Wouldn’t it be wonderful if change happened in an instant? Wouldn’t it be great to wake up in the morning and think: “I want to start eating better.” And then we do. Or decide, “I am going to stop smoking” and never pick up another cigarette?
But we all know that’s not how change works. It isn’t a one-time event or singular action—instead, it is a process. And the more we understand the process of change, the more we can empathize, support, and demonstrate compassion for ourselves and those around us who seek to alter their behavior. What is the process of change?
The Transtheoretical Model of Behavior Change
The Transtheoretical Model (TTM), also commonly referred to as the Stages of Change Model, provides us with an understanding of how change occurs (Prochaska et al., 1992). Developed in the early ’80s out of research with former smokers, Prochaska and DiClemente found that individuals who successfully make changes go through a series of stages over time (Prochaska & DiClemente, 2005). In contrast to the assumption that change begins with behavior modification, Prochaska and DiClemente discovered several stages prior to taking action.
The Five Stages of Change
The first stage of the change process is marked by a lack of awareness of a problem. This stage, known as pre-contemplation, is when individuals fail to see their behavior as an issue. Others in their life may be telling them they need change, but they do not agree and have no intention of making a change in the next six months. A person in pre-contemplation may say, “It’s not my drinking that needs to change, it’s my job that is causing all my problems.” Pre-contemplation is a common starting place for many who embark upon the journey of change.
The second stage of change, contemplation, is when an individual becomes aware of the problem, but is ambivalent about making a change. They perceive the pros and cons of changing as approximately equal and thus have not committed to change. They may be considering making a change in the next six months, but currently are not ready to act. A person in contemplation may say, “I know I need to eat better, but it’s so expensive to buy fruit and vegetables. I don’t know how I would make it work.” The contemplation stage is marked by ambivalence and people can get stuck in this stage for months or years.
The third stage of change, preparation, is characterized by making a commitment to change. The individual intends to take action within the next month and may already be making small changes (e.g., reducing their pornography use). A person in preparation may say, “I’m ready to stop smoking. I’ve already purchased a nicotine patch and haven’t bought any more cigarettes.” Individuals in preparation are on the brink of taking action.
After the preparation stage comes action, in which individuals modify their problem behavior and make the change. In this stage, there is a strong commitment to change, and the change is intentional (i.e., self-directed) rather than imposed by others or the environment. A person in action may say, “I did it. I filled my prescription for Depakote and I have been taking it consistently for the past week.” The action stage lasts for approximately six months as the new behavior modifications are solidified.
Finally, the fifth stage of change is maintenance, in which individuals sustain their behavioral change indefinitely. During this stage, the focus is on avoiding relapse and fully integrating the behavioral change into their lives. A person in maintenance may say, “It’s been almost a year since I last used cocaine. I’ve learned how to control cravings and find support when I need it.” In maintenance, individuals learn to sustain their behavior change through various seasons of life.
The Process of Change as a Spiral
Although the five stages of change sound like a natural forward progression, this often is not the case. Anyone who has made a New Year’s Resolution that lasted until February knows that relapse (or the return to prior behavior patterns) is the rule rather than the exception. The TTM recognizes that recycling through stages is likely before individuals reach sustained maintenance (DiClemente, 2015), thus the change process is better understood as a spiral rather than a straight line.
In addition, individuals can spend varying amounts of time in each stage, thus the process of change looks different for different people (Prochaska & DiClemente, 2005). When conceptualizing change as a process, the goal is for an individual to move from whatever stage they currently find themselves in (e.g., contemplation) to the next stage (e.g., preparation). In this way, people can acknowledge and affirm the small steps leading up to change (e.g., moving from one stage to the next), rather than waiting for the maintenance stage to celebrate.
Meeting People Where They Are
The genius of the TTM is the acknowledgment that people in one stage of change are addressing different tasks than those in another stage (Prochaska & DiClemente, 2005). For example, a person in pre-contemplation benefits from gaining insight, information, and feedback to raise awareness about their problem behavior, while a person in contemplation benefits from exploring the impact of their behavior on others, examining their emotions, and working through ambivalence. The person in preparation benefits from creating an action plan and troubleshooting, while a person in action benefits from restructuring their environment to avoid triggers and implementing replacement behaviors. Finally, a person in maintenance benefits from relapse prevention strategies and increasing overall wellness (Prochaska & DiClemente, 2005).
As we learn to conceptualize change as a process, we can identify an individual’s current stage of change, meet them where they are, and help them attend to their current needs. Reaching sustained behavioral change is a journey and the more we know about the process, the more we can support one another along the way.
Change is pivotal in therapy. In fact, it’s the reason people seek professional help in the first place, according to Deborah Serani, Psy.D, a clinicial psychologist and author of the book Living with Depression. Sometimes, they want to change themselves. Other times they yearn to change others.
“I’m still surprised at the number of people who come to therapy to learn how to get someone else to change,” said Ryan Howes, Ph.D, a clinical psychologist and author of the popular blog “In Therapy.” “They want to know how to get their boss to talk to them differently, or want their wife to appreciate them more, or want their friends to be more considerate.”
