Housing First Dual Diagnosis Team Blog: Supporting Change
By Andrea Cain, Dual Diagnosis Practitioner
The Housing First Dual Diagnosis blog this month will take a closer look at a model that is widely used in Substance Misuse Services to assess levels of motivation.
This model can be applied to any area in which an individual is seeking to make a behaviour change and its application can aid engagement and improve outcomes.
This intervention can be added to your current tool kit to help to better support those you are working with.
The Transtheoretical model (also called stages of change) was developed by Prochaska and DiClemente in 1983 as part of smoking cessation.
People can move forwards and backwards and spend varying degrees of time within the different stages.
The key thing is to be aware of the stage of change the person you are working with is at and to match your intervention accordingly.
Individuals will present to us with varying stages of motivation to change.
It is important to understand that regardless of how hopeless someone may feel about their ability to change, or opposition to doing so, there will always be ways in which we can work with them.
This model will help identify which stage in the journey of change somebody is at.
It can be useful to discuss the cycle collaboratively to recognise where they are and what might help them move forward.
More about the stages of change and how better to identify which stage the person you are working with is currently at:
Pre-contemplation might sound like ‘What problem?’
When people are in this stage they may not recognise or want to admit they have a problem. People can remain in this stage for a long time during which period associated problems can escalate. This stage is often called ‘denial.’
What it might look like: unaware of problems associated with behaviour. Believe the positives of the behaviour outweigh the negative. Uninterested and not willing to change.
Unaware
Resistant
Contemplation might sound like ‘I want to change…but then, on the other hand…’
This is where people can have mixed feelings about change however in this stage there is recognition of the problem.
What it might look like: begin to develop an awareness of problems associated with the behaviour. Ambivalent regarding positives and negatives. Increased willingness to explore the potential to change. Desires to change behaviour but may lack confidence and commitment. Intends to change within a longer timescale (6 months plus).
Awareness
Openness
Decision
When the person reaches a point whereby they conclude the negatives of the behaviour outweigh the positives and they make a choice to change the behaviour - this is an event, not a stage.
Commitment
Preparation might sound like ‘I know I have to, but how?’
Here is where people begin to make decisions and are preparing for change. Changes might include more of a future orientated outlook.
What it might look like: Accepts responsibility to change behaviour. Evaluates and selects techniques for behaviour. Develops a plan. Builds confidence and commitment. Intends to change within one month.
Anticipation
Willingness
Action might sound like ‘Now I’ve got the bull by the horns!’
This is where preparing for change is converted into action. This stage requires a level of commitment from the individual and it is important they have access to the right support to assist them in making desired changes.
What it might look like: Engages in self-directed behaviour change effort. Gains new insights and develops new skills. Consciously chooses new behaviour. Learns to overcome the tendencies for unwanted behaviour. Active in action stage for less than six months.
Enthusiasm
Momentum
Maintenance might sound like ‘I’ve got to stay with it!’
Forward planning and goals can be helpful for the positive change to be maintained. This will include exploring potential triggers and high-risk situations that may tempt/lead the person back to former behaviours.
What it might look like: Masters the ability to sustain new behaviour with minimum effort. Establishes desired new behaviour patterns and self-control. Remains alert to high- risk situations. Focus is on lapse prevention. Has changed behaviour for six months.
Perseverance
Consolidation
Lapse/Relapse might sound like ‘I’ve messed up!’
Any lapses are treated as a temporary delay in forward progress and something that can be learned from. It can be helpful to remind people of the anchor of all their well-planned contemplation and preparation that they can continue to rely on.
May occur at any time. Personal distress or social pressures are allowed to interrupt the behaviour change process. Temporary loss of progress which resumes at an earlier stage. Experience is educational to help prevent further recurrence.
Danger
Opportunity
Most people will go through these stages many times before they make it through the cycle without at least one lapse. The majority will return to the contemplation stage. It is helpful to explore lapses to maximise potential learning from these slips and to acknowledge and continue to build on former successes.
Reference
https://smartrecovery.org.uk/articles-essays/stages-of-change/
