March 18, 2025 • 22 mins
Breaking down behavior change into manageable stages helps us understand why people struggle to make lasting changes and how we can better support them through the process. The Trans-Theoretical Model provides a practical framework for conceptualizing behavior change as a non-linear journey through six distinct stages, each requiring different therapeutic approaches.
• Pre-contemplation - clients don't recognize they have a problem or need to change
• Contemplation - weighing pros and cons while feeling ambivalent about making changes
• Preparation - planning specific steps and intending to take action within the next month
• Action - actively modifying behavior and implementing new strategies
• Maintenance - sustaining changes for six months or more and focusing on relapse prevention
• Termination - complete confidence in maintaining changes without risk of relapse
Remember the stages with our simple memory trick: PCP AMT (Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Termination)
If you're preparing for your licensing exam, understanding the Trans-Theoretical Model and its stages of change is essential knowledge that will likely appear in your test questions.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Eric (00:05):
Well, hello there.
Welcome to our first Grill andDrill podcast, where we're going
to review today thetrans-theoretical model Now, if
you've been following thepodcast, you may have listened
to the one from November wayback in 2023, on the theory to
therapy, which we dealt with,the trans-theoretical model, or
(00:28):
also called the stages of changemodel.
So we've been doing it thatlong, possibly even longer.
It's hard to tell, but the TTM,or the trans-theoretical model,
is a framework that wasdeveloped by James Prochaska and
Carlo De Clementi thatconceptualizes behavior change
as a process that occurs througha series of distinct stages,
(00:52):
rather than just one event whereyou have a bad habit and you
stop.
They recognized that there wasa process to it.
Hey, do you have any idea howthey figured that out, eric?
I bet one of them had anaddiction they were trying to
get rid of.
Linton (01:06):
Yeah, well, that's close .
But they received a grant tostudy how clients become
non-smokers and in the processthey came out and developed this
idea and they called ittrans-theoretical model.
Eric (01:19):
Huh, so we can be assured that it wasn't funded by Philip
Morris, really.
Well, yes, but it doesdistinguish itself from other
approaches because it recognizesthat behavior change involves
progressing through a bunch ofstages, each one characterized
by different attitudes,intentions and behaviors, and it
acknowledges that relapse is acommon occurrence that clients
(01:44):
are often cycling throughmultiple times before they get
to the lasting change whichanybody that's worked in
addictions can tell you.
That's how that works, really.
So there are four keyconstructs of it the stages of
change, the process of change,the decisional balance of how
you decide and the concept ofself-efficacy.
Linton (02:07):
So basically what I hear you saying, Eric, is that it's
just a bunch of differenttheories that have been thrown
together.
Eric (02:13):
Well, yes, it is, but it was written in an academic way
and, remember, if it's academicand it's research, then that's
legitimate, and it draws from abunch of different theories.
That's why it'strans-theoretical.
So there are cognitive parts toit, there are behavioral parts
to it, so there are all of these, and it ends up being a
(02:35):
non-linear kind of thing because, like I said, it goes in a
circle.
People will, you know, startdoing it, relapse, go back, and
so it's something that takesthat into account and isn't
surprised by the fact thatpeople fail to make lasting
decisions the first time.
Linton (02:51):
Okay.
So of those four key constructs, let's start with the stages of
change.
In fact, probably if you runinto anything on the
trans-theoretical model on yourlicensing exam, it'll be around
the stages of change.
So the stages of change are thecore, basic construct of TTM
(03:13):
and what it does.
It describes the temporalprogression clients go through
during their modification oftheir behavior, right?
So the first part of the stagesof change is called
pre-contemplation.
So during pre-contemplations,clients are not considering
change, they're unaware thatthey have any kind of
(03:36):
problematic behavior.
They don't want to make anykind of changes, at least for at
least six months.
They don't think there's aproblem to address.
Like I said, they have reallylimited insight on how their
behavior is linked to thenegative consequences that are
happening in their lives.
They may have tried to modifytheir behaviors, but they've
(03:57):
been unsuccessful in the pastand basically they become
discouraged.
So the concept of thepre-contemplation stage is that
they're just not ready and thatleads to when they finally are
ready.
Eric (04:12):
That's the contemplation stage.
So pre-contemplation beforethey start contemplation is
where they actually startlooking at the pros and cons.
They still feel ambivalent, butthey're getting their mind
around the fact that whateverthe people around them think is
problematic, they're finallybeginning to see it as
problematic as well, but they'restill flip-flopping.
So that's why it might last awhile in the contemplation stage
(04:34):
and the overall concept then isgetting ready.
Linton (04:37):
Right.
Then they go into thepreparation or planning stage.
This is when the client isintended to take action soon and
they're thinking of maybehaving small steps that will
help them do that.
So they will get a piece ofpaper.
They've written down the pros,they've written down the cons
and they've decided that thescales have tipped in the side
(05:00):
of pro, that they do need tomake changes.
