Changing for Good Part One: The Stages of Change

Chelsea came from a solid church family.  She sang in the worship band, helped with the children’s ministry, and brought several friends to her youth group.  She was an “A” student, popular, athletic, and beautiful.  Everything seemed to be going great for Chelsea.

Nobody saw it coming when she admitted to the entire youth group that she had an eating disorder.

Her tearful public confession inspired several other girls to declare that they, too, struggled with the same addiction.  Chelsea and her friends came to the youth staff to get help to change.  As a 19 year-old intern barely out of high school, I had no idea what to tell them.

Situations like Chelsea’s give the body of Christ opportunities to touch the deepest parts of people’s lives, but those who most want to help are often left wondering what to do.  How do people change, and how are we supposed to help them in the process?  Moreover, how can we help students embrace change that lasts?

The dynamics of life change are important for any youth worker to understand.  Whatever negative habits our students deal with, from drug abuse to obsessive texting,¹ we need to be armed with the ability to help them make positive and long-lasting change.  This two-part series will examine the process of behavioral change and offer research-tested interventions you can use to help change begin and last a lifetime.  Part One will use addiction research to examine the “Stages of Change Model” and its insights into how people change negative behaviors.  Part Two will look at several “Catalysts of Change” that can motivate even the most turned-off student to break negative habits and form new, positive ones.

The Stages of Change

In order to help students change, we must first understand how people change.  In 1978, University of Rhode Island researchers James Prochaska and Carlo DiClemente initiated a series of experiments to make sense of how people become motivated to quit smoking.  Their research results were consolidated to form the Stages of Change Model.

Though Prochaska and DiClemente focused on quitting cigarette smoking, subsequent research has found that people tend to progress through these same stages regardless of what habit they are trying to change.   Most people perceive change as happening in one step, a “just do it” approach, but the Stages of Change Model describes it as a lengthy, inside-out process.  Lasting and meaningful change begins as a driving, internal motivation that ultimately translates into habitual, external behavior through five distinct stages.

Figure 1. Diagram of the Stages of Change Model²

Stage One: Precontemplation

In this stage, the individual is not thinking about change and is unwilling to admit they have a problem.  That denial is a driving force behind their indulgence in negative behavior.  A girl who is clothed with more skin than fabric might say that she wishes she could change the way she dresses, but has no serious intention to do so in the immediate future.  Without noticeable consequences for her behavior, a precontemplator’s ability to act differently will be held hostage by her lack of motivation.  This is especially difficult if the behavior is socially acceptable, like obsessive texting or cursing.  If this rings a bell for any of your students, keep in mind that your goal in this stage is only to get them thinking about change.  Here are a few questions that might help them do that:

• What would have to happen for you to know that this is a problem?
• What warning signs would let you know that this is a problem?
• Have you tried to change in the past?³

Stage Two: Contemplation

A person enters this stage when he becomes aware that he has a problem and is seriously thinking about overcoming it in the immediate future.  This person is weighing the pros and cons of change, but has not yet made a commitment to action.  A teen smoker may know that his habit is unhealthy, but continues to enjoy the pleasures of his addiction, wondering if the effort and energy needed to overcome his habit will be worth it in the long run.  It is impossible to predict what kind of consequences will lead someone to seriously consider change; some will quit their addiction simply because “the Bible tells me so,” and others refuse to quit even when faced with jail or homelessness.  Everyone’s “rock bottom” is different.  Your goal in this stage is to help teenagers understand the benefits of change.  Asking questions like these may help them do just that:

• Why do you want to change now?
• What would keep you from changing at this time?
• What are the barriers today that keep you from change?
• What might help you with those barriers?
• What things (people, programs, and behaviors) have helped you change in the past?
• What would help you at this time?

Stage Three: Preparation

This is the first stage when any actual steps are taken toward change.  A person enters this stage when he starts planning for and experimenting with change, seriously intending to make permanent change to quit or reduce his negative behavior within the next month.  For example, the student leader/closet party animal may rehearse turning down invitations to the weekend kegger in front of a mirror and think about how his popularity at school will be affected.  As Dr. Marc Kern notes, “Too many people skip this stage…and fall flat on their faces because they haven’t adequately researched or accepted what it is going to take to make this major lifestyle change.”⁴  If we are seeking change that will last, it is important to research, struggle, and plan rather than just blindly dive in. Here are some exercises to help a student in this stage:

• Create (or look back at) a list of some of the barriers to change—things that would keep you from changing right now. Pick one of the barriers to change and then list some things that could help you overcome this barrier.
• When will you begin to take action to overcome one of those barriers (pick a date together)? What about the next barrier?

Stage Four: Action

When a person purposely and successfully alters their negative behavior even once, they have entered the action stage.  This stage demonstrates the most observable behavioral changes and requires the greatest commitment of time and energy, since the person trying to change is inexperienced with her new life choices.  She cannot merely drop her bad habit, but also must work to build a new one that is incompatible with her old ways.  The former gossip has to avoid people that might tempt her to spread the latest rumor and envelop herself into a community that encourages truth-telling and encouragement.  Here are some questions for someone in this stage:

• What made you decide on that particular step?
• What has worked in taking this step?
• What helped it work?
• What else might help?

Stage Five: Maintenance

Once a person successfully alters his negative behavior for at least six months, the change has become a regular part of his life and he is no longer worried about getting motivated to change or figuring out how to change; instead, he has to think about maintaining change toward behaviors incompatible with the past.  The overeater not only reduces his portion sizes, but begins reading health magazines and exercising regularly.  A teenager in this stage needs continued affirmation, guidance, and social support to keep practicing positive change.  A few questions for processing with someone in this stage include:

• Congratulations! What’s helping you?
• What else would help?
• What are your high-risk situations?  What are you doing to avoid or get out of those situations?

