abuse TreatmentAbuse Treatment..

• Miller & Rollnick (2002). Miller & Rollnick (2002). Motivational Interviewing: Preparing Motivational Interviewing: Preparing People for ChangePeople for Change..

• http://www.motivationalinterview.orghttp://www.motivationalinterview.org