In working to support tenants in changing their behavior, the stages of change can be a helpful model to offer the appropriate support to tenants. The Stage of Changes are often used with tenants who are abusing substances but are applicable to any behavior change, ranging from quitting smoking to losing weight.

The section below describes the behavior of people in each of the five stages of change — Precontemplation, Contemplation, Preparation, Action, and Maintenance—as well as actions service providers can take to support them.

Precontemplators

  • Are not seeing how their suffering is related to what they are doing; are not thinking about making a change; and may not have enough or the best information.
  • Are sometimes fearful of change or don’t want to risk discomfort that may come with change.

Service providers can:

  • Offer empathetic and accurate information, followed by compassionate advice.
  • Always join with the resistance; don’t go against it.

Contemplators

  • Are aware of wanting to change something, and are seriously thinking about it.  The “yes… but…” stage.
  • Often struggle to understand their challenge, to see its causes and to think about possible solutions.
  • Often know where they want to be and maybe even how to get there – not quite ready to make a commitment.

Service providers can:

  • Validate, respect and help tenants explore ambivalence.
  • Help the tenant “tip the balance” in favor of change – but don’t take sides.

Preparers

  • Begin to think about how to make a change or take steps toward change. This is the “uh-oh” stage.
  • Are often anxious and worried; they are really experiencing the suffering/problems.
  • May have tried and “failed” to change in the past.

Service providers can:

  • Remember that the tenant decides what they want to change.
  • Help tenants develop a realistic change plan that is acceptable, accessible and effective.

Action takers

  • Take action – modify their behavior, activities and/or environment. The “I’m on it” stage.
  • Often erroneously equate action with change – as do many service providers.
  • May still have some conflicting feelings about the change.

Service providers can:

  • Support right-sized steps.
  • Explore “how is this working?”
  • Assist with revising the original change plans as needed.
  • Focus on the process – Be sure you don’t invest in the tenant’s outcome as a measure of your own competence.

Maintainers

  • “The grind” stage.
  • Work to consolidate gains.
  • Sometimes struggle to sustain behavior and prevent relapse.
  • Continue maintenance from six months to a lifetime.

Service providers can:

  • Remember that if the tenant reaches their goal, your work isn’t over.
  • Reinforce behavior change.

Relapse

  • A natural part of the process.
  • Breaking a promise, lowering self-esteem and self-efficacy.
  • Often caused by major life changes (welcome or unwelcome).

Adapted from Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change. Applications to addictive behaviours. Am Psychol 47:1102.

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