Getting Ready for Change

The process of getting ready for change has been the focus of the research of James Prochaska for the last 40 years.

James O. Prochaska and Carlo Di Clemente, developed the Transtheoretical Model for change (TTM), which is the most widely accepted framework for understanding change in the mental health and substance use treatment communities.

They found that successful changes in life typically followed a common sequence, beginning with a state of vague dissatisfaction with things as they are (pre-contemplation); then a state of clear and definite dissatisfaction combined with doubts about one’s ability to change, or fear of the pain or losses associated with change (contemplation); then a stage of preparation for change and finally action.

Prochaska and Di Clemente developed a set of stage specific activities to help people move from one stage to the next. They argued strongly that it is a lack of knowledge and skills that keeps people from changing.

This idea contrasts with common sense views of why some people succeed and others don’t. Asked why people fail to make needed changes, most people say:

  • they don’t have enough motivation
  • they don’t have enough will-power
  • they don’t have the right genes
  • they are “weak”
  • they don’t have enough “confidence”

The transtheoretical model suggests that the correct answer is:

  • they don’t know how to change.

In the book Changing to Thrive, Prochaska reviews the stages of change and identifies the key steps to take in order to succeed with a big life change.

  • Precontemplation (Not Ready for Change) – People aren’t planning on taking action in the near future. They may be unaware that their behavior is problematic. Or they may feel trapped in a life situation that makes change impossible.
  • Contemplation (Getting Ready for Change) – People are beginning to recognize the negative effects of their behavior. They start to look at the pros and cons of their bad habit.
  • Preparation (Ready to Change) – People plan to act soon and they may make small steps to prepare for that change.
  • Action – People are actively modifying their problem behavior or are acquiring healthy new habits to replace unhealthy ones.
  • Maintenance – People have been able to sustain change for six months or more and are working to prevent relapse.

Precontemplation (Not Ready for Change)

Of all of the stages, this one is the most difficult for outsiders to understand. They see the negative effects of the bad habit or bad behavior but the person denies any intention to change. There are several reasons for this inactivity.

Don’t Know How or Why

People often don’t know what the negative effects of their behavior are and they frequently don’t know how to make positive changes. These two problems tend to reinforce each other. Not knowing how to make change makes it seem foolish to attend to evidence that change is necessary.

Bridget is a 45 year old, divorced public school teacher. Her work is emotionally exhausting and she feels that she needs to unwind as soon as she gets home. She sits on her couch and watches TV while eating snack food (making dinner is too hard) and drinking “a couple” of beers. She has a vague sense of dissatisfaction with her life but feels strongly that “there is nothing to be done” and, besides, doesn’t see the negative consequences of her behavior. Is not aware that her fatigue is worsened by her physical inactivity, her poor diet, and the negative effect of alcohol on her sleep quality. Bridget is in the precontemplation stage.

Demoralization from Past Failures

Some people end up in the precontemplation stage because they have become convinced that they can’t make a change. For example, many people have tried over and over again to lose weight or quit smoking without success. They become convinced that this failure reflects some essential quality of their personality or a problem that is unsolvable. They conclude that they don’t have enough will power, or they focus on flaws in their personality (“do you expect me to get a personality transplant?”).

The Stages of Change model provides an alternative view and argues that there are things that can be done at every stage in the process that make it much more likely that a person will succeed.

Realistic hope is the antidote to demoralization.

Defensiveness

Quite naturally people develop various ways of explaining or defending patterns of behavior, however harmful they may be, that have been present for quite a while.

They may minimize or deny the significance of their behavior. They may withdraw from people who express legitimate concerns. Or they may become overly harsh and critical of themselves, leading to a state of demoralization rather than the impetus for change. Finally, they make turn responsibility for their behavior over to others. It’s not my fault, anyone would act the same way in this situation, or dealing with the behavior of this person, etc. All of these defenses serve to legitimize a pattern of behavior that is objectively harmful.

One antidote to defensiveness is the exploration of alternative perspectives. There is no circumstance which everyone would see in exactly the same way, so what are alternative perspectives on this situation? How might a close friend see it? Or a relative? Or partner? Realizing that there are different ways of viewing the same situation can help defuse defensiveness.

Contemplation (Getting Ready for Change)

At this point, someone has begun to seriously consider the costs of their behavior. They’re becoming more aware of the “pros” and “cons” of change. This can be an uncomfortable place because with increased awareness there may be more discomfort. And yet the person is still not ready to begin the process of change.

Doubt and Delay

Is change really worth it? Awareness of potential costs of making a change. Having to face anxiety in a social encounter without a drink, having to deal with hunger, etc., can lead to delay. “Lord make me pure, but not yet!” said St. Augustine as he considered making the large change that his newfound Christian belief told him he needed to make in a dissolute life.

When in doubt don’t act.

Seeing the benefits more clearly is the antidote to doubt and delay. As people get closer to making a positive change, the language that they use shifts from a focus on the costs or difficulties involved in making the change to clear vision of what may be gained in this focus on the benefits increases the motivation to move into the next step in the process.

Preparation (Beginning to Change)

Preparation is an important stage that is often neglected. But without proper preparation changes likely to follow old patterns, which often means early success and commitment followed by an unexpected challenge and then a lapse and perhaps giving up.

Preparation means thinking about what has worked and not worked in the past. Gathering information about what has been helpful for others. Mobilizing supports and anticipating problems.

Action (Making the Change)

This is often part of change that people focus on but, we hope with convinced you, from this brief overview of Prochaska’s writings, that action is not necessarily the most important step in the process of change. WIthout the work involved in finding the reasons to change, strategies for change, ways of dealing with challenges, and creating a positive vision of what will improve in your life after the change, you are much less likely to succeed.

Doing the Work of Getting Ready

In my next post on the subject I will talk about tools for change that you can use to help move forward creating your new life.

References

Prochaska, J.O. and Prochaska, J.M. (2016). Changing to Thrive. Center City, MN: Hazeldon Publishing.

For More Information

Changing Bad Habits: Helpful Resources

Tools for Change