So they have intention to makesome kind of changes within the
first month or so.
Basically, the preparationstage is that they are ready.
They're ready to make thosechanges.
Eric (05:13):
And then, after you've, you know, done that, now you're
in the action phase.
You're starting to actually dowhat it takes to modify your
behavior, and some changes areoccurring Now.
Whether they're lasting or not,that's something else, but
you're making the actual stepsto change, you know.
Whatever the techniques are,however, you modify habits.
(05:34):
All of that changes dependingon what you're trying to change,
but the overall concept isyou're doing it.
Linton (05:41):
And then after that they go into the maintenance stage.
And in the maintenance stagethey've been able to change
their behaviors for half a yearor so and they are still
focusing on relapse prevention.
So they're still working onconsolidating any gains that
they've made and their newbehaviors have become habitual.
(06:03):
They use fewer change processes.
So they're sort of in a placewhere if they went out clubbing,
they're not going to pick up acigarette or they're not going
to start drinking at thatparticular point.
They're sort of good to go, sothey're continuing to go.
So they keep going on with thechanges that they've made during
(06:24):
the maintenance.
Eric (06:25):
And finally the Arnold Schwarzenegger phase, the
terminator phase, thetermination phase, and you have
complete confidence that youhave made the changes.
You don't need to bother withbehavioral aspects of it anymore
.
You used to smoke and now younever have.
It's been quite a while and youdon't even think of it anymore.
(06:47):
So you actually are ready tostop going to therapy, stop
working a process, whatever itwas you were doing you thought
you had to.
You don't need to anymore.
So the overall concept is noproblem.
Linton (06:59):
Okay.
So when that happens and yousee that your client is able to
do that maybe it took five years, I don't know but when they do
come to that stage, then it'stime for you to do what.
Eric (07:12):
It's time for you to have a party.
No, it's time for you toterminate the client.
Oh yes yes, it's when you, as atherapist, would terminate the
client.
That's right.
Linton (07:22):
Eric, how are you going to remember all this information
?
I mean, you know you're alreadystudying for the exam, you've
got all kinds of differentthings, so how am I going to
remember the stages of change?
Eric (07:34):
Well, that's the tough part, isn't?
It Is remembering all of thisstuff.
Okay.
Linton (07:39):
Let me help you out here .
Do you remember angel deathsfrom the 60s?
Eric (07:47):
Sherm love.
Linton (07:48):
Boat.
Eric (07:48):
O's Hogg, it sounds like you're talking about how
marijuana used to be called MaryJane, or Marajacuna, or the
Devil's Lettuce.
Linton (07:57):
This is how you're going to remember the stages of
change.
Very easy, just remember PCP,amt.
Pcp was a drug also known asangel dust.
Yes, okay, pcp.
Amount pcp it was okay, so okay.
So p would stand for thepre-contemplation right, yeah, c
(08:19):
was the contemplation.
Eric (08:21):
So pre-contemplation contemplation okay, that that
makes sense and p forpreparation.
So okay, preparation yes amountamt a action, action, right,
and then maintaining, keep itgoing right, maintaining, and
then finally, uh t termination,termination.
Okay T Termination.
Linton (08:41):
Termination Okay, termination.
Don't look at it and tell mewhat the stages are.
So PCPAMT.
Eric (08:49):
So pre-contemplation, right Contemplation, preparation
, right Action, maintenance andtermination, termination.
Okay, I almost got it, okaythat's good.
Linton (09:02):
So that's the first part of the trans-theoretical model
and that's what you need toremember for the exam.
I think I'm going to give yousome examples and you're going
to tell me what stages they arein.
Are you ready, right?
So you have a client that comesin and says I don't see why I
need to reduce my salt and fatconsumption.
(09:25):
I've been fine without doingthat for years, and if I do when
I go out to a restaurant Iwon't be able to eat anything.
Eric (09:32):
Okay, so that sounds like they haven't even fathomed the
idea that they need to change,which sounds like
pre-contemplation.
Okay, all right.
Linton (09:41):
You got that All right?
How about if they said I'vedecided to only drink celery
juice for?
Eric (09:51):
breakfast and just today I told my family to get ready.
Oh, okay, I've decided to make,so they've gone.
They've already contemplated it, right?
So they're in the preparationphase.
They've decided to do it, butthey haven't preparation phase.
Linton (10:02):
They've decided to do it but they haven't done it.
Exactly.
They're planning thepreparation.
Okay, right, what if yourclient said you know I should
start eating healthier, but Ireally still enjoy, like you do,
mcdonald's and I'm not reallyready to give up my Big Mac and
fries.
Just yet Big Mac.
(10:23):
Stop making yet Big Mac.
Eric (10:24):
Stop making me hungry man, so all right.
So the pre-contemplation was Idon't need to be ready.
The planning was get ready, I'mdoing it.
So this must be thecontemplation stage.
And why is that?
