¶ Intro / Opening
Well , hello there . Welcome to our first Grill and Drill
¶ Introduction to Trans-Theoretical Model
podcast , where we're going to review today the trans-theoretical model Now , if you've been following the podcast , you may have listened to the one from November way back in 2023 , on the theory to therapy , which we dealt with , the trans-theoretical model , or also called the stages of change model . So we've been doing it that long , possibly even longer .
It's hard to tell , but the TTM , or the trans-theoretical model , is a framework that was developed by James Prochaska and Carlo De Clementi that conceptualizes behavior change as a process that occurs through a series of distinct stages , rather than just one event where you have a bad habit and you stop . They recognized that there was a process to it .
Hey , do you have any idea how they figured that out , eric ? I bet one of them had an addiction they were trying to get rid of .
Yeah , well , that's close . But they received a grant to study how clients become non-smokers and in the process they came out and developed this idea and they called it trans-theoretical model .
Huh , so we can be assured that it wasn't funded by Philip Morris , really . Well , yes , but it does distinguish itself from other approaches because it recognizes that behavior change involves progressing through a bunch of stages , each one characterized by different attitudes , intentions and behaviors , and it acknowledges that relapse is a common
¶ Four Key Constructs of TTM
occurrence that clients are often cycling through multiple times before they get to the lasting change which anybody that's worked in addictions can tell you . That's how that works , really . So there are four key constructs of it the stages of change , the process of change , the decisional balance of how you decide and the concept of self-efficacy .
So basically what I hear you saying , Eric , is that it's just a bunch of different theories that have been thrown together .
Well , yes , it is , but it was written in an academic way and , remember , if it's academic and it's research , then that's legitimate , and it draws from a bunch of different theories . That's why it's trans-theoretical .
So there are cognitive parts to it , there are behavioral parts to it , so there are all of these , and it ends up being a non-linear kind of thing because , like I said , it goes in a circle .
People will , you know , start doing it , relapse , go back , and so it's something that takes that into account and isn't surprised by the fact that people fail to make lasting decisions the first time .
Okay . So of those four key constructs , let's start with the stages of change . In fact , probably if you run into anything on the trans-theoretical model on your licensing exam , it'll be around the stages of change . So the stages of change are the core , basic construct of TTM and what it does . It describes the temporal
¶ The Six Stages of Change
progression clients go through during their modification of their behavior , right ? So the first part of the stages of change is called pre-contemplation . So during pre-contemplations , clients are not considering change , they're unaware that they have any kind of problematic behavior . They don't want to make any kind of changes , at least for at least six months .
They don't think there's a problem to address . Like I said , they have really limited insight on how their behavior is linked to the negative consequences that are happening in their lives . They may have tried to modify their behaviors , but they've been unsuccessful in the past and basically they become discouraged .
So the concept of the pre-contemplation stage is that they're just not ready and that leads to when they finally are ready .
That's the contemplation stage . So pre-contemplation before they start contemplation is where they actually start looking at the pros and cons . They still feel ambivalent , but they're getting their mind around the fact that whatever the people around them think is problematic , they're finally beginning to see it as problematic as well , but they're still flip-flopping .
So that's why it might last a while in the contemplation stage and the overall concept then is getting ready .
Right . Then they go into the preparation or planning stage . This is when the client is intended to take action soon and they're thinking of maybe having small steps that will help them do that . So they will get a piece of paper .
They've written down the pros , they've written down the cons and they've decided that the scales have tipped in the side of pro , that they do need to make changes . So they have intention to make some kind of changes within the first month or so . Basically , the preparation stage is that they are ready . They're ready to make those changes .
And then , after you've , you know , done that , now you're in the action phase . You're starting to actually do what it takes to modify your behavior , and some changes are occurring Now . Whether they're lasting or not , that's something else , but you're making the actual steps to change , you know . Whatever the techniques are , however , you modify habits .
All of that changes depending on what you're trying to change , but the overall concept is you're doing it .
