In this stage, the client does not have the intention to change. They are not aware that their behavior is creating a challenge for themselves. They may choose to defend their current behaviors when others ask if they are interested in change. For example, a client who smokes one pack of cigarettes a day may express frustration with friends and family who are concerned about their tobacco use and its health effects.
The Change Process: A Social Work Model
In the world of Social Work, there are many frameworks and theories that professionals use with clients in their treatment plan. The change process, developed by Prochaska and DiClemente in the late 1970s, is a model that allows healthcare professionals to meet the client where they are in their readiness to change. This is essential for supporting behavioral health clients as they work toward change. Identifying where a client is in their readiness to change allows the social worker and client to work together to select an intervention that is most appropriate for the client’s readiness to change. Social workers use this model understanding that change is not necessarily a linear process, as clients move along the continuum. This model can be applied in any social work setting to support clients and promote their autonomy so that they are able to move forward at their own pace.
Pre-Contemplation
Pre-Contemplation Example
Social worker: “Thank you for sharing that you are using tobacco. Are you interested in stopping tobacco use?”
Client: “I enjoy using tobacco, especially with my friends. I don’t want to talk about it today.”
Contemplation
During contemplation, clients know they are experiencing a challenge and are considering a change in their behavior. However, they are not fully committed to change. This stage may include weighing the pros and cons of change, identifying barriers to change, and experiencing conflicting emotions. Clients may remain in the contemplation stage for prolonged periods of time. For example, a client who smokes one pack of cigarettes a day may begin to consider stopping tobacco use, make a list of pros and cons, but not be quite ready to start the process of stopping.
Contemplation Example
Client: “Maybe I do need to change. But, I don’t know that I’m ready.”
Social worker: “So, you understand that change is important but maybe you are not quite ready to change.”
Preparation
This stage is when a client is ready to take steps toward change, usually within the next month. The client will begin to experiment with small changes and may make a list of goals, prepare an action plan, or collect information about the change they wish to make. For example, if a client’s goal is to stop tobacco use, they may take steps such as smoking less each day or learning about the health benefits they will experience after quitting.
Preparation Example
Client: “I am ready to change and I’m going to take steps toward change.”
Social worker: “Okay! What kind of steps are you thinking about?”
Client: “I am thinking about cutting back on my tobacco use by two cigarettes a day each week.”
Social worker: “Since you are smoking 20 cigarettes per day, does that mean you are thinking about smoking 18 per day for a week, then 16 for a week, and so on?”
Client: “Yes!"
Action
The action stage is characterized by behavior modification and action toward a goal. The client is changing the behavior or aspect of their life that has created a challenge. In this stage, support from family and friends is important as a client works toward change.
Action Example
Client: “I am committed to stopping using tobacco. My health provider made sure I have nicotine replacement therapy.”
Social worker: “What a great choice. I understand that stopping tobacco use impacts health in many positive ways.”
Maintenance
In the maintenance stage, the client will avoid former adverse behaviors, maintain healthy coping mechanisms, and stay focused on their goals and recovery. They may continue counseling, support groups, and interacting with an accountability partner. People committed to maintaining change can do so for their entire lives.
Maintenance Example
Client: “I’m so proud of myself. I stopped using tobacco 3 months ago. My accountability partner, counseling, and support group have been a huge help.”
Social worker: “I’m so proud of you.”
Clients can be in different stages of the change process in different areas of their life. For example, a client may be in the pre-contemplation stage in relation to their readiness to stop using alcohol. This same client may be in the action phase in relation to stopping tobacco use.
BH WELL exists to promote behavioral health and wellness among individuals facing behavioral health challenges. Learn more about BH WELL at https://bhwell.uky.edu. Follow us on social media.