The stages of change (transtheoretical) model has proven to be highly successful with substance abuse clients, because it helps us match our interventions to where the client is located on the change continuum. Matching interventions to the stage of change is also crucial when promoting change in individual staff members, and when guiding change of programs as a whole. So the model also can be very helpful in clinical supervision and long-range planning.
The first stage in the model is called precontemplation. In this stage, people are not in the market for change. They may not think they have a problem, or they may not believe anything can be done about their problem. Successful changers move from precontemplation into the contemplation stage. This stage is characterized by ambivalence—feeling two ways about changing. On one hand they are bothered by some things, but on the other hand they are not sure what, if anything, they want to do about it.
Once this ambivalence is resolved and a commitment to change is made, people enter the preparation stage. Here they develop the change plan they will use in the action stage. After about six months in the action stage, those with alcohol or other drug problems may move to the maintenance stage, where they consolidate their recent gains, work to avoid relapse, and strengthen their commitment to their new lifestyle. When the new way of doing things seems to be effortless, and the newly acquired skills protect against any return to the problem behavior, a person has reached the termination stage.
Application to clinical supervision
The stages are as applicable to us as they are to our clients. They can be utilized in our own personal and professional growth and as an approach to clinical supervision.
Viewing the change process from the perspective of the stages offers a highly respectful way to relate to staff. Rather than looking at staff members as stubborn, resistant, or plotting to undermine the agency's goals, supervisors can view staff members as being at the precontemplation stage of change. So rather than scold, formally discipline, or fire a staff member, supervisors will work in partnership with the person, to move him/her to the contemplation stage. One of the most attractive aspects of the model is that it helps promote real change (rather than compliance).
Using other models, such as progressive discipline, very often will win the battle but lose the war. A staff member treated this way may decide to comply but go underground with complaints. This can very quickly create a class of employees who become compliant but less productive, less enthusiastic, and less fun to be around. And this is more likely to undermine program goals than the isolated behavior that started the cycle of progressive discipline in the first place.
The stages of change model also promotes empathy for our staffs. It is a nonjudgmental, nonblaming approach. By understanding and utilizing the processes of change, supervisors can avoid being discouraged by staff members who haven’t been responding well to clinical supervision.
At the same time, it helps us become more likely to identify staff members at high risk of jeopardizing program goals. Because real change occurs in predictable stages, all the work of one stage must be completed before moving to the next. A staff member who jumps from precontemplation to action poses a security risk—much more likely to be simply complying as opposed to growing professionally.
Application to long-range planning
Staff members, management, board members, and other stakeholders can also use the stages of change model in long-range planning for their programs. The corporate culture of any program can be assessed in terms of obstacles to the program's long-term goals. The program as a whole may be in precontemplation with regard to some of the obstacles and in contemplation with regard to others. There already may be planning to solve some problems and actions being taken to solve others. In still other areas, the program will seek to maintain changes it has already made.
The model helps stakeholders assess which changes are doable, and in what time frame. Then, by matching the interventions to the stage of change, programs can be respectfully guided through the change process. When changes are made with the full support of all stakeholders, experienced staff members stay onboard and take a major role in the changes. Guiding your program through the stages of change will promote lasting improvement that can be built upon, rather than half-hearted compliance.
Here's an example. A residential substance abuse program has a policy not to accept any client who requires psychiatric medications. Staff members are all convinced that psychiatric medication is not compatible with quality sobriety. But the board of directors believes that the program's current success rates are unacceptable, at least in part because of this policy. The board views the corporate culture as an obstacle to a policy change, and assesses the program as being in precontemplation—unaware of the connection between an untreated second diagnosis and an increased rate of administrative discharge.
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