Relapse

We all hope that change will be linear, smooth, and have a concrete beginning and ending point.  But in reality, change is usually a bumpy, winding road with many detours.  Relapse is a very common and sometimes necessary event in the stages of change.  It is at once a mistake, a crisis, and an opportunity.

1. Relapse as Mistake

The porn addict visits a graphic web site.  The bulimic binges and purges.  The alcoholic takes a drink.  When a person engages in thoughts or behaviors associated with the negative behavior, their journey toward permanent change is interrupted.  But keep in mind that relapse can begin long before someone plunges into the negative behavior.  For the porn addict, relapse began when they used the Internet alone late at night, for the bulimic when they catalogued their imperfections in front of the mirror, for the partier when they hung out with an old drinking buddy.  As a 15-year veteran of substance abuse treatment noted, relapse begins when “the addiction’s coming after you, and you’re not putting up a fight.”⁵

2. Relapse as Crisis of Belief

The person desiring change will experience the guilt and shame that comes with relapse, but they must also make a serious decision.  How will they proceed now?  Will they quit change and go back to their old lifestyle, or will they keep trying to change despite this momentary setback?  It is important that after someone relapses they reenter the Preparation stage as quickly as possible to ensure the greatest possibility of making the change last long-term.

3. Relapse as Learning Opportunity

If someone chooses to keep changing, relapse can actually be a valuable asset.  They can learn what triggered the mistake, and plan for how to avoid making the same mistake in the future.  People often cycle through the stages several times before successfully achieving maintenance, and learning from relapse is an important step in predicting that success.

It is crucial that students pursuing change clearly understand their current stage.  When guiding a teen through this journey, consistently check in and give them feedback about what stage you think they are in and listen to their assessment as well.  Those conversations are among your greatest tools to stay focused on lasting transformation and give incredible opportunities to confront denial that could cripple the change process.  For a student who has relapsed, here are a few things to discuss:

• Don’t kick yourself; long-term change almost always takes a few cycles.
• What worked for a while? What might work again now?
• What did you learn from the experience that will help you when you try again?

Now What?

This model of change has proven to be quite robust, applicable to a wide variety of behaviors.  Whether a person wants to quit a habit they’ve developed for a decade or one they picked up last week, they will travel through the stages of change.  Similarly, this process applies whether a person decides to remove a negative habit or embrace a positive one, such as exercise or personal Bible study.

The Stages of Change tell us that positive transformation is a journey and that long-lasting change hinges upon a person’s serious, internal, and individual motivation to pursue it.  Without that personal drive, change cannot last.  This may make it seem as if change only happens in isolation, as a journey shared only between God and the individual.  But the truth is that outside influences play a crucial role in moving students from one stage to the next.  You see habits in your students that break your heart, and you know the journey your students must take to change them, but how can you help them move along the journey?  What can the church do for Chelsea and her friends?  Part Two of this series will focus on “catalysts of change,” tools that empower you to engage self-destructive kids where they are and give them the best chance at changing for good.

Action Points

1. Teach the stages of change to your students, volunteers, and parents so they can recognize where they and others might be in the change journey.
2. At a volunteer or staff meeting, discuss troubled students and identify what stage of the change journey they seem to be in (making sure to keep all discussions confidential).  Another approach could be to discuss destructive behaviors you’ve seen in your students or adolescents in general and what each stage of change would look like for that behavior.
3. Basics on how to help someone in need of change:
   • Concretely target the behavior to be changed.
   • Assess the student’s current stage of change and how many times he’s been through the stages before.
   • Match the way you treat her to her stage of change (does she need more help with inspiring motivation or modifying behavior?).
   • Give the student your feedback along the way.  Dialogue with him regularly about what stage you think he is in and let him respond with where he thinks he is.
   • Reward your student as she progresses toward maintenance.  Process relapse compassionately and prepare for action as soon as possible.

1. WHAT IS ADDICTION?

   Keep in mind: just because someone engages repeatedly in a negative behavior doesn’t mean they’re an addict.  On the flip side, just because a behavior is not yet an addiction doesn’t mean it shouldn’t be changed.  At least four of the following symptoms must be present for a habit to be considered an addiction:

   • Giving up or limiting important social, occupational obligations or recreational activities because of the behavior
   • Hiding the behavior from loved ones
   • Experiencing anxiety, insomnia, irritability, mood swings or depression when unable to indulge in the behavior
   • Behavior is done more and more over time
   • Several unsuccessful attempts to stop the behavior
   • Behavior continues despite negative consequences

   See “Addiction,” Therapist Finder (web site), http://www.therapistfinder.com/c_addiction.cfm, accessed 8/14/2010. [↩]

2. Model adapted from Prochaska and DiClemente. See Kern, Marc F., “Stages of Change Model,”  Addiction Info (web site),  http://www.addictioninfo.org/articles/11/1/Stages-of-Change-Model/Page1.html , accessed 8/1/10. [↩]
3. These questions and those in the following stages are adapted from Gretchen L. Zimmerman, Cynthia G. Olsen, and Michael F. Bosworth,  “A ‘Stages of Change’ Approach to Helping Patients Change Behavior,” American Academy of Family Physicians (web site), http://www.aafp.org/afp/20000301/1409.html, accessed 8/2/10. [↩]
4. Kern, Marc F., “Stages of Change Model,”  Addiction Info (web site),  http://www.addictioninfo.org/articles/11/1/Stages-of-Change-Model/Page1.html , accessed 8/1/10. [↩]
5. Sedwick, Jacqueline, LCDCi, interview by author, Dallas, July 25, 2010. [↩]

©2010 Fuller Youth Institute