By Sue Newton, MN, RN
Change is an inevitable part of life but it can be very challenging for people to take action and make necessary change. For most people, behaviour change occurs gradually but the pace can vary greatly. Understanding the stages of change and ways to work through each stage is essential to help people achieve their goals, if and when they are ready. Change is thought to occur in five stages: precontemplation, contemplation, preparation, action, and maintenance. Each of these stages helps in the understanding of how ready somebody is to make change in their life.
Precontemplation (not ready)
People in the precontemplation stage do not intend to take action in the foreseeable future. Someone who is in this stage typically displays resistance and may say things like “get off my back, I’m fine”. Multiple unsuccessful attempts at change can lead to demoralization about the ability to change. At this stage of change, people tend to avoid reading, talking, or thinking about their high-risk behaviors. They are often characterized as resistant, unmotivated, or unready for help. Trying to convince someone to change at this stage will be fruitless; a better strategy is to talk about risks vs. benefits and positive outcomes related to change.
Contemplation (getting ready)
Once there is some evidence that the individual is aware there is a problem but may still be somewhat ambivalent, this is the contemplation stage. They are more aware of the pros of changing, but are also acutely aware of the cons. This weighing of the costs and benefits of change can produce profound ambivalence that can cause people to remain in this stage for long periods of time. You may hear people saying things like ‘I am not sure I can do it, but I would like to.’ At this stage it is important to address concerns, identify support systems, provide information and guidance to prepare for change. Being too pushy can spark fear, resentment, and defensiveness and push them back to a precontemplation stage.
When there is movement towards ‘I want to change, who can help?” friends, family members, and care providers can become more directive with suggestions. The preparation stage is when individuals are open to change but may not know what to do.
It is important to capitalize on this sometimes narrow window of opportunity and help them develop realistic goals and a timeline for change. There is a high risk at the preparation phase that individuals will lose momentum and slip back to contemplation or precontemplation stages. If this happens, it is important to not get discouraged. If someone has reached the preparation stage before, they can get there again.
When you hear, ‘I need to change, this is what I have been doing. What else can I do?’ this is someone in the action phase. They may have already started taking steps to change their current situation and have a high level of motivation and momentum. At this stage it is important to emphasize that ‘Alone one can’t, but together we can.’ It is important that people access supports around them, both formal treatment as well as informal peer, family, and friend support, to maintain the momentum. This is the time to provide positive reinforcement.
Maintenance (keeping it going)
The maintenance stage is where people have been involved in action to change their lives. It takes 2-5 years of action before one can be considered to be in the maintenance stage, which is where the new way of living feels more familiar. This way of life is now more sustainable and natural, with less effort required to maintain it. It is essential during the maintenance stage that one watches for stressors or complacency, as these can take an individual back into contemplation and relapse very quickly. Resistance, especially internally, is part of the recovery process and it is important that individuals, family members, friends, and care providers deal with the resistance without going into fear, anger, shame, or resentment.
Wherever you are in your life right now, it can be helpful to look at your challenges through the lense of these stages to gain clarity on what you may need to move forward and look honestly at what is keeping you stuck.