And then after that they go into the maintenance stage . And in the maintenance stage they've been able to change their behaviors for half a year or so and they are still focusing on relapse prevention . So they're still working on consolidating any gains that they've made and their new behaviors have become habitual . They use fewer change processes .
So they're sort of in a place where if they went out clubbing , they're not going to pick up a cigarette or they're not going to start drinking at that particular point . They're sort of good to go , so they're continuing to go . So they keep going on with the changes that they've made during the maintenance .
And finally the Arnold Schwarzenegger phase , the terminator phase , the termination phase , and you have complete confidence that you have made the changes . You don't need to bother with behavioral aspects of it anymore . You used to smoke and now you never have . It's been quite a while and you don't even think of it anymore .
So you actually are ready to stop going to therapy , stop working a process , whatever it was you were doing you thought you had to . You don't need to anymore . So the overall concept is no problem .
Okay . So when that happens and you see that your client is able to do that maybe it took five years , I don't know but when they do come to that stage , then it's time for you to do what .
It's time for you to have a party . No , it's time for you to terminate the client . Oh yes yes , it's when you , as a therapist , would terminate the client . That's right .
Eric , how are you going to remember all this information ? I mean , you know you're already studying for the exam , you've got all kinds of different things , so how am I going to remember the stages of change ?
Well , that's the tough part , isn't ? It Is remembering all of this stuff . Okay .
Let me help you out here . Do you remember angel deaths from the 60s ?
Sherm love .
Boat .
O's Hogg , it sounds like you're talking about how marijuana used to be called Mary Jane , or Marajacuna , or the Devil's Lettuce .
This is how you're going to remember the stages of change . Very easy , just remember PCP , amt . Pcp was a drug also known as angel dust . Yes , okay , pcp . Amount pcp it was okay , so okay . So p would stand for the pre-contemplation right , yeah , c was the contemplation .
So pre-contemplation contemplation okay , that that makes sense and p for preparation . So okay , preparation yes amount amt a action , action , right , and then maintaining , keep it going right , maintaining , and then finally , uh t termination , termination . Okay T Termination .
Termination Okay , termination . Don't look at it and tell me what the stages are . So PCPAMT .
So pre-contemplation , right Contemplation , preparation , right Action , maintenance and termination , termination . Okay , I almost got it , okay that's good .
So that's the first part of the trans-theoretical model and that's what you need to remember for the exam .
¶ Remembering Stages with PCP AMT
I think I'm going to give you some examples and you're going to tell me what stages they are in . Are you ready , right ? So you have a client that comes in and says I don't see why I need to reduce my salt and fat consumption . I've been fine without doing that for years , and if I do when I go out to a restaurant I won't be able to eat anything .
Okay , so that sounds like they haven't even fathomed the idea that they need to change , which sounds like pre-contemplation . Okay , all right .
You got that All right ? How about if they said I've decided to only drink celery juice for ?
breakfast and just today I told my family to get ready . Oh , okay , I've decided to make , so they've gone . They've already contemplated it , right ? So they're in the preparation phase . They've decided to do it , but they haven't preparation phase .
They've decided to do it but they haven't done it . Exactly . They're planning the preparation . Okay , right , what if your client said you know I should start eating healthier , but I really still enjoy , like you do , mcdonald's and I'm not really ready to give up my Big Mac and fries . Just yet Big Mac . Stop making yet Big Mac .
Stop making me hungry man , so all right . So the pre-contemplation was I don't need to be ready . The planning was get ready , I'm doing it . So this must be the contemplation stage . And why is that ? Because they're thinking about it , I know I should do it and I've put it in the should do category as opposed to the why are you bothering me category .
But I haven't started planning yet . Okay , All right .
Is that it ? Yeah , that's it , okay . Okay , how about this ? Your client tells you that they've been buying their food from Whole Foods and they'd rather do that than go the smoky bones , and they've been doing it for the past two months .
