Stages of change

You also may remember that client motivation dictates what kinds of therapeutic strategies should be used by a therapist in order to successfully match interventions with stages of change. Because it is essential to understand these client factors for successful treatment to occur, assessing these variables is a must. 

Relapse does not just suddenly happen without warning or without reason. Research into the processes of relapse has identified a rather predictable chain of events that lead up to it (see Figure 7.1). Moreover, the fact that a client slips into old behavior once does not mean all is lost. On the contrary, a slip offers a tremendous opportunity for both client and therapist or counselor to improve upon the recovery plan. A slip identifies a weakness in the recovery plan and offers an indication of how to improve it. Remembering the transtheoretical stages of change model (see Chapter 3), a relapse is viewed as part of the change cycle and as a fairly common occurrence when a person learns how to overcome a drug problem. So there is no need to panic if a relapse occurs. 

A strategy that can be used to renew commitment to the posttreatment recovery plan is called the decision matrix. The decision matrix is quite similar to a prosand-cons list used when a client or potential client is in the contemplation stage of change to enhance motivation. This strategy is particularly useful to challenge the rise of positive expectancies during a chain of events that place the client at risk for a lapse. 

DiClemente, C. C., Hughes, S. O. (1990). Stages-of-change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2, 217-235. 

Mignault, J. P., Pallonen, U. E., Velicer, W. F. (1997). Decisional balance and stage of change for adolescent drinking. Addictive Behaviors, 22, 339-351. 

Miller, W. R., Tonigan, J. S. (1996). Assessing drinkers motivations for change The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behaviors, 10, 81-89. 

Sulfur content in fuel and sulfur removal processor development are in a constant stage of change and the reader is referred to the literature to assess the latest status and techniques. 

These were issues that were predominantly mentioned in time-period 2, but not time-period 1. These are actions characterizing the second period of the study but not the first, or critical success factors relevant at the later stages of change. A frequency difference of three or more would represent predominance for a sample of this size. 

There is an abundance of questionnaires, monitoring forms, diaries, and decision matrices available for use with people in the contemplation stage of change. These instruments assist the client in recording as factually and extensively as possible the nature of the behaviour and all of its consequences. For example, the client is asked to record in exactly what circumstances does the behaviour occur when, where, with whom, what thoughts, feelings, moods are present. 

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