The Stages of Change Model (SCM) was originally developed in the late 1970’s and early 1980’s by James Prochaska and Carlo DiClemente at the University of Rhode Island.
Addiction: The negative end state of a syndrome (of neurobiological and psychosocial causes) resulting in continued or increasing repetitive involvement despite consequences and conscious efforts to discontinue the behavior. Addiction to any particular substance or behavior is seen mainly as a matter of personal vulnerability, exposure and access, and the capacity to produce a desirable shift in mental state.
This definition was originally formulated by Howard J. Shaffer, Ph.D., C.A.S.Harvard Medical School, Division on Addictions.
The SCM model has been applied to a broad range of behaviors including weight loss, injury prevention, overcoming alcohol, and drug problems among others.
The idea behind the SCM is that behavior change does not happen in one step. Rather, people tend to progress through different stages on their way to successful change. Also, each of us progresses through the stages at our own rate.
So expecting behavior change by simply telling someone, for example, who is still in the “pre-contemplation” stage that he or she must go to a certain number of AA meetings in a certain time period is rather naive (and perhaps counterproductive) because they are not ready to change.
Each person must decide for himself or herself when a stage is completed and when it is time to move on to the next stage. Moreover, this decision must come from you; stable, long term change cannot be externally imposed.
In each of the stages, a person has to grapple with a different set of issues and tasks that relate to changing behavior.
The Stages of Change
The stages of change are:
- Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
- Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
- Preparation/Determination (Getting ready to change)
- Action/Willpower (Changing behavior)
- Maintenance (Maintaining the behavior change) and
- Relapse (Returning to older behaviors and abandoning the new changes)
Stage One: Precontemplation
In the precontemplation stage, people are not thinking seriously about changing and are not interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do not feel it is a problem. They may be defensive in the face of other people’s efforts to pressure them to quit.
Stage Two: Contemplation
In the contemplation stage people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it.
In this stage, people are on a teeter-totter, weighing the pros and cons of quitting or modifying their behavior. Although they think about the negative aspects of their bad habit and the positives associated with giving it up (or reducing), they may doubt that the long-term benefits associated with quitting will outweigh the short-term costs.
It might take as little as a couple weeks or as long as a lifetime to get through the contemplation stage. (In fact, some people think and think and think about giving up their bad habit and may die never having gotten beyond this stage)
On the plus side, people are more open to receiving information about their bad habit, and more likely to actually use interventions and reflect on their own feelings and thoughts concerning their bad habit.
Stage Three: Preparation/Determination
In the preparation/determination stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this – this is serious. Something has to change. What can I do?”
This is sort of a research phase: people are now taking small steps toward cessation. They are trying to gather information (sometimes by reading things like this) about what they will need to do to change their behavior.
Or they will call a lot of clinics, trying to find out what strategies and resources are available to help them in their attempt. Too often, people skip this stage: they try to move directly from contemplation into action 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.
Stage Four: Action/Willpower
This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques.
This is the shortest of all the stages. The amount of time people spend in action varies. It generally lasts about 6 months, but it can literally be as short as one hour! This is a stage when people most depend on their own willpower. They are making overt efforts to quit or change the behavior and are at greatest risk for relapse.
Mentally, they review their commitment to themselves and develop plans to deal with both personal and external pressures that may lead to slips. They may use short-term rewards to sustain their motivation, and analyze their behavior change efforts in a way that enhances their self-confidence. People in this stage also tend to be open to receiving help and are also likely to seek support from others (a very important element).
Hopefully, people will then move to:
Stage Five: Maintenance
Maintenance involves being able to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo. People in this stage tend to remind themselves of how much progress they have made.
People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. They are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance.
They remain aware that what they are striving for is personally worthwhile and meaningful. They are patient with themselves and recognize that it often takes a while to let go of old behavior patterns and practice new ones until they are second nature to them. Even though they may have thoughts of returning to their old bad habits, they resist the temptation and stay on track.
As you progress through your own stages of change, it can be helpful to re-evaluate your progress in moving up and down through these stages.
(Even in the course of one day, you may go through several different stages of change).
And remember: it is normal and natural to regress, to attain one stage only to fall back to a previous stage. This is just a normal part of making changes in your behavior.
Along the way to permanent cessation or stable reduction of a bad habit, most people experience relapse. In fact, it is much more common to have at least one relapse than not. Relapse is often accompanied by feelings of discouragement and seeing oneself as a failure.
While relapse can be discouraging, the majority of people who successfully quit do not follow a straight path to a life time free of self-destructive bad habits. Rather, they cycle through the five stages several times before achieving a stable life style change. Consequently, the Stages of Change Model considers relapse to be normal.
There is a real risk that people who relapse will experience an immediate sense of failure that can seriously undermine their self-confidence. The important thing is that if they do slip and say, have a cigarette or a drink, they shouldn’t see themselves as having failed.
Rather, they should analyze how the slip happened and use it as an opportunity to learn how to cope differently. In fact, relapses can be important opportunities for learning and becoming stronger.
Relapsing is like falling off a horse – the best thing you can do is get right back on again. However, if you do “fall off the horse” and relapse, it is important that you do not fall back to the precontemplation or contemplation stages. Rather, restart the process again at preparation, action or even the maintenance stages.
People who have relapsed may need to learn to anticipate high-risk situations (such as being with their family) more effectively, control environmental cues that tempt them to engage in their bad habits (such as being around drinking buddies), and learn how to handle unexpected episodes of stress without returning to the bad habit. This gives them a stronger sense of self control and the ability to get back on track.
Eventually, if you “maintain maintenance” long enough, you will reach a point where you will be able to work with your emotions and understand your own behavior and view it in a new light. In this stage, not only is your bad habit no longer an integral part of your life but to return to it would seem atypical, abnormal, even weird to you.
