Prochaska and DiClemente’s Stages of Change Model

Imagine that a client came to you as a first step, in one of the provided scenarios. It is likely you will need to recommend outside resources, beyond what you would provide, such as counselling, too. Even though you might not provide all the resources for a client as he or she goes through the stages of change, you should be able to predict which stages a client in a given situation is likely to go though.

In your chosen scenario, identify the stages of change that a client would likely go through and questions that you would ask him or her during each stage to help progress. Assess the resources that he or she might need and referrals that you might make for the client to be successful at each stage.

Choose a scenario from the given list and evaluate the stages of change. As part of your analysis, you should identify the culture, ethnicity, and/or country of the client. Analyse the scenario from the viewpoint of a human and social services professional after the client has come to your organisation for help.

A client who received news of being diagnosed with a sexually transmitted disease

A manager of an organisation that experienced a large layoff and employee morale is low

A community without clean running water

A client who is considered obese and obesity runs in the family

A client who is 43 and started smoking as a teenager

A community that has experienced a natural disaster, which has left many homeless and members of the community are coming to your organisation for help

For your chosen scenario, use Prochaska and DiClemente’s Stages of Change. In 1–2 pages: Identify the questions you might ask while interviewing the client during each stage. Assess the resources that he or she might need and referrals that you might make for the client to be successful in moving from one stage to another. Be specific.

Prochaska and DiClemente’s Stages of Change Model

Stage of Change Characteristics Techniques Pre-Contemplation Not currently considering change: “Ignorance is bliss” Validate lack of readiness Clarify: decision is theirs Encourage re-evaluation of current behaviour Encourage self-exploration, not action

Explain and personalise the risk Contemplation Ambivalent about change: “Sitting on the fence” Not considering change within the next month Validate lack of readiness Clarify: decision is theirs Encourage evaluation of pros and cons of behaviour change Identify and promote new, positive outcome expectations P

reparation Some experience with change and are trying to change: “Testing the waters” Planning to act within 1 month Identify and assist in problem solving re: obstacles Help patient identify social support Verify that patient has underlying skills for behaviour change

Encourage small initial steps Action Practising new behaviour for 3–6 months Focus on restructuring cues and social support Bolster self-efficacy for dealing with obstacles Combat feelings of loss and reiterate long-term benefits Maintenance Continued commitment to sustaining new behaviour Post-6 months to 5 years Plan for follow-up support Reinforce internal rewards Discuss coping with relapse

Relapse Resumption of old behaviours: “Fall from grace “Evaluate trigger for relapse

Reassess motivation and barriers Plan stronger coping strategies

Pre-contemplation Stage

“Ignorance is bliss” “Weight is not a concern for me

“Goals:

1. Help patient develop a reason for changing
2. Validate the patient’s experience
3. Encourage further self-exploration
4. Leave the door open for future conversations
5. Validate the patient’s experience:

“I can understand why you feel that way”

2. Acknowledge the patient’s control of the decision: “I don’t want to preach to you; I know that you’re an adult and you will be the one to decide if and when you are ready to lose weight.”
3. Repeat a simple, direct statement about your stand on the medical benefits of weight loss for this patient: “I believe, based upon my training and experience, that this extra weight is putting you at serious risk for heart disease, and that losing 10 pounds is the most important thing you could do for your health.”
4. Explore potential concerns: “Has your weight ever caused you a problem?” “Can you imagine how your weight might cause problems in the future?”
5. Acknowledge possible feelings of being pressured: “I know that it might feel as though I’ve been pressuring you, and I want to thank you for talking with me anyway.”
6. Validate that they are not ready: “I hear you saying that you are nowhere near ready to lose weight right now.”
7. Restate your position that it is up to them: “It’s totally up to you to decide if this is right for you right now.”
8. Encourage re-framing of current state of change—the potential beginning of a change rather than a decision never to change: “Everyone who’s ever lost weight starts right where you are now; they start by seeing the reasons where they might want to lose weight. And that’s what I’ve been talking to you about.” Contemplation Stage “Sitting on the fence” “Yes my weight is a concern for me, but I’m not willing or able to begin losing weight within the next month.” Goals:
9. Validate the patient’s experience
10. Clarify the patient’s perceptions of the pros and cons of attempted weight loss
11. Encourage further self-exploration
12. Leave the door open for moving to preparation

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