They know it's challenging , but they're starting to see some results so a big plate of kale instead of some nice juicy ribs ? Hey , so
¶ Client Examples for Each Stage
okay , doesn't sound like they've gone into the maintenance stage yet ? No , so it sounds like they're gone into the maintenance stage yet . No , so it sounds like they're actually doing it , they're doing something . They're going to Whole Foods , not going to Smokey Bones . So it's action , right , yeah , it is action . Yeah , yeah , okay .
All right . How about if they say I've been a vegetarian for eight months now and I've developed new coping strategies , like eating celery sticks when I crave a blooming onion or a juicy steak from Outback ?
Hmm , so I've been doing it for eight months , so not long enough to really make it a total lifestyle change , but they've set themselves up for success , right yeah . So it doesn't sound like they're ready to terminate yet , but they've been in the action stage for long enough that it's become a new habit . So I'd say maintenance .
So if you found yourself in Outback , where would you go ?
Big juicy steak in front of you and you'd say give me that plate of kale over there . I want some big juicy celery stick , while my friend eats the bloomin' onion and the sirloin steak . Okay , all right , good on you .
All right . So lastly , to your chagrin , your client tells you I've been a vegetarian for the last five years . Even when I'm stressed , the thought of eating meat doesn't ever cross my mind .
Right , well , that sounds like five years . Yeah , they've been your client for five years . All right , it sounds like it was time for termination about four years ago .
Really , okay , okay , yes , I've got to say that sounds like termination time , because if they just don't even think about meat anymore and they , you know , just love being a vegetarian then it sounds like they're ready to terminate the process . Uh-huh , you know that could happen to you , as that's not out of the realm of possibility .
Certainly , absolutely okay , I had some celery just last month I just had some celery this morning you . You're on your way , man , there you go Okay .
so those are the kind of scenarios that you might find and they may ask you where you are in the stages of change . So again , remember , that is PCP amount .
So pre contemplation preparation , wait , wait , pcp . Yeah , p is pre , okay , contemplation . Uh-huh , I didn't say contemplation , okay , all right , you didn't have to say it twice . So pre-contemplation contemplation , right . Preparation , uh-huh . Action m maintenance and termination . Okay , you got , you got it .
Now we're going to go and give you some questions . I think I'm ready Shoot . What is the primary reasons clients remain in the pre-contemplation stage ? All
¶ Practice Questions for Exam Preparation
right , pre-contemplation stage . Lack of motivation , high levels of stress , okay . Lack of awareness about their problems . All right , or success , past experience .
So why would I stay in the pre ? Why would I stay ignorant of the fact that I have a problem ? Right , I'm going to say that I'm so stressed I can't deal with it . B .
Close , but no cigar . Oh man , Okay , it's their lack of awareness about their problem . Oh , all right , yes , right , so clients in the pre-contemplation stage are unaware of their problems , which keeps them from even considering change . Their lack of awareness is significant and it's a barrier to moving forward to the change process . All right .
One down , all right , try a second one . All right . One down , all right , try a second one .
How do clients in the contemplation stage typically feel about changing their behavior ?
Okay , so we're in the contemplation stage now , and how do they feel about whether they need to change ? Okay .
Okay . Are they confident and motivated ? Ambivalent and conflicted ? Okay , unaware and unmotivated . Or successful and satisfied All right .
So how do they feel about changing their behavior ? Well , if they were successful , they wouldn't be in the contemplation stage . So D is out . And if they were confident and motivated they wouldn't be in the contemplation stage . They'd already be acting on it . So A is out , unaware and unmotivated . See now , that sounds like pre-contemplation to me .
It is Unaware and unmotivated , so I'm going to go with B ambivalent and conflicted , right .
So when clients are in this stage of the contemplation , they often experience ambivalence . Stage of the contemplation , they often experience ambivalence . They're weighing the pros and cons of changing their behavior , but you know they're still in that whole process . Okay , all right . How does the preparation stage differ from contemplation stage ?
It involves taking immediate action . It involves weighing pros and cons . It involves planning and intention to act soon or it involves ignoring the problem .