Because they're thinking aboutit, I know I should do it and
(10:45):
I've put it in the should docategory as opposed to the why
are you bothering me category.
But I haven't started planningyet.
Okay, All right.
Linton (10:51):
Is that it?
Yeah, that's it, okay.
Okay, how about this?
Your client tells you thatthey've been buying their food
from Whole Foods and they'drather do that than go the smoky
bones, and they've been doingit for the past two months.
Eric (11:05):
They know it's challenging , but they're starting to see
some results so a big plate ofkale instead of some nice juicy
ribs?
Hey, so okay, doesn't soundlike they've gone into the
maintenance stage yet?
No, so it sounds like they'regone into the maintenance stage
yet.
No, so it sounds like they'reactually doing it, they're doing
(11:26):
something.
They're going to Whole Foods,not going to Smokey Bones.
So it's action, right, yeah, itis action.
Yeah, yeah, okay.
Linton (11:34):
All right.
How about if they say I've beena vegetarian for eight months
now and I've developed newcoping strategies, like eating
celery sticks when I crave ablooming onion or a juicy steak
from Outback?
Eric (11:48):
Hmm, so I've been doing it for eight months, so not long
enough to really make it a totallifestyle change, but they've
set themselves up for success,right yeah.
So it doesn't sound likethey're ready to terminate yet,
but they've been in the actionstage for long enough that it's
become a new habit.
So I'd say maintenance.
Linton (12:10):
So if you found yourself in Outback, where would you go?
Eric (12:15):
Big juicy steak in front of you and you'd say give me
that plate of kale over there.
I want some big juicy celerystick, while my friend eats the
bloomin' onion and the sirloinsteak.
Okay, all right, good on you.
Linton (12:31):
All right.
So lastly, to your chagrin,your client tells you I've been
a vegetarian for the last fiveyears.
Even when I'm stressed, thethought of eating meat doesn't
ever cross my mind.
Eric (12:43):
Right, well, that sounds like five years.
Yeah, they've been your clientfor five years.
All right, it sounds like itwas time for termination about
four years ago.
Really, okay, okay, yes, I'vegot to say that sounds like
termination time, because ifthey just don't even think about
meat anymore and they, you know, just love being a vegetarian
(13:04):
then it sounds like they'reready to terminate the process.
Uh-huh, you know that couldhappen to you, as that's not out
of the realm of possibility.
Certainly, absolutely okay, Ihad some celery just last month
I just had some celery thismorning you.
You're on your way, man, thereyou go Okay.
Linton (13:24):
so those are the kind of scenarios that you might find
and they may ask you where youare in the stages of change.
So again, remember, that is PCPamount.
Eric (13:36):
So pre contemplation preparation, wait, wait, pcp.
Yeah, p is pre, okay,contemplation.
Uh-huh, I didn't saycontemplation, okay, all right,
you didn't have to say it twice.
So pre-contemplationcontemplation, right.
Preparation, uh-huh.
Action m maintenance andtermination.
(13:59):
Okay, you got, you got it.
Linton (14:01):
Now we're going to go and give you some questions.
I think I'm ready Shoot.
What is the primary reasonsclients remain in the
pre-contemplation stage?
All right, pre-contemplationstage.
Lack of motivation, high levelsof stress, okay.
Lack of awareness about theirproblems.
All right, or success, pastexperience.
Eric (14:26):
So why would I stay in the pre?
Why would I stay ignorant ofthe fact that I have a problem?
Right, I'm going to say thatI'm so stressed I can't deal
with it.
B.
Linton (14:37):
Close, but no cigar.
Oh man, Okay, it's their lackof awareness about their problem
.
Oh, all right, yes, right, soclients in the pre-contemplation
stage are unaware of theirproblems, which keeps them from
even considering change.
Their lack of awareness issignificant and it's a barrier
to moving forward to the changeprocess.
(14:58):
All right.
Eric (14:59):
One down, all right, try a second one.
All right.
One down, all right, try asecond one.
Linton (15:02):
How do clients in the contemplation stage typically
feel about changing theirbehavior?
Eric (15:09):
Okay, so we're in the contemplation stage now, and how
do they feel about whether theyneed to change?
Okay.
Linton (15:14):
Okay.
Are they confident andmotivated?
Ambivalent and conflicted?
Okay, unaware and unmotivated.
Or successful and satisfied Allright.
Eric (15:28):
So how do they feel about changing their behavior?
Well, if they were successful,they wouldn't be in the
contemplation stage.
So D is out.
And if they were confident andmotivated they wouldn't be in
the contemplation stage.
They'd already be acting on it.
So A is out, unaware andunmotivated.
See now, that sounds likepre-contemplation to me.
(15:49):
It is Unaware and unmotivated,so I'm going to go with B
ambivalent and conflicted, right.
Linton (15:57):
So when clients are in this stage of the contemplation,
they often experienceambivalence.
Stage of the contemplation,they often experience
ambivalence.