Of course the only person you can change is yourself. That includes changing your beliefs, behaviors, reactions and patterns. As therapist Joyce Marter, LCPC, said, “In therapy, change may mean letting go of dysfunctional relationship patterns, irrational beliefs and self-sabotaging behaviors and then replacing them with a more positive, conscious and proactive mode of operation that leads to greater happiness, wellness and success.”
Why is Change so Hard?
According to clinical psychologist Christina G. Hibbert, PsyD, change is difficult because most people don’t know how to change, or we’re just not ready. She believes there are six stages of change, which are part of the “transtheoretical model of change.” This model demonstrates that change isn’t linear but a spiral. She said:
Most people spiral up and down the six stages of change several times before they actually make change that lasts. That’s just part of the nature of change.
As I always say, “As long as you’re in the spiral, you’re making progress. It doesn’t matter whether you’re spiraling up or down, what counts is that you keep on working.” Teaching this to my clients helps them see they’re actually doing better than they think.
(Hibbert explains the model in this post.)
Sometimes change isn’t really what you want. Howes gave an example of a husband who thought he wanted his wife to change.
I’ve worked with couples who claimed to want changes from their partner, but when change happens they want the old familiar dynamic back. A husband wants his wife to be more social, for example, but when she branches out he feels jealous and wants the homebody back. I encourage couples to be clear about the change they ask for, and prepared for that change to occur.
We also gravitate toward the familiar, and fear the unfamiliar, said Marter, owner of the counseling practice Urban Balance. “Change can be scary because people fear the unknown, perceived loss of relationships or the risk of failure.”
Howes quoted the common saying: “The devil we know is better than the devil we don’t.”
Some people hyperfocus on external changes. “I’d say that so many of us struggle with external change because we secretly hope we can bypass the true work which is changing how we feel inside,” said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. Put another way, “when we place too much concern in things looking different then we tend to overlook the deeper need to shift our internal climate.”
Change is tough because it also takes time. According to Serani, “It takes time to discover patterns that create undesirable thoughts and behaviors. It also takes time to understand what issues get in the way of achieving your goals once you know what you need to change.”
Naturally, resisting change is normal, Marter said. “Breaking through defense mechanisms and developing the tools to think and operate differently is a process with ups and downs.”
While change is difficult, it’s to be expected. “I think we need to recognize the inevitability of change. We are all changing in some way or another, every day,” said clinical psychologist John Duffy, Ph.D, author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.
How Therapists Facilitate Change
“I try to teach clients to be like a super-sleuthing detective. I want them not to just crave change, but to be immensely curious about it,” Serani said. In fact, she believes that “enthusiastic curiosity” helps us develop insight and replace old behaviors with new ones much faster.
Healthy change, she said, happens when we ask key questions, such as “Why isn’t this new technique working? What’s getting in the way? How can we make it work better?”
Hibbert, an expert in postpartum mental health, helps her clients learn how to change. “My job as a psychologist is to provide the ‘how’ so the client can get to work. I’ve seen many people make amazing changes, so I know it’s possible. You just have to believe it’s possible for you.”
Howes helps clients gain a clearer understanding of the trade-offs of change.
As pessimistic as it might sound, I try to help people know that change means trading in one set of problems for another. Sure, there may be some clear benefits to change, but there is always a different set of hardships to endure.
Just ask the people who win the lottery. Financial problems are solved, but a host of new problems emerge. If they’re informed and prepared for their new set of problems, change may be welcomed instead of dreaded.
Change is an inside job. Marter quoted Eckhart Tolle, author of The Power of Now, who said: “If we get the inside right, the outside will fall into place.” She explained:
Many people think if they have the perfect job, house, relationship, or body, they will finally be happy. Through therapy, I help clients make internal changes – such as detachment from ego, focus on essence, silencing the inner critic, practicing positive thinking and gratitude – that lead to positive change in life.
Marter teaches her clients to recognize that it’s “inner forces” that determine their lives, not external ones. This way “they feel empowerment to enact positive change in their lives, both personally and professionally.”
Plus, she teaches them to practice assertive communication, which includes “asking for what they need, setting healthy limits and boundaries and saying no to old patterns that are no longer serving them.”
Sumber also helps his clients transfer the focus from external change to internal transformation.
I work with clients to release their expectation of external manifestations and allow for a shift in their conscious awareness of who they are and why they are doing what they are doing. Most clients are surprised in the end to find that things have indeed shifted externally as a result.
Duffy helps clients foster self-awareness, which he views as a requisite “for satisfactory, proactive change. Otherwise, we are simply reacting to life, and often feel we are victim to it.”
Real change requires work and effort. As Serani said, “toxic tendencies or undesirable thoughts don’t happen overnight. They are created and cultivated over time. And the same goes for change. It doesn’t happen overnight either.”
Positive change is a process that ebbs and flows. But it’s worth it. Change is “an essential part of healing and development,” Marter said.
