1. Employing the Transtheorectical Model to Transform Behavior: A Tool Box for Change Agents

2. Objectives Understand the usefulness of the stages of change as a change agent. Understand the usefulness of the stages of change as a change agent. Understanding the process of change involved for each stage of change. Understanding the process of change involved for each stage of change. Practical applications or techniques of the processes involved in the stages of change. Practical applications or techniques of the processes involved in the stages of change.

3. Stages of Change Theory of how change takes place Asserts that for change to occur people will go through defined stages and that these stages are common to everyone. This theory purports to underlie all other psychological theories in explaining how people change. It is not a developmental or psychological theory. It is how change takes place in people once our personalities are formed.

4. Brief Review of the Five Stages Stage 1: Pre-contemplation: Acknowledging the Problem Stage 1: Pre-contemplation: Acknowledging the Problem Stage II: Contemplation Resolving Ambivalence; the desire to change vs. the desire to stay the same. Stage II: Contemplation Resolving Ambivalence; the desire to change vs. the desire to stay the same. Stage III: Preparing to Change; Strengthening the will Stage III: Preparing to Change; Strengthening the will Stage IV: Action Stage of Change; Making It Happen Stage IV: Action Stage of Change; Making It Happen Stage V: Maintenance; Maintaining vigilence Stage V: Maintenance; Maintaining vigilence

5. Stage I: Pre-Contemplation Acknowledging problem Active resistance Active resistance Given up Given up Demoralized Demoralized Avoidance Avoidance Denial Denial Lack information Lack information Hopeless Hopeless Fated Fated Responsibility out of their control Responsibility out of their control

7. Attitudes Mind your own Business Avoidance of learning Avoid taking responsibility Paradox: How do you help people to change who do not intend to change?

8. To the Pre-contemplator Change does not = action Change does not = action Nagging = or creates anger Nagging = or creates anger Apathy or giving up = approval Apathy or giving up = approval Minimizing or softening the damage of behavior = enabling Minimizing or softening the damage of behavior = enabling

9. Major Processes at Work: Consciousness Raising Raises the level of awareness Raises the level of awareness Gain insight into thoughts and feelings Gain insight into thoughts and feelings Develop a real conviction around the value Develop a real conviction around the value of change Increases information Increases information

10. Consciousness Raising Techniques Ask Powerful Questions Questions that raise clients awareness Questions that raise clients awareness Questions that gauge clients emotional Questions that gauge clients emotionalreactions Gauge your clients perception of their loved ones reaction Gauge your clients perception of their loved ones reaction

11. Consciousness Raising Techniques Educate on Defenses Denial and minimization Denial and minimization Rationalization Rationalization Projection and displacement Projection and displacement Internalization Internalization

12. Stage II: Contemplation: Resolving Ambivalence The desire to change vs. the desire to stay the same. Substitute thinking for action Substitute thinking for action Someday Promise: suspension of conflict Someday Promise: suspension of conflict Educate themselves on the subject Educate themselves on the subject Need a greater understanding Need a greater understanding Remaining unaware of ones ambivalence can keep one can trapped in this stage for a long time.

13. Resolving Ambivalence Essential Contemplation Traps: Delay tactics Search for absolute certainty Search for absolute certainty Waiting for the Magic Moment Waiting for the Magic Moment Wishful thinking Wishful thinking Pre-mature action Pre-mature action

14. Major Processes at Work: Emotional Arousal Drama regarding the negative troubling consequences of ones behavior Increases awareness Increases awareness Increases depth of feeling Increases depth of feeling Moves towards action Moves towards action Films Films Psychodrama Psychodrama Other fear-arousing methods Other fear-arousing methods

15. Process: Emotional Arousal Ask Powerful Questions That address advantages and disadvantages of change That address optimism and pessimism about change That address intention or lack of intention to change

16. Emotional Arousal Techniques Movies Movies Websites Websites Propaganda Propaganda Contracts Contracts Continue with consciousness raising by asking the right questions in search of the right answers.