They're weighing the pros andcons of changing their behavior,
but you know they're still inthat whole process.
Okay, all right.
How does the preparation stagediffer from contemplation stage?
It involves taking immediateaction.
(16:19):
It involves weighing pros andcons.
It involves planning andintention to act soon or it
involves ignoring the problem.
Eric (16:31):
So taking immediate action sounds like the action phase,
right, so I'm going to rule thatone out.
Involves weighing the pros andcons.
That sounds like the differencebetween preparation and action
to me.
That you're weighing the prosand cons, deciding so, instead
of contemplation to act, youknow, to preparation.
(16:52):
That sounds like preparation toaction to me.
All right, oh, I'm gonna getrid of b.
And then involves planning anintention to act soon.
Or involves ignoring theproblem.
Well, ignoring the problemsounds like pre-contemplation.
You don't have a problem, whatare you bothering me for?
So I'm going to go with C onthat.
(17:12):
Okay, exactly.
Linton (17:15):
How can you support clients in the maintenance stage
?
Could you support them byignoring their efforts?
Eric (17:23):
Yes, providing ongoing support and resources Forcing
them to maintain their choices,or by discouraging their action
Okay, so ignore their effortswould be to just say you've been
doing it okay, and I don't evenneed to bother because you're
on autopilot or providingongoing support and resources.
(17:46):
You're doing it, so keep doingit.
Forcing them doesn't sound liketherapy.
That sounds like what my motherused to do, right.
So I'm going to say no to C andthen discouraging their actions
.
That doesn't sound right either.
So it's either A or B.
A or B, a or B.
I'm going to say A You'reletting them go.
(18:09):
They've done it.
They're obviously doingsomething, right?
Linton (18:12):
So no, no, the answer is providing ongoing support and
resources.
Ok, that's how you as atherapist can assist by offering
ongoing support and resourcesto help them maintain their new
behaviors.
Eric (18:27):
resources to help them maintain their new behaviors.
Linton (18:28):
So really at this stage in maintenance support is
critical for preventing relapse.
Eric (18:34):
Okay, okay, yes, that does sound more therapist-y.
Linton (18:52):
So, okay, how might a therapist approach someone in
the pre-contemplation stage?
Here are your optionsImmediately encourage them to
take some action, discussing therisk associated with their
current behavior, ignoring theircurrent behavior or by forcing
them to change.
Okay, let's get rid of D, thatsounds more like your mom which
sometimes it worked.
Eric (19:09):
So I gotta give her props on that.
But uh, that doesn't sound likea therapisty thing.
So d is out, okay, and ignoringdoesn't sound like that's going
to work either, because if it'sreally, you know, if we're
putting it conceptually in themodel, then somebody's not
ignoring it.
You know you've been smokingfor 10 years that that's a
problem.
You need to deal with it.
(19:29):
So I'm going to say discussingthe risks B, that's right.
Linton (19:35):
What is a common challenge faced by clients in
the action stage?
Lack of awareness about theirproblems.
Eric (19:46):
No, because they're in the action stage, so they're aware
that they have a problem.
So A is out.
High levels of stress Well,they would have high levels of
stress.
Yes, although common challenge,I've got to think that not
everybody's going to have a highlevel of stress, okay, so I'm
going to put that one off to theside.
(20:07):
I've got to hear the restbefore I know whether that's
okay successful past experienceswell, that's not a challenge,
so that one's out.
Okay, if you've been, ifeverything's worked, you're not
challenged at all.
So that wouldn't be a commonchallenge, okay.
Linton (20:22):
So obviously the the last one is maintaining
motivation and overcomingobstacles.
Eric (20:30):
Yes, that's it.
Linton (20:32):
Want another one.
Yep, keep going.
What is a common challengefaced by clients in the
contemplation stage?
Common challenge, okay.
Eric (20:42):
Lack of resources All right.
Lack of resources right.
Linton (20:45):
Balancing the pros and cons of changing.
High motivation, successfulpast experiences, yeah, no.
Eric (20:54):
So yeah, it's B.
It's got to be B becausethey're weighing the pros and
cons right.
If they had all the success inthe past, they don't need to
contemplate, and if they didn'thave any resources, then they're
probably not contemplatingeither.
So yeah, I go with be there.
Linton (21:11):
What is a common misconception about clients in
the pre-contemplation stage?
They are highly motivated tonot change.
They're aware of their problems, but choose not to change.
They are unaware of theirproblems all right, or they have
(21:31):
successfully changed theirbehavior they're unaware of
their problem.
Eric (21:37):
All right, okay, you get it that's.
Yeah, I think that's.
It is that they.
The misconception would be thatthey're unaware, when they
probably are aware, but theyjust don't want to admit it,
right?
Linton (21:52):
Well, this has been interesting, as All right, yes.
Eric (21:56):
And I got to say, dr Hutchinson, that it's not as
complicated.
