The five stages
The stages of change (or the transtheoretical model), developed by Prochaska and DiClemente1, breaks down the stages as follows:
- Pre-contemplation: At this stage, people are not thinking about change or planning on taking action in the foreseeable future.
- Contemplation: People at this stage are starting to think about change and weighing the pros and cons.
- Preparation: Here, people are motivated to change. They believe change can lead to more positive outcomes and are taking small steps towards it.
- Action: This is when people have recently changed their behaviour and intend to keep moving forward with these changes.
- Maintenance: At this stage, people have sustained the change in behaviour and intend on continuing their effort to maintain the change.
Depending on which stage of change the person is in, they will be more or less open to the idea of changing and having discussions about it. Therefore, it's important to adjust your engagement accordingly to not push them away or further cause harm.
Working with the stages of change
The following are a few guiding points, based on our experiences, to help you work with individuals at each stage of change:
- Explore survivors' thoughts and feelings. Find out what they’re focusing on and how they would like you to assist them.
- Use motivational interviewing techniques to discover moments of internal conflict and talk about it with the survivor.
- Encourage them without pressure.
- Help them identify the pros and cons of given issues or desired outcomes.
- When the pros outweigh the cons, they may be motivated and ready to move to the next step.
- Support survivors to identify concrete steps towards their goals:
- If they're looking to quit drinking, inform them of resources and options available to help them such as detox programs, peer support groups, medication, etc.
- Determine together what you can do to support them with these steps.
- Working with the survivor, help them put their plan in place and activate it:
- If the survivor would like to join a support group, you can accompany them for the first few meetings if it's helpful.
- With the survivor, identify strategies they can apply to maintain the gains they’ve achieved.
- Together, determine if other instrumental supports can also assist with maintenance.
- This is an opportunity to identify additional goals (new goals as well as goals they may have previously had which may appear much more achievable now).
We recommend, at any stage, that you be an active listener. Listen patiently and attentively, use open-ended questions and offer a safe space for the person to speak. Doing this builds your relationship, gives you a better sense of how they feel, what their needs are and how to move forward.
As service providers, our mandate is to offer assistance in the best way we can and much of that is about meeting the individual where they're at in their journey. They will shift and change only when they’re ready to do so.