Assessing Readiness to Change

The Five Stages of Change were recognized and outlined in the 1980's by Prochaska and DeClemente to help people stop smoking. In the years since that time, these changes have proven to be useful in helping clients change a variety of behaviors--from drug abuse to alcoholism--and can be helpful in assessing your own clients' readiness to change eating behaviors in order to lose weight.

Here is a brief definition of the stages:
1. PRECONTEMPLATION: The client does not recognize their behavior as a problem

2. CONTEMPLATION: The client is considering the possibility of changing behavior and at the same time rejecting the idea of change

3. PREPARATION: The client is leaning toward change, seriously considering no longer engaging in present behavior

4. ACTION: The client is taking steps to no longer engage in the behavior

5. MAINTENANCE: The client is identifying and using strategies to prevent relapse and addressing other areas of life

6. This stage has been added more recently and signifies the person now has the new habits ingrained in their daily life. In the first five stages we often see relapses and the client can move back and forth easily from one stage to the other. In this last stage there is rarely a backward move.

How can these be used in your practice?
First identifying where the client is currently gives you a great starting place for the conversation. If the client is ready to start limiting their intake of high-fat foods, they may benefit from information on label-reading, or ideas on how to cook using less fat. However, if the client is in stage one or two, they will not be receptive to ideas about eating a lower fat diet. What first needs to be addressed may be the fact that they are overweight and it is harmful to their health. Perhaps they need to know that they will still be able to eat some of the foods they like before they say, "Okay, I'll give it a try".

Finding out where your client is in the readiness to change spectrum will help you realize what they need right now, and this will make you a very attractive professional to them, increasing the chances they come back for another visit.

Another way the stages of change can be helpful is to be able to show the client where they are right now and why. It may be helpful for some people to see that they are in a stage of ambivalence and that, indeed, there are reasons they do enjoy engaging in their current behavior. Just reflecting to them that you hear them say 'eating is an enjoyable activity' and confirming that this is true of most humans will help them see that you are not judging them or making them wrong. This keeps them from becoming defensive, allows them to relax and hear what you have to say, and encourages them because you understand where they are coming from.

And thirdly, the best use of the stages of change is to help your client move ahead to the next one! Later this week I'll show you how I use the stages of change when I start working with clients for weight loss. It's not just one change they are going to make, so I'll show you how I break it down to make it much less intimidating.