You know, once you have thosesix down, they sort of sell
themselves.
Once you, you know, see howthat breaks down, right, not
that it's easy if you'reactually working it, but from
once you, you know, see how thatbreaks down, right, not that
it's easy if you're actuallyworking it, but from the outside
you could see how they, youknow how actions could fall into
each of those categories.
(22:16):
Exactly, part of the key is toremember the six stages, right
PCP, amount, pcp, amt, very good, and remember it's in there,
it's in there.
Thanks.
Well, hello there.
Welcome to our first Grill andDrill podcast, where we're going
to review today thetrans-theoretical model Now, if
you've been following thepodcast, you may have listened
to the one from November wayback in 2023, on the theory to
therapy, which we dealt with,the trans-theoretical model, or
(00:28):
also called the stages of changemodel.
So we've been doing it thatlong, possibly even longer.
It's hard to tell, but the TTM,or the trans-theoretical model,
is a framework that wasdeveloped by James Prochaska and
Carlo De Clementi thatconceptualizes behavior change
as a process that occurs througha series of distinct stages,
(00:52):
rather than just one event whereyou have a bad habit and you
stop.
They recognized that there wasa process to it.
Hey, do you have any idea howthey figured that out, eric?
I bet one of them had anaddiction they were trying to
get rid of.
Linton (01:06):
Yeah, well, that's close .
But they received a grant tostudy how clients become
non-smokers and in the processthey came out and developed this
idea and they called ittrans-theoretical model.
Eric (01:19):
Huh, so we can be assured that it wasn't funded by Philip
Morris, really.
Well, yes, but it doesdistinguish itself from other
approaches because it recognizesthat behavior change involves
progressing through a bunch ofstages, each one characterized
by different attitudes,intentions and behaviors, and it
acknowledges that relapse is acommon occurrence that clients
(01:44):
are often cycling throughmultiple times before they get
to the lasting change whichanybody that's worked in
addictions can tell you.
That's how that works, really.
So there are four keyconstructs of it the stages of
change, the process of change,the decisional balance of how
you decide and the concept ofself-efficacy.
Linton (02:07):
So basically what I hear you saying, Eric, is that it's
just a bunch of differenttheories that have been thrown
together.
Eric (02:13):
Well, yes, it is, but it was written in an academic way
and, remember, if it's academicand it's research, then that's
legitimate, and it draws from abunch of different theories.
That's why it'strans-theoretical.
So there are cognitive parts toit, there are behavioral parts
to it, so there are all of these, and it ends up being a
(02:35):
non-linear kind of thing because, like I said, it goes in a
circle.
People will, you know, startdoing it, relapse, go back, and
so it's something that takesthat into account and isn't
surprised by the fact thatpeople fail to make lasting
decisions the first time.
Linton (02:51):
Okay.
So of those four key constructs, let's start with the stages of
change.
In fact, probably if you runinto anything on the
trans-theoretical model on yourlicensing exam, it'll be around
the stages of change.
So the stages of change are thecore, basic construct of TTM
(03:13):
and what it does.
It describes the temporalprogression clients go through
during their modification oftheir behavior, right?
So the first part of the stagesof change is called
pre-contemplation.
So during pre-contemplations,clients are not considering
change, they're unaware thatthey have any kind of
(03:36):
problematic behavior.
They don't want to make anykind of changes, at least for at
least six months.
They don't think there's aproblem to address.
Like I said, they have reallylimited insight on how their
behavior is linked to thenegative consequences that are
happening in their lives.
They may have tried to modifytheir behaviors, but they've
(03:57):
been unsuccessful in the pastand basically they become
discouraged.
So the concept of thepre-contemplation stage is that
they're just not ready and thatleads to when they finally are
ready.
Eric (04:12):
That's the contemplation stage.
So pre-contemplation beforethey start contemplation is
where they actually startlooking at the pros and cons.
They still feel ambivalent, butthey're getting their mind
around the fact that whateverthe people around them think is
problematic, they're finallybeginning to see it as
problematic as well, but they'restill flip-flopping.
So that's why it might last awhile in the contemplation stage
(04:34):
and the overall concept then isgetting ready.
Linton (04:37):
Right.
Then they go into thepreparation or planning stage.
This is when the client isintended to take action soon and
they're thinking of maybehaving small steps that will
help them do that.
So they will get a piece ofpaper.
They've written down the pros,they've written down the cons
and they've decided that thescales have tipped in the side
(05:00):
of pro, that they do need tomake changes.
So they have intention to makesome kind of changes within the
first month or so.
Basically, the preparationstage is that they are ready.
They're ready to make thosechanges.
Eric (05:13):
And then, after you've, you know, done that, now you're
in the action phase.
You're starting to actually dowhat it takes to modify your
behavior, and some changes areoccurring Now.
Whether they're lasting or not,that's something else, but
you're making the actual stepsto change, you know.
Whatever the techniques are,however, you modify habits.
