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Motivation for Change Continued

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Prochaska and DiClemente initially developed this model to describe the process of adopting any healthy behavior. However, it is particularly useful in addictions treatment. Ordinarily, most psychological, behavioral, emotional, or relationship difficulties cause people to experience acute distress. This distress is sufficiently motivating and they are ready to change. They typically enter treatment at Stage 3 Preparation, or Stage 4 Action. For example, consider the person with depression. They clearly do not get any enjoyment or benefit from being depressed. By the time they seek treatment, they are usually ready and motivated to make needed changes so that they can feel better. They are not ambivalent about whether or not they want to remain depressed.

In contrast, many people enter addiction treatment against their will. Sometimes this is in response to a court order. Other times it may be their partner has threatened to leave. Or, perhaps they are about to lose their job. In other words, their external environment is motivating them to change. However, they are not completely certain they want to change. They are ambivalent. Unlike our example of a depressed person, the addiction still has some appeal.

This ambivalence is one of the key differences between addictive disorders and other types of mental health concerns. Unlike most other types of mental disorders, people with addictive disorders often enter treatment at Stage 1 Pre-contemplation, or Stage 2 Contemplation. Therefore, their treatment does not begin by helping them to make changes as it might for a depressed person. Instead, treatment focuses on strengthening the motivation for change. This requires a specific therapeutic strategy. Motivational Interviewing LINK is one such strategy.

Therapists often serve as "change agents." For this reason, the Stages of Change Model has been particularly useful for therapists. Prior to the development of this model, many therapists discharged patients seeking addiction treatment because they "lacked motivation." Therapists considered these patients untreatable due to this apparent lack of motivation. We now know that therapists working with addictive disorders may be required to help someone to strengthen their motivation for change. Furthermore, the Stages of Change Model helps clinicians identify which therapeutic strategies would be best suited for a particular therapy participant, at a particular point in time. For instance, motivational interviewing is most suitable for people in the pre-contemplation and contemplation stage of change . On the other hand, relapse prevention is a strategy that is most suitable for people in either the action or maintenance stage of change. Contingency management, cognitive-behavioral therapy, dialectical behavior therapy, and acceptance and commitment therapy are treatment approaches that are most suitable to an action stage. As therapy participants move through the various stages of change, therapists adjust their therapeutic approach to match the participant's changing motivation.