A particularly useful model for counsellors and clients is the cycle of change, developed by DiClemente, Prochaska and Norcross and described in their very readable book, Changing For Good. The video (above) is an interview with Carlo DiClemente co-developer of the model. The cycle of change is an excellent tool for understanding the process of change and for identifying where people are in the process. The model also provides a guide to the interventions that best support individuals at different stages in the cycle. The authors argue that the wrong intervention at the wrong time may actually hinder the process of change, raising defences and entrenching denial in clients.
Before individuals enter the cycle they are in a stage that DiClemente calls “pre-contemplation”. As the name suggests, individuals in this stage may be unaware of their problem or deny that the problems exists or affects them. Denial is an active process that involves pushing a problem out of awareness and a fascinating subject in itself. The appropriate intervention in this stage of the cycle is consciousness raising through the provision of information. A successful intervention helps the individual to the next stage of the cycle, which DiClemente terms “contemplation”.
When an individual begins to consider the possibility of change he or she has entered the “contemplation” stage of the cycle. This stage is marked by ambivalence, commonly expressed by clients in the form: “Part of me wants to make a change but another part wants to keep things as they are”. Resolving this ambivalence is the key task for individuals before they can move to the next stage of the cycle.
Two approaches to resolving ambivalence can be employed here. The first approach to resolving ambivalence is to create within the individual a psychological state known as cognitive dissonance. This state occurs when an individual’s actions are in conflict with his or her values. Cognitive dissonance is resolved when changes are made to bring a person’s behaviour in line with their values. The second approach is the decisional balance exercise in which clients are invited to consider the short-term and long-term positive and negative effects of their limiting behaviour. This also increases levels of cognitive dissonance in the individual as they recognise that the long-term consequences of their behaviour are negative.
Ambivalence is resolved when the individual moves to the next stage of the cycle, the “decision” or “commitment” stage. In this stage the individual decides to make a change or makes a commitment to the change process. It is commonplace for individuals at this moment to slip back into ambivalence or, more helpfully, to move round the cycle a little further to the “action” phase. The counsellor can reinforce the client’s commitment to change through genuine praise and by focusing on the gains that will be realised once changes are made.
The action stage of the cycle is the point at which the client prepares to make changes. Methodical preparation is a key factor in successful change. Counsellors can support their clients in this phase of the process by helping with goal setting and action planning. Effective goal setting and action planning can create a compelling future that pulls the client towards the next stage of the cycle: the maintenance of new and desired behaviours.
In the maintenance stage of the cycle the individual successfully creates change in their lives and sustains it over a period of time. If change is maintained then permanent change takes place and the individual leaves the cycle. Maintenance requires conscious effort. Permanent change has occurred when the new behaviour has become automatic, natural or effortless. Helpful interventions in the maintenance stage of the cycle include “old self” v “new self” comparisons, listing the gains and good feelings associated with the new behaviour and importantly relapse prevention.
Preparing clients for the possibility of relapse may seem like a risky thing to do, as though acknowledging the possibility of a relapse might bring it on. But exploring and planning for a relapse is preventative work and provides the client with the knowledge and skills the will need to manage a lapse and return to the maintenance phase of the process. If a lapse turns into a relapse the counsellor can reframe the relapse as essential learning - another piece of the jigsaw – on the way to permanent change. DiClemente discovered that individuals tended to go round the cycle a number of times before reaching permanent change, but each trip round the cycle is developmental and prepares the individual for their next more informed attempt at change.