17. Process: Self Re-evaluation Taking stock Taking stock Reveals essential values are in conflict Reveals essential values are in conflict Feeling, thinking, and believing Life would be improved Feeling, thinking, and believing Life would be improved Requires the contemplator to abandon all hope that change is effortless Requires the contemplator to abandon all hope that change is effortless

18. Process: Self Re-evaluation Ask Powerful Questions that address: How can one feel good about themselves How can one feel good about themselves while continuing the behavior: essential values How they would feel if the did not have the How they would feel if the did not have the behavior: lines up with values & positive feelings Cost of change: giving up the belief that change is easy Cost of change: giving up the belief that change is easy

19. Re-evaluation techniques Think before you act Think before you act Create a new self image Create a new self image Make a decision: evaluate the pros and cons Make a decision: evaluate the pros and cons Solicit Input Solicit Input

20. End of Contemplation Ambivalence that undermines determination has been resolved. Change is necessary, Change is not effortless. Ready to start making plans to change Dangers: contemplation traps or premature action

21. Stage III: Preparation Hopeful Vision of themselves Stronger commitment develops Stronger commitment develops Feel more confident Feel more confident Small steps toward action Small steps toward action Focus is on the future Focus is on the future Focus is on the positive aspects of change Focus is on the positive aspects of change Focus is on alternatives Focus is on alternatives

22. Process: Commitment Strengthening and encouraging the will Strengthening and encouraging the will Pledge to yourself Pledge to yourself Pledge to behavior change Pledge to behavior change Pledge to just and reasonable cause: life instead of death Pledge to just and reasonable cause: life instead of death

23. Process: Commitment Ask Powerful Questions that address: Anxiety Anxiety Obstacles Obstacles Options Options Resources Resources

24. Ask Powerful Questions What have you heard others say about what has worked for them? What have you heard others say about what has worked for them? What have you considered doing? What have you considered doing? What have you tried in the past? What have you tried in the past? What worked? What worked? What are your options? What are your options? What your life will be like when you change your behavior? What your life will be like when you change your behavior? How will your life be enhanced? How will your life be enhanced? What will it free me up to become? List the benefits and keep it before you. What will it free me up to become? List the benefits and keep it before you.

25. Countering Anxiety Do something concrete Take small steps to reduce anxiety Take small steps to reduce anxiety Set a date Set a date Have courage and go public Have courage and go public Prepare for major surgery Prepare for major surgery Create a plan of action that your client buys into Create a plan of action that your client buys into

26. Plan of Action Setting Goals Set concrete goals Set concrete goals Make goals realistic Make goals realistic State them positively State them positively Make them measurable Make them measurable Create the specific steps you will take to reach those goals.

27. Now that they have created a detailed, specific, realistic and concrete plan of action, it is time to move into the fourth stage of change, action.

28. Stage IV Action: Making It Happen This is where one pulls it all together. This is where the all the work of going through the stages starts to pay off in action and in results. Theoretically this is where one follows through and takes action. They involve others for support and accountability, they engage in change and move forward.

29. Stage IV Action: Making It Happen Pitfalls Poor preparation Cheap change No simple solutions Same ole, same ole

30. Ask Powerful Questions What could you do instead? What could you do instead? What has worked in the past? What has worked in the past? What do you think will work in the future? What do you think will work in the future? What moves you to change? What moves you to change? What were your original reasons to make a change? What were your original reasons to make a change? What would help you take action? What would help you take action? Is there some concrete reminder of where you want to be in the future? Is there some concrete reminder of where you want to be in the future? Is there some concrete reminder of where you dont want to be in the future? Is there some concrete reminder of where you dont want to be in the future?

31. Process: Countering Substituting healthy behaviors for problematic ones If you do not provide a different behavior one is likely to return to old behaviors

32. Countering Techniques Active Diversion Active Diversion Exercise Exercise Relaxation Relaxation Counter Thinking Counter Thinking Assertiveness Assertiveness

33. Process: Environment Control The process of restructuring your environment to remove as much as possible the likely occurrence of the problem behavior

34. Environment Control Techniques Avoidance Avoidance Cue exposure Cue exposure Reminders Reminders

35. Process: Reward Environment control modifies the cues that precede and trigger problem behavior; reward modifies the consequences that follow and reinforce it.

36. Reward Techniques Covert management Covert management Contracting Contracting Shaping Shaping

37. Using helpful relationships Identify your helpers Exercise together Exercise together Have a buddy Have a buddy Use your family Use your family

38. Stage V: Maintenance Keeping what you got….by far the most difficult of the stages. This is because success is measured in years and decades and lifetimes. Combating the erosion of commitment

39. Process: All of the above Dont forget Dont forget Keep your distance Keep your distance Create a new lifestyle Create a new lifestyle Be aware of your thinking Be aware of your thinking Use your support Use your support Guard against backsliding Guard against backsliding

40. Resources Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. James O. Prochaska, John Norcross, Carlo, DiClemente n. 1994. Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. James O. Prochaska, John Norcross, Carlo, DiClemente n. 1994. Miller (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Miller (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Miller & Rollnick (2002). Motivational Interviewing: Preparing People for Change. Miller & Rollnick (2002). Motivational Interviewing: Preparing People for Change. http://www.motivationalinterview.org http://www.motivationalinterview.org