(05:34):
All of that changes dependingon what you're trying to change,
but the overall concept isyou're doing it.
Linton (05:41):
And then after that they go into the maintenance stage.
And in the maintenance stagethey've been able to change
their behaviors for half a yearor so and they are still
focusing on relapse prevention.
So they're still working onconsolidating any gains that
they've made and their newbehaviors have become habitual.
(06:03):
They use fewer change processes.
So they're sort of in a placewhere if they went out clubbing,
they're not going to pick up acigarette or they're not going
to start drinking at thatparticular point.
They're sort of good to go, sothey're continuing to go.
So they keep going on with thechanges that they've made during
(06:24):
the maintenance.
Eric (06:25):
And finally the Arnold Schwarzenegger phase, the
terminator phase, thetermination phase, and you have
complete confidence that youhave made the changes.
You don't need to bother withbehavioral aspects of it anymore
.
You used to smoke and now younever have.
It's been quite a while and youdon't even think of it anymore.
(06:47):
So you actually are ready tostop going to therapy, stop
working a process, whatever itwas you were doing you thought
you had to.
You don't need to anymore.
So the overall concept is noproblem.
Linton (06:59):
Okay.
So when that happens and yousee that your client is able to
do that maybe it took five years, I don't know but when they do
come to that stage, then it'stime for you to do what.
Eric (07:12):
It's time for you to have a party.
No, it's time for you toterminate the client.
Oh yes yes, it's when you, as atherapist, would terminate the
client.
That's right.
Linton (07:22):
Eric, how are you going to remember all this information
?
I mean, you know you're alreadystudying for the exam, you've
got all kinds of differentthings, so how am I going to
remember the stages of change?
Eric (07:34):
Well, that's the tough part, isn't?
It Is remembering all of thisstuff.
Okay.
Linton (07:39):
Let me help you out here .
Do you remember angel deathsfrom the 60s?
Eric (07:47):
Sherm love.
Linton (07:48):
Boat.
Eric (07:48):
O's Hogg, it sounds like you're talking about how
marijuana used to be called MaryJane, or Marajacuna, or the
Devil's Lettuce.
Linton (07:57):
This is how you're going to remember the stages of
change.
Very easy, just remember PCP,amt.
Pcp was a drug also known asangel dust.
Yes, okay, pcp.
Amount pcp it was okay, so okay.
So p would stand for thepre-contemplation right, yeah, c
(08:19):
was the contemplation.
Eric (08:21):
So pre-contemplation contemplation okay, that that
makes sense and p forpreparation.
So okay, preparation yes amountamt a action, action, right,
and then maintaining, keep itgoing right, maintaining, and
then finally, uh t termination,termination.
Okay T Termination.
Linton (08:41):
Termination Okay, termination.
Don't look at it and tell mewhat the stages are.
So PCPAMT.
Eric (08:49):
So pre-contemplation, right Contemplation, preparation
, right Action, maintenance andtermination, termination.
Okay, I almost got it, okaythat's good.
Linton (09:02):
So that's the first part of the trans-theoretical model
and that's what you need toremember for the exam.
I think I'm going to give yousome examples and you're going
to tell me what stages they arein.
Are you ready, right?
So you have a client that comesin and says I don't see why I
need to reduce my salt and fatconsumption.
(09:25):
I've been fine without doingthat for years, and if I do when
I go out to a restaurant Iwon't be able to eat anything.
Eric (09:32):
Okay, so that sounds like they haven't even fathomed the
idea that they need to change,which sounds like
pre-contemplation.
Okay, all right.
Linton (09:41):
You got that All right?
How about if they said I'vedecided to only drink celery
juice for?
Eric (09:51):
breakfast and just today I told my family to get ready.
Oh, okay, I've decided to make,so they've gone.
They've already contemplated it, right?
So they're in the preparationphase.
They've decided to do it, butthey haven't preparation phase.
Linton (10:02):
They've decided to do it but they haven't done it.
Exactly.
They're planning thepreparation.
Okay, right, what if yourclient said you know I should
start eating healthier, but Ireally still enjoy, like you do,
mcdonald's and I'm not reallyready to give up my Big Mac and
fries.
Just yet Big Mac.
(10:23):
Stop making yet Big Mac.
Eric (10:24):
Stop making me hungry man, so all right.
So the pre-contemplation was Idon't need to be ready.
The planning was get ready, I'mdoing it.
So this must be thecontemplation stage.
And why is that?
Because they're thinking aboutit, I know I should do it and
(10:45):
I've put it in the should docategory as opposed to the why
are you bothering me category.
But I haven't started planningyet.
Okay, All right.
Linton (10:51):
Is that it?
Yeah, that's it, okay.
Okay, how about this?
Your client tells you thatthey've been buying their food
from Whole Foods and they'drather do that than go the smoky
bones, and they've been doingit for the past two months.
