The transtheoretical model is more commonly known as ” stages of change” was initially developed by Prochaska and

D’Clementi to better understand the process involved in changing a behavior including smoking, overeating, and other problems. This model assesses an individual’s readiness to change and can be applied to a variety of behaviors, settings, and population. The transtheoretical model is made up of five stages of change precontemplation, contemplation, preparation, action, and maintenance. During this process, clients are experiencing discomfort as they change old habits and making new choices. Keep in mind that the stages of change are not always linear as clients can move back and forth and between stages depending on the barriers they face.

Precontemplation (“I don’t have a problem”)

The client lacks the interest to change and has no plans or intentions to adopt a healthy lifestyle; in other words, they are unaware of their problems or the negative effects of their existing lifestyle. This is the stage where the family members or others may try to convince or help the individual see that a problem exists. The client usually feels coerced into changing and may become angry at those who suggest they have a problem and believes that people are overly concerned about nothing.

Keywords: Unaware, resistant, unmotivated, reluctant, rationalization, denial

Social worker: Establish rapport with the client.

Contemplation (“I’m thinking about it”)

The client recognizes that a problem exists and is thinking about making changes but has not yet made a commitment to take action. Clients at this stage are described as ambivalent as they begin to weigh the cost and benefits of changing their behavior.

Keywords: Awareness, ambivalent, desire to change

Social worker: Help client recognize ambivalence, review the pros and cons (decisional balance scale)

Preparation (“I’m ready”)

In this stage, the client has decided that they want to make lifestyle changes and has made a commitment to change. The preparation stage can be considered the planning stage as the client begins to consider the steps they need to take to make it happen; this includes exploring options and developing a plan to change their behavior. Once this process starts, for instance, decreasing their use of drugs, the client has moved to the action stage.

Social worker: Help the client determine the course of action to take, clarify goals, reinforce accountability.

Action (“I’m taking action”)

The client has begun making behavioral changes and is carrying out the plan developed during the preparation stage. For instance, ceasing the use of drugs, changing their previous friends, changing the environment, and activities (people, places, and things).

Social worker: Reinforce the behavior and develop coping strategies.

Maintenance (I’m doing it!”)

In this stage, the client strives for continued abstinence and works to prevent relapse.

Question

A social worker at an outpatient substance abuse facility meets with a client who states, “I am on the fence, I have failed so many times, that I don’t think it’s possible to change.” According to the transtheoretical model, what stage is the client MOST likely in?

A. Preparation

B. Contemplation

C. precontemplation

D. Maintenance

Answer: The client states that he is “on the fence,” meaning that he is torn between the pros and cons of changing, therefore the correct answer is B contemplation stage. At this stage, the client is ambivalent about changing and has not yet made a commitment.