Change Process

transtheoretical stage of change

Another major influence on motivational interviewing is the trans- theoretical stages of change (TSOC) model, developed to recognize and address the reluctance of many people with substance use disorders to change their behaviors. TSOC offers an alternative to approaches that view clients as resistant, in denial, or uncooperative if they express a lack of readiness or willingness to change. It views motivation as a state of readiness to change and proposes that all people follow a predictable course when changing behavior. The following six stages of change have been formulated in the TSOC: Precontemplation—The person does not believe that he or she has a prob- lem and is unwilling to change, even though others suggest there may be a problem. Contemplation—The person is considering changing a behavior, seeing that there are significant benefits to be gained by (for example) stopping alcohol use, even as he or she continues to drink. Preparation—The person is poised to change the problematic behavior within the next month, and works on a strategy for doing so. Action—The person implements a change in behavior (for example, going to rehab). Maintenance—Sustained change persists for six months. Relapse—The person resumes the problem behavior.

The TSOC model may seem simple, but as a guide to approaching inter- vention, it has advanced the process of treating substance abusers remarkably. The model has also been tested with other kinds of presenting problems such as dietary change (Armitage, 2006), male battering behavior (Scott & Wolfe, 2003), and smoking cessation and exercise adoption (Rosen, 2009), and has been found to be a largely (but not completely) valid predictor of client change. Motivational interviewing focuses mainly on clients in the first three stages of change, while motivational enhancement therapies guide a client through the fourth and fifth stages. Collaboration, rather than confrontation, is a hallmark of motivational inter- viewing and enhancement. Indeed, within this perspective, confrontation is “sidestep” denial, and instead emphasize listening reflectively to clients’ concerns and supporting change talk. This is defined as talk that emphasizes the: Disadvantages of the status quo Advantages of change Optimism about change Intention to change Motivational interviewing also contrasts with the principles of Alcoholics Anonymous (AA), a dominant treatment paradigm demanding that people label themselves as alcoholic and admit their powerlessness over alcohol. MI down- plays the use of labels, stressing more of a non-hierarchical collaboration between the client and practitioner, as well as the development of self-efficacy so the client can develop confidence for changing