Think of the number of smokers you know and the number of times they have tried to quit. Think of the number of friends you know who have tried repeatedly to diet, only to gain all the weight (and more) back within a year.

Change can happen when the person is ready to change. A psychotherapist can help people identify their readiness to change and move toward the stage of taking action to make the changes occur. A major emphasis in therapy is examining why change may be difficult and understanding how to get past the roadblocks that stand in the way of change.

Research has identified six major stages in the change process, as described in Changing for Good by Prochaska, Norcross, and DiClemente (see the Recommended Reading box). A key to successful psychotherapy is knowing the stage you are in for the problem you are working on. While these are identified as “stages,” it is important to remember that it is common for a person to move back and forth between stages in terms of their needs at various times. It is not a failure when you need to go back to a previous stage – and, in fact, you may have to go backward before you can go forward again. Let’s examine the six stages –

1.) Precontemplation Stage In the precontemplation stage, while others (family, friends, medical professionals) can see there is a problem, precontemplators fail to see the problem and see no need to make changes. They may be coerced by others into seeing a therapist, and their main complaint is that they are tired of being nagged. A precontemplator might make changes under great external pressure, but they are prone to going back to their old ways again once the pressure is off. The main defense of the precontemplator is denial; they tend to blame outside factors for their problematic behavior and claim that they have no control over it. They easily become demoralized – but this is common at the precontemplation stage and can actually give the person some motivation to take charge of their lives. Precontemplators resist change. When a conversation turns to the problem, they switch topics. When a television show focuses on the problem, they change channels. In a sense, the person at the precontemplation stage feels safe. They don’t have to face failure if they don’t tackle the problem. Nor do they have to feel guilty. When they refuse to discuss the topic, other people leave them alone. The focus of therapy in the precontemplation stage is not on making immediate changes (which would have a good probability of failure), but on understanding, in a trusting setting, what the continuation of the problem-laden behavior means both for the person and for those who care about the person (friends and family). The person is encouraged to understand the idea of accepting personal responsibility for his or her behavior and to imagine what life could be like with an altered lifestyle. The goal of therapy is to help the person begin to contemplate what making changes would mean.

2.) Contemplation Stage The contemplator is tired of feeling trapped by the self-defeating behavior. People at this stage feel that they can start making changes within perhaps the next six months or so. They admit that there is a problem in their way of living and start thinking about ways to come to terms with it. They begin to try to understand the problem. They are not, however, willing, just yet, to make the commitment to change. Unfortunately, some people stay in the contemplation stage for a very long time. Like precontemplators, the contemplator may prefer the familiar, thus delaying the anxiety that accompanies change.

Contemplators are open to raising their consciousness about the problem at hand. Thus, they might ask relevant questions (such as, “What effect does being overweight have on my ability to exercise?” Or, “How does drinking the night before affect my work the next day?”). It is during this stage that people seeking change may begin to define their own goals (e.g., “I want to feel better,” or “I want to live longer”) – and not the goals that others have set for them. They begin to monitor their behavior (“I’m smoking less than a pack a day now, and that’s better than I was doing two months ago”). And they might start to examine what causes the negative behavior (“When I’m stressed at work, I want to come home and eat”). Contemplators benefit from empathic support as they begin to imagine what life will be like without engaging in self-defeating behavior. They work with their self-image and imagine what life will be like as, perhaps, a thin person or a former smoker. The goal of therapy at this point is for the person to redefine their self-image, gather information, and imagine the possibilities for a better life. They are becoming ready to prepare to make life changes.

3.) Preparation Stage Those in the preparation stage are planning to take action within the next month. They have made the commitment to change their problematic behavior in the near future. However, they may still have some ambivalence about starting the change process (which is understandable since it will mean giving up familiar behaviors, and this may entail some anxiety). They are now aware of the problem and anticipate what life will be like once the self-defeating behavior has ended. The preparation stage is valuable since starting to take action prematurely, without the increase in motivation that accompanies the preparatory stage, might short-circuit the eventual change process – it may be too soon to go cold turkey. The person needs to sit on it for a while and set a date for the change to occur. The person in preparation will make the commitment public – he or she will talk to family members and friends, or even acquaintances at work, about the forthcoming changes, and will solicit the support of these people in making the changes (“I am starting a new diet in three weeks, and I want you to help me stay on it – so please don’t tempt me with food”).

The person in preparation is making plans to take specific steps to bring about lifestyle changes. The focus is on the future and not so much now on the past, although it is still valuable in therapy to use this time to evaluate where the person has been and to anticipate how taking action steps will be incorporated into everyday living.

4.) Action Stage The action stage is the one that is most visible to other people. This is the stage where most of the change activity takes place, and it is the stage where the greatest degree of commitment is needed. This stage takes real work – but if the previous stages have been addressed adequately, then this stage has a higher probability of success.

It helps at this point to engage in healthy self-soothing behavior to replace the loss of the old self-defeating behavior (which was, in itself, probably soothing – but it was also ultimately destructive, like overeating, smoking, drinking, or gambling). Thus, it is important to get exercise (people feel great after a good workout) and to learn how to relax (this tool can be learned in therapy). A therapist will focus on helping the person stay on track and working through any difficulties that may occur in the process.

Now that the changes have been made, the main focus becomes on how to maintain the changes over time.

5.) Maintenance Stage Maintaining the changed behavior requires a long-term effort and a revised lifestyle. Making the change in the action stage is not enough – it means staying with the changes from now on. There may be a temptation to go back to the old behavior – perhaps as a way of celebrating having made the change, or even to see how it would be like to go back to, say, overeating, having a drink, or playing a videogame again.

The maintenance phase is a time to consolidate the changes and to make them part of everyday life. But it is also a period of testing one’s strength, getting in touch with the part of oneself that’s strong and cares about living a good and healthy life.

6.) Termination Stage The termination stage is the stage of victory over the old self-defeating patterns. The lifestyle change has taken hold and the old behavior will never return. The temptations have disappeared. The person can now go on living without fear that a relapse will occur. A brand new day has begun.