Eric (11:05):
They know it's challenging , but they're starting to see
some results so a big plate ofkale instead of some nice juicy
ribs?
Hey, so okay, doesn't soundlike they've gone into the
maintenance stage yet?
No, so it sounds like they'regone into the maintenance stage
yet.
No, so it sounds like they'reactually doing it, they're doing
(11:26):
something.
They're going to Whole Foods,not going to Smokey Bones.
So it's action, right, yeah, itis action.
Yeah, yeah, okay.
Linton (11:34):
All right.
How about if they say I've beena vegetarian for eight months
now and I've developed newcoping strategies, like eating
celery sticks when I crave ablooming onion or a juicy steak
from Outback?
Eric (11:48):
Hmm, so I've been doing it for eight months, so not long
enough to really make it a totallifestyle change, but they've
set themselves up for success,right yeah.
So it doesn't sound likethey're ready to terminate yet,
but they've been in the actionstage for long enough that it's
become a new habit.
So I'd say maintenance.
Linton (12:10):
So if you found yourself in Outback, where would you go?
Eric (12:15):
Big juicy steak in front of you and you'd say give me
that plate of kale over there.
I want some big juicy celerystick, while my friend eats the
bloomin' onion and the sirloinsteak.
Okay, all right, good on you.
Linton (12:31):
All right.
So lastly, to your chagrin,your client tells you I've been
a vegetarian for the last fiveyears.
Even when I'm stressed, thethought of eating meat doesn't
ever cross my mind.
Eric (12:43):
Right, well, that sounds like five years.
Yeah, they've been your clientfor five years.
All right, it sounds like itwas time for termination about
four years ago.
Really, okay, okay, yes, I'vegot to say that sounds like
termination time, because ifthey just don't even think about
meat anymore and they, you know, just love being a vegetarian
(13:04):
then it sounds like they'reready to terminate the process.
Uh-huh, you know that couldhappen to you, as that's not out
of the realm of possibility.
Certainly, absolutely okay, Ihad some celery just last month
I just had some celery thismorning you.
You're on your way, man, thereyou go Okay.
Linton (13:24):
so those are the kind of scenarios that you might find
and they may ask you where youare in the stages of change.
So again, remember, that is PCPamount.
Eric (13:36):
So pre contemplation preparation, wait, wait, pcp.
Yeah, p is pre, okay,contemplation.
Uh-huh, I didn't saycontemplation, okay, all right,
you didn't have to say it twice.
So pre-contemplationcontemplation, right.
Preparation, uh-huh.
Action m maintenance andtermination.
(13:59):
Okay, you got, you got it.
Linton (14:01):
Now we're going to go and give you some questions.
I think I'm ready Shoot.
What is the primary reasonsclients remain in the
pre-contemplation stage?
All right, pre-contemplationstage.
Lack of motivation, high levelsof stress, okay.
Lack of awareness about theirproblems.
All right, or success, pastexperience.
Eric (14:26):
So why would I stay in the pre?
Why would I stay ignorant ofthe fact that I have a problem?
Right, I'm going to say thatI'm so stressed I can't deal
with it.
B.
Linton (14:37):
Close, but no cigar.
Oh man, Okay, it's their lackof awareness about their problem
.
Oh, all right, yes, right, soclients in the pre-contemplation
stage are unaware of theirproblems, which keeps them from
even considering change.
Their lack of awareness issignificant and it's a barrier
to moving forward to the changeprocess.
(14:58):
All right.
Eric (14:59):
One down, all right, try a second one.
All right.
One down, all right, try asecond one.
Linton (15:02):
How do clients in the contemplation stage typically
feel about changing theirbehavior?
Eric (15:09):
Okay, so we're in the contemplation stage now, and how
do they feel about whether theyneed to change?
Okay.
Linton (15:14):
Okay.
Are they confident andmotivated?
Ambivalent and conflicted?
Okay, unaware and unmotivated.
Or successful and satisfied Allright.
Eric (15:28):
So how do they feel about changing their behavior?
Well, if they were successful,they wouldn't be in the
contemplation stage.
So D is out.
And if they were confident andmotivated they wouldn't be in
the contemplation stage.
They'd already be acting on it.
So A is out, unaware andunmotivated.
See now, that sounds likepre-contemplation to me.
(15:49):
It is Unaware and unmotivated,so I'm going to go with B
ambivalent and conflicted, right.
Linton (15:57):
So when clients are in this stage of the contemplation,
they often experienceambivalence.
Stage of the contemplation,they often experience
ambivalence.
They're weighing the pros andcons of changing their behavior,
but you know they're still inthat whole process.
Okay, all right.
How does the preparation stagediffer from contemplation stage?
It involves taking immediateaction.
(16:19):
It involves weighing pros andcons.
It involves planning andintention to act soon or it
involves ignoring the problem.
Eric (16:31):
So taking immediate action sounds like the action phase,
right, so I'm going to rule thatone out.
Involves weighing the pros andcons.
