Dr. Carlo DiClemente is professor of psychology and director of The Habits Lab at the University of Maryland-Baltimore County. He has written and co-authored several books, as well as numerous articles and book chapters about the stages of change. Dr. DiClemente was awarded a Presidential Citation in recognition of his scientific and clinical contributions to understanding motivation and behavior change and developing an integrative transtheoretical model that has advanced the treatment and prevention of addictive and health behaviors.
Stages and Tasks of Recovery
Many clinicians use the stages of change to make concrete motivational steps involved in cessation or modification of an addictive behavior. Sometimes they are used as ways to label people (Precontemplator, Contemplator). Although we have used these terms in some of our writings, I want to share my most recent thoughts about using the stages.
Stages are not boxes to put people into or labels that denote a trait of the individual. They are dynamic categories, and most importantly represent a series of tasks that one needs to accomplish to move forward through the process of change. As such, they represent states and not traits so we should use terms like an individual in Precontemplation or Contemplation rather than Precontemplator or Contemplator to reflect the transitory nature of the stage status. If you watch a skilled clinician use motivational approaches in a brief intervention, you can often see an individual move from precontemplation to contemplation in a 15 to 20-minute interview. So movement through the stages is variable. For some it does seems like a permanent state (trying to get some smokers with mental health issues to consider quitting), for others a brief intervention can promote engagement in the critical tasks that help them move forward (make a commitment and setting a date for a quit attempt).
The point is to be mindful of current stage status but to make sure that you are also aware of shifts in motivation and accomplishment of the key tasks. Someone in Precontemplation showing interest in and concern about the need for change has moved forward to Contemplation. Once someone has made a decision to change based on their view of the costs and benefits, they move to the next tasks of committing and planning of the Preparation stage. Some can move quickly through these tasks but the key is not the speed but the adequacy of their accomplishment of the tasks. Tasks poorly done (weak decision or commitment, flawed plan, minimal concern) cannot support successful movement through the stages. Weak commitment, inadequate implementation intentions and plans have been associated with less success. Tracking how which tasks need to be done and how well they are done is an important way to use the stages to tailor treatment and track progress.