When you reach this point in your process of change, you will know that you have transcended the old bad habits and that you are truly becoming a new “you”, who no longer needs the old behaviors to sustain yourself.
From BMJ Open:
Objectives The arts therapies include music therapy, dance movement therapy, art therapy and dramatherapy. Preferences for art forms may play an important role in engagement with treatment. This survey was an initial exploration of who is interested in group arts therapies, what they would choose and why.
Conclusions Large proportions of the participants expressed an interest in group arts therapies. This may justify the wide provision of arts therapies and the offer of more than one modality to interested patients. It also highlights key considerations for assessment of preferences in the arts therapies as part of shared decision-making.
According to the American Dance Therapy Association (ADTA): Based on the understanding that the body and mind are interrelated, dance/movement therapy (D/MT) is defined as the psychotherapeutic use of movement to further the emotional, cognitive, physical, and social integration of the individual. Dance/movement therapy is practiced in mental health, rehabilitation, medical, educational, and forensic settings, and in nursing homes, day care centers, disease prevention, and health promotion programs. The dance/movement therapist focuses on movement behavior as it emerges in the therapeutic relationship. Expressive, communicative, and adaptive behaviors are all considered for both group and individual treatment. Body movement as the core component of dance simultaneously provides the means of assessment and the mode of intervention for dance/movement therapy.
I often define D/MT to clients as psychotherapy that is not limited to talking but encompasses the full range of human expression, including movement such as gestures and or postures, drawing, writing, drama, music and other expressions that can have a therapeutic benefit for the client(s).
Dance Movement Therapy is a creative arts therapy rooted in the expressive nature of dance. Since dance/movement comes from the body it is considered the most fundamental of the arts and is a direct expression (and experience) of the self. Dance/movement is a basic form of authentic communication, and as such it is an especially effective medium for therapy.
Dance/movement therapists (R-DMT or BC-DMT) work with individuals of all ages, groups and families in a wide variety of settings. They focus on helping their clients improve self-esteem and body image, develop effective communication skills and relationships, expand their movement vocabulary, gain insight into patterns of behavior, as well as create new options for coping with problems. Movement is the primary medium DMT’s use for observation, assessment, research, therapeutic interaction, and interventions.
DMT’s work in settings that include psychiatric and rehabilitation facilities, schools, nursing homes, drug treatment centers, counseling centers, medical facilities, crisis centers, and wellness and alternative health care centers.
I often work with groups using lists. In movement therapy as well as psychotherapy, educational and process oriented groups lists are a great structure for groups to explore thoughts, and/or feelings. Here is a list that often comes up in groups ten suggestions about feelings.
1. Become emotionally literate. Label your feelings, rather than labeling people or situations.
Use three word sentences beginning with “I feel”.
Start labeling feelings; stop labeling people & situations
“I feel impatient.” vs “This is ridiculous.” I feel hurt and bitter”. vs. “You are an insensitive jerk.”
“I feel afraid.” vs. “You are driving like an idiot.”
2. Distinguish between thoughts and feelings.
Thoughts: I feel like…& I feel as if…. & I feel that
Feelings: I feel: (feeling word)
3. Take more responsibility for your feelings.
“I feel jealous.” vs. “You are making me jealous.”
Analyze your own feelings rather than the action or motives of other people. Let your feelings help you identify your unmet emotional needs.
4. Use your feelings to help make decisions
“How will I feel if I do this?” “How will I feel if I don’t?”
“How do I feel?” “What would help me feel better?”
Ask others “How do you feel?” and “What would help you feel better?”
5. Use feelings to set and achieve goals
– Set feeling goals. Think about how you want to feel or how you want others to feel. (your employees, your clients, your students, your children, your partner)
– Get feedback and track progress towards the feeling goals by periodically measuring feelings from 0-10. For example, ask clients, students, teenagers how much they feel respected from 0 to 10.
6. Feel energized, not angry.
Use what others call “anger” to help feel energized to take productive action.
7. Validate other people’s feelings.
Show empathy, understanding, and acceptance of other people’s feelings.
8. Use feelings to help show respect for others.
How will you feel if I do this? How will you feel if I don’t? Then listen and take their feelings into consideration.
9. Don’t advise, command, control, criticize, judge or lecture to others.
Instead, try to just listen with empathy and non-judgment.
10. Avoid people who invalidate you.
While this is not always possible, at least try to spend less time with them, or try not to let them have psychological power over you.
Here is an interesting article from the NYT about the brain and art from a professor of brain science at Columbia University.:
…… The portraiture that flourished in Vienna at the turn of the 20th century is a good place to start. Not only does this modernist school hold a prominent place in the history of art, it consists of just three major artists — Gustav Klimt, Oskar Kokoschka and Egon Schiele — which makes it easier to study in depth.
As a group, these artists sought to depict the unconscious, instinctual strivings of the people in their portraits, but each painter developed a distinctive way of using facial expressions and hand and body gestures to communicate those mental processes.
Their efforts to get at the truth beneath the appearance of an individual both paralleled and were influenced by similar efforts at the time in the fields of biology and psychoanalysis. Thus the portraits of the modernists in the period known as “Vienna 1900” offer a great example of how artistic, psychological and scientific insights can enrich one another.
The idea that truth lies beneath the surface derives from Carl von Rokitansky, a gifted pathologist who was dean of the Vienna School of Medicine in the middle of the 19th century. Baron von Rokitansky compared what his clinician colleague Josef Skoda heard and saw at the bedsides of his patients with autopsy findings after their deaths. This systematic correlation of clinical and pathological findings taught them that only by going deep below the skin could they understand the nature of illness.
I’ve read many a book and chatted with art therapists about the psychological process involved in art and art making and this article comes from a different perspective; brain science.