Process / Frameworks
Stages of change
A model, associated with Prochaska and DiClemente, that describes how people move through stages when changing a behaviour.
Overview
The stages-of-change model, also called the transtheoretical model, describes change as movement through stages rather than a single decision. It grew from work by James Prochaska and Carlo DiClemente on how people change smoking behaviour, published in 1983.
The stages
A Cochrane review of smoking cessation describes five stages: precontemplation, contemplation, preparation, action and maintenance. This entry has not checked which stages the 1983 paper itself named, so the list follows that later presentation.
How it is used in a therapy process
Practitioners and services may use the stages to think about what a person is ready for, so that the work fits where they are and does not assume they have already decided to change. Motivational interviewing is often discussed alongside the model but is a distinct approach.
A constructed example
Constructed for learning. Not a real case.
A person attends a first appointment at a partner's urging and says they do not think they have a problem. In the language of the model they might be in precontemplation. The practitioner asks what they make of the concern and does not push towards an action plan. Later the person says they are weighing up what it would mean to change, which the model would call contemplation.
UK and US
The model originated in US research. This entry does not compare its use in the UK and the US.
Limits and open questions
How well people fit the stages, and whether stages are separate from one another, is debated. A Cochrane review of smoking cessation found that the extra value of matching support to a stage was unclear. Its latest search was in August 2010; the finding concerns smoking cessation and should not be assumed to apply to psychotherapy generally. For smoking cessation, the review also cautioned against restricting quitting advice and encouragement only to people judged ready to act. A stage label alone does not determine what support someone should be offered.
Sources and inspection notes
Supports: The existence and date of the stages-of-change paper. Bibliographic record confirmed through Crossref; the full text was not read.
Supports: The five-stage presentation, uncertainty about the extra value of stage-matched smoking cessation support, and the caution against restricting quitting advice based on perceived readiness. The Cochrane summary and abstract were read; the latest search was August 2010. Findings are limited to smoking cessation.