So taking immediate action sounds like the action phase , right , so I'm going to rule that one out . Involves weighing the pros and cons . That sounds like the difference between preparation and action to me . That you're weighing the pros and cons , deciding so , instead of contemplation to act , you know , to preparation . That sounds like preparation to action to me .
All right , oh , I'm gonna get rid of b . And then involves planning an intention to act soon . Or involves ignoring the problem . Well , ignoring the problem sounds like pre-contemplation . You don't have a problem , what are you bothering me for ? So I'm going to go with C on that . Okay , exactly .
How can you support clients in the maintenance stage ? Could you support them by ignoring their efforts ?
Yes , providing ongoing support and resources Forcing them to maintain their choices , or by discouraging their action Okay , so ignore their efforts would be to just say you've been doing it okay , and I don't even need to bother because you're on autopilot or providing ongoing support and resources . You're doing it , so keep doing it .
Forcing them doesn't sound like therapy . That sounds like what my mother used to do , right . So I'm going to say no to C and then discouraging their actions . That doesn't sound right either . So it's either A or B . A or B , a or B . I'm going to say A You're letting them go . They've done it . They're obviously doing something , right ?
So no , no , the answer is providing ongoing support and resources . Ok , that's how you as a therapist can assist by offering ongoing support and resources to help them maintain their new behaviors .
resources to help them maintain their new behaviors .
So really at this stage in maintenance support is critical for preventing relapse .
Okay , okay , yes , that does sound more therapist-y .
So , okay , how might a therapist approach someone in the pre-contemplation stage ? Here are your options Immediately encourage them to take some action , discussing the risk associated with their current behavior , ignoring their current behavior or by forcing them to change . Okay , let's get rid of D , that sounds more like your mom which sometimes it worked .
So I gotta give her props on that . But uh , that doesn't sound like a therapisty thing . So d is out , okay , and ignoring doesn't sound like that's going to work either , because if it's really , you know , if we're putting it conceptually in the model , then somebody's not ignoring it . You know you've been smoking for 10 years that that's a problem .
You need to deal with it . So I'm going to say discussing the risks B , that's right .
What is a common challenge faced by clients in the action stage ? Lack of awareness about their problems .
No , because they're in the action stage , so they're aware that they have a problem . So A is out . High levels of stress Well , they would have high levels of stress . Yes , although common challenge , I've got to think that not everybody's going to have a high level of stress , okay , so I'm going to put that one off to the side .
I've got to hear the rest before I know whether that's okay successful past experiences well , that's not a challenge , so that one's out . Okay , if you've been , if everything's worked , you're not challenged at all . So that wouldn't be a common challenge , okay .
So obviously the the last one is maintaining motivation and overcoming obstacles .
Yes , that's it .
Want another one . Yep , keep going . What is a common challenge faced by clients in the contemplation stage ? Common challenge , okay .
Lack of resources All right . Lack of resources right .
Balancing the pros and cons of changing . High motivation , successful past experiences , yeah , no .
So yeah , it's B . It's got to be B because they're weighing the pros and cons right . If they had all the success in the past , they don't need to contemplate , and if they didn't have any resources , then they're probably not contemplating either . So yeah , I go with be there .
What is a common misconception about clients in the pre-contemplation stage ? They are highly motivated to not change . They're aware of their problems , but choose not to change . They are unaware of their problems all right , or they have successfully changed their behavior they're unaware of their problem .
All right , okay , you get it that's . Yeah , I think that's . It is that they . The misconception would be that they're unaware , when they probably are aware , but they just don't want to admit it , right ?
Well , this has been interesting , as All right , yes .
And I got to say , dr Hutchinson , that it's not as complicated . You know , once you have those six down , they sort of sell themselves .
Once you , you know , see how that breaks down , right , not that it's easy if you're actually working it , but from once you , you know , see how that breaks down , right , not that it's easy if you're actually working it , but from the outside you could see how they , you know how actions could fall into each of those categories .
Exactly , part of the key is to remember the six stages , right PCP , amount , pcp , amt , very good , and remember it's in there , it's in there . Thanks .