The lenient is an active participant in their life, able to make their own choices, able to learn from their experiences and to make changes here and now. The Trans-Theoretical Model () Decremented and Approaches (1983) – Loss and Change This model was originally developed in order to outline the stages and processes of self-change in smoking. However over time the model has been developed and applied in many settings including health and social care and also business studies. The model describes the different change processes. )
The Stages: Precipitation – At this stage the individual has no intention of changing he behavior. They may have not acknowledged the problems associated with the behavior. This may be particularly true of clients who present at the drug service as a Restriction of Bail or Drug Rehabilitation Requirement as they have not presented voluntarily (however this is by no means always the case). Contemplation – At this stage an individual acknowledges that there may be problems associated with the behavior and are starting to think about change.
Some may decide to take steps towards a change fairly immediately (within the next 6 months). Preparation – Many at this stage egging to plan a strategy to change the behavior, although at this point they may not commit or take action towards it. Some may begin to put an action plan into place to begin the process. Action -? At this point the individual begins to follow their action plan. Approaches (1994) suggests that the more developed this plan is and the more attention they have given to the work of the previous stages, the more successful they will be in making the change.
This a significant point as many assume that the action element is the most important, however the model accepts the idea that it is vital that an individual does not move immediately into action that they may not be ready for as this may not provide sustainable change. Maintenance – Individuals at this point are working towards preventing relapse and to continue the achievements of the action stage. Another positive aspect of this model is that it views the stage not as a static process but the process of change is continued, this maintenance is often a lifelong process.
Termination Although this is not recognized always as a stage of change, it is a feature of the model. Approaches (1994) states that this stage is only possible for a small argental of people, it occurs when an individual no longer has to struggle to avoid lapse or relapse as the change has become an integral part of the individual’s lifestyle. 12 step approaches would dismiss this as a possibility, as individuals who have had an addiction would always have the potential to relapse. Re)Lapse – As with termination, (re)lapse is not always acknowledged as a Stage in the cycle of change, however especially in the Drug and Alcohol sector, it is a reality. Often individuals will relapse many times before becoming abstinent (if that is their goal), it is often the case that hose relapses are a normal part of the individual’s journey towards their goal of change. Ii) Processes of Change Processes of change are the cognitive (covert) and behavioral (overt) activities that workers use to assist the individual to move through the stages.
Consciousness Raising – Individual acknowledges the causes and consequences of the behavior Dramatic Relief – Process whereby the individual needs to experience their feelings and emotions that are related to the behavior. Patten (2000) indicate that major losses such as a death, can move an individual into the Precipitation stage. This is particularly evident in the drug and alcohol sector where death of someone close to the client can often drive them to take a step towards accessing treatment, especially when the death was a result of an overdose.
Environmental Re- evaluation – Individual acknowledges how their behavior is impacting their social environment, for example how their drug or alcohol use is affecting friends and family. Self re-evaluation – Is an evaluation of the individual’s image with and without the behavior. This is particularly important when moving from contemplation to preparation stage (Patten 2000). Self Liberation -? Belief within the individual that change is possible and commitment to take action.
Social Liberation – Increase in opportunities and alternatives to the behavior, for example in the Drug and Alcohol field part of an individual’s care plan will be to gain further training, education and employment. Stimulus Control – Remove stimuli associated with the behavior and provide alternative environment. In the Drug field these are generally referred to as ‘triggers’, a client may be made aware of these triggers (often other people such as dealers) and to create a safer environment and social network, for example support groups – cannabis groups, AAA, AN CA.
Helping Relationships – Similarly, this involved helping the individual to be open and trust those who are helping to assist the behavior change, for example peer support Reward – Recognition and reward for making and maintaining change; an example might be group recognition of achievements Countering – Replacing old behavior with new positive behaviors, for example replacing heroin use with complimentary therapies such as Yoga or Acupuncture. Iii) Evaluation As the title suggests, the Trans-theoretical model of change is a dynamic approach that considers a number of different psychological theories.
The individual is central; they make the decisions and are active in the process Of changing their behavior, not just a product of his or her socio-biological influences. Probably the biggest danger associated with the cycle of change would be its application as a rigid process that applies to every individual. There are many different illustrations of the Cycle of change, some have depicted it as a spiral, as a pie chart or simply as a list. Have chosen to adapt my own version as below (Fig.
X), as this highlights the movement of the client not just in one erection, but that lapse or relapse may occur at any point in the cycle and that the client may also re-renter at any point of the cycle. Fig X Cycle of Change b) Application in work setting The Processes outlined above are particularly useful as they outline how myself as a trainee worker can assist a client to move through the stages of change to achieve their goal of reducing their drug use or abstinence and also reducing high risk behavior.
For example, if clients present and are in the Precipitation or Contemplation stage, although they may not be ready to engage in tier 3 services immediately, it is still an opportunity to give harm reduction advice, not everybody will immediately want to aim for abstinence immediately and it is important not to force people into Action if they are not ready. The cycle of change can be used in many different ways in the drug and alcohol field.
In my work place the cycle of change is utilities in the triage assessment. During the assessment the worker and client can together decide which stage the client that has presented at the service is at. At this point the client would usually be between the Precipitation, Contemplation, Preparation or Action stages. The cycle of change can also be used in a group setting to identify where different individuals are on the cycle in relation to their drug using.
The advantage of using this approach is that each person is allowed to visualize the process and to see others that have progressed through the stages and how they were able to do that. This worked well recently in the cannabis group where we focused on the model and identified where each client was in the cycle, there were some who had been abstinent for long periods (maintenance stage) and others who were new to the group and the service ND it acted as a tangible and clear representation of their potential for progression and to reach their personal goals usually of abstinence.
The model is particularly useful in keynoting for example if a client is in the contemplation phase it is an opportunity to support their self-efficacy and use motivational interviewing. In the later stages, it is useful to talk about triggers, managing cravings and encourage the individual to get into support groups (possibly therapeutic groups cannabis, stimulant etc to 12 step groups), part of the Action phase for the client may be supporting the client to access detect and residential rehab.