Traveling the Stages of Behavior Change

Coaching is meant to facilitate change — and especially behavioral change. However, intentional behavioral change doesn’t happen by accident. There is a series of stages that people go through on the path toward achieving a sustainable change goal.

This process is best described by James Prochaska and Carlo DiClemente in their Transtheoretical Model of Change. Their model is based on an analysis and integration of key constructs from a variety of theories (hence, the use of the word “transtheoretical”) to form a comprehensive model of change that can be applied to a variety of behaviors, populations and settings. This article introduces you to the process; future articles will describe how to coach individuals through the process to reduce resistance, facilitate progress and prevent relapse.

Because behavioral change occurs over time, it is reasonable to expect that an individual will go through a process that can be thought of as a continuum — from “I’m not ready to change” to “I have changed and feel comfortable.” The transtheoretical model describes points on this continuum as stages.

As a coach-leader, being able to diagnose what stage a person is in as he or she moves through the change process allows you to make an informed judgment about the strategies to employ to expedite the needed or desired change. Furthermore, physicians who understand and employ this with patients who need to make healthful changes in behavior or lifestyle will increase the odds that those changes can and will be made.

There are five stages of change.(1)

1. Precontemplation

This happens when someone is not ready to even think about changing. A person at this stage is either unaware of the need to change (“I don’t have anything that needs changing”) or under-aware of the need for change (“I guess I’m a little too aggressive, but it’s nothing that I really need to change”). When a person is under-aware, he or she might realize something might be a problem, but thinks it’s not enough of an issue for concern, and, therefore, nothing needs to change. When people are in this stage, it is difficult to help them. According to Prochaska and his colleagues, “precontemplators process less information about their problems, devote less time and energy to re-evaluating themselves and experience fewer emotional reactions to the negative aspects of their problems.”(2)

Perhaps one of the most challenging aspects of being a coach-leader is recognizing that someone under your charge is in this stage, relative to behavioral issues that are creating problems or could create problems in the future — for example, the surgeon who can’t keep a team together because of the way he or she treats the people, or the faculty member who wants to become a division chief but is perceived negatively by his or her peers. If you find yourself coaching or mentoring someone in this stage, remember that no progress will be made until he or she advances beyond precontemplation. The same is true for patients as well. If you have made them aware of a health-risk behavior, but they dismiss its importance, they are in precontemplation if they take no action to change.

2. Contemplation

This is the stage in which people are aware the status quo is not acceptable. Once they have reached this stage, they begin to think about doing something to change their condition, but they have not yet made a commitment to act. The reason for this is, while they are aware of the pros of changing, they are also acutely aware of the cons (“I know that if I delegate more I will have more time, but if I give up control over something, it might not get done according to my standards” or “I know that working out will be good for me, but I’m already spending too much time away from my family”).

This weighing of pros and cons can produce extreme ambivalence that can cause people to remain in this stage for long periods. A sign that a person is struggling with his or her ambivalence about change is procrastination. Do not expect someone in this stage to take action to change right away. For action to take place soon, someone must reach the next stage.

3. Preparation

This stage signals a person is serious about taking an action to change. One sign a person is in this stage is that he or she can talk about what they are going to do to change with some degree of specificity (“To lose weight, I’ve decided to skip lunch and use the workout facility during my lunch hour. Also, I’m going to sign up for a program to control my portions for the next three months”).

In some cases, a person in this stage will talk about actions to discover what he or she can do to make a change. In the case of the surgeon not doing well with his team, he might not know what to do to change his or her relationship but at least can outline a plan for figuring out what to do (“I’m going to talk to one of my colleagues I trust and get some suggestions for what I might try with the team to build better relationships”). The point is that this stage indicates a person is serious about changing and ready to act toward a goal. At this point, there is nothing left to do but do it.

4/5. Action and Maintenance

Goals without action are merely pipe dreams. To this stage, the change process has been a cognitive exercise, but now the person is fully involved in making a change, as evidenced by his or her commitment of time and energy. Actions are the means by which people manifest their goals. As a coach-leader, when you see a person you have helped take action to change, you have done your job — almost. The problem with behavioral change is that it is a heuristic process.

Consider this goal: “I want to become more tactful in my conversations with others.” How does the person go about doing that? There is no single answer, and there are as many possible actions as there are answers. Therefore, a person must engage in trial and error to figure out what helps achieve this goal. During this stage, it is important for a coach to reinforce actions that work and support the person when actions must be modified when they don’t. As the “take action/get feedback/continue or modify actions” process unfolds, change begins to manifest itself as new behaviors become the norm.

Maintenance is the stage at which people have made overt modification in their behaviors. People in this stage do not have to think consciously about their new behavior as it comes naturally. They grow increasingly confident that they can continue their changes in the future.

Summary

Changing is not easy for anyone, or for a coach-leader helping someone making the change. Understanding the stages of behavioral change will not alter that, but it will increase the odds that you can guide a person through the process successfully.

References

1. Prochaska JO, Norcross JC and DiClemente CC (2005). Stages of change: Prescriptive guidelines. In GP Koocher, JC Norcross and SS Hill III (eds.), Psychologists’ Desk Reference (2nd ed., New York: Oxford University Press, 2005, pp. 226-31.

2. Prochaska JO, Redding CA and Evers, KE. The Transtheoretical Model and Stages of Change. In K Glanz, BK Rimer and K Viswanath (eds.), Health Behavior and Health Education (4th ed.). San Francisco: Jossey-Bass, 2008.