That sounds like the differencebetween preparation and action
to me.
That you're weighing the prosand cons, deciding so, instead
of contemplation to act, youknow, to preparation.
(16:52):
That sounds like preparation toaction to me.
All right, oh, I'm gonna getrid of b.
And then involves planning anintention to act soon.
Or involves ignoring theproblem.
Well, ignoring the problemsounds like pre-contemplation.
You don't have a problem, whatare you bothering me for?
So I'm going to go with C onthat.
(17:12):
Okay, exactly.
Linton (17:15):
How can you support clients in the maintenance stage
?
Could you support them byignoring their efforts?
Eric (17:23):
Yes, providing ongoing support and resources Forcing
them to maintain their choices,or by discouraging their action
Okay, so ignore their effortswould be to just say you've been
doing it okay, and I don't evenneed to bother because you're
on autopilot or providingongoing support and resources.
(17:46):
You're doing it, so keep doingit.
Forcing them doesn't sound liketherapy.
That sounds like what my motherused to do, right.
So I'm going to say no to C andthen discouraging their actions
.
That doesn't sound right either.
So it's either A or B.
A or B, a or B.
I'm going to say A You'reletting them go.
(18:09):
They've done it.
They're obviously doingsomething, right?
Linton (18:12):
So no, no, the answer is providing ongoing support and
resources.
Ok, that's how you as atherapist can assist by offering
ongoing support and resourcesto help them maintain their new
behaviors.
Eric (18:27):
resources to help them maintain their new behaviors.
Linton (18:28):
So really at this stage in maintenance support is
critical for preventing relapse.
Eric (18:34):
Okay, okay, yes, that does sound more therapist-y.
Linton (18:52):
So, okay, how might a therapist approach someone in
the pre-contemplation stage?
Here are your optionsImmediately encourage them to
take some action, discussing therisk associated with their
current behavior, ignoring theircurrent behavior or by forcing
them to change.
Okay, let's get rid of D, thatsounds more like your mom which
sometimes it worked.
Eric (19:09):
So I gotta give her props on that.
But uh, that doesn't sound likea therapisty thing.
So d is out, okay, and ignoringdoesn't sound like that's going
to work either, because if it'sreally, you know, if we're
putting it conceptually in themodel, then somebody's not
ignoring it.
You know you've been smokingfor 10 years that that's a
problem.
You need to deal with it.
(19:29):
So I'm going to say discussingthe risks B, that's right.
Linton (19:35):
What is a common challenge faced by clients in
the action stage?
Lack of awareness about theirproblems.
Eric (19:46):
No, because they're in the action stage, so they're aware
that they have a problem.
So A is out.
High levels of stress Well,they would have high levels of
stress.
Yes, although common challenge,I've got to think that not
everybody's going to have a highlevel of stress, okay, so I'm
going to put that one off to theside.
(20:07):
I've got to hear the restbefore I know whether that's
okay successful past experienceswell, that's not a challenge,
so that one's out.
Okay, if you've been, ifeverything's worked, you're not
challenged at all.
So that wouldn't be a commonchallenge, okay.
Linton (20:22):
So obviously the the last one is maintaining
motivation and overcomingobstacles.
Eric (20:30):
Yes, that's it.
Linton (20:32):
Want another one.
Yep, keep going.
What is a common challengefaced by clients in the
contemplation stage?
Common challenge, okay.
Eric (20:42):
Lack of resources All right.
Lack of resources right.
Linton (20:45):
Balancing the pros and cons of changing.
High motivation, successfulpast experiences, yeah, no.
Eric (20:54):
So yeah, it's B.
It's got to be B becausethey're weighing the pros and
cons right.
If they had all the success inthe past, they don't need to
contemplate, and if they didn'thave any resources, then they're
probably not contemplatingeither.
So yeah, I go with be there.
Linton (21:11):
What is a common misconception about clients in
the pre-contemplation stage?
They are highly motivated tonot change.
They're aware of their problems, but choose not to change.
They are unaware of theirproblems all right, or they have
(21:31):
successfully changed theirbehavior they're unaware of
their problem.
Eric (21:37):
All right, okay, you get it that's.
Yeah, I think that's.
It is that they.
The misconception would be thatthey're unaware, when they
probably are aware, but theyjust don't want to admit it,
right?
Linton (21:52):
Well, this has been interesting, as All right, yes.
Eric (21:56):
And I got to say, dr Hutchinson, that it's not as
complicated.
You know, once you have thosesix down, they sort of sell
themselves.
Once you, you know, see howthat breaks down, right, not
that it's easy if you'reactually working it, but from
once you, you know, see how thatbreaks down, right, not that
it's easy if you're actuallyworking it, but from the outside
you could see how they, youknow how actions could fall into
each of those categories.
(22:16):
Exactly, part of the key is toremember the six stages, right
PCP, amount, pcp, amt, very good, and remember it's in there,
it's in there.
Thanks.
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