The Processes of Change are covert and overt activities that people use to move through the Stages of Change. They are independent variables that have been demonstrated to support change. This means that young people ‘can’ rather than ‘need’ to apply them to support their efforts to change.
Prochaska, DiClemente and Norcross (1992) identify 10 processes, five that are experiential and five that are behavioural. The efficacy of each process is likely to be maximised when tailored to a young person’s stage of change. Studies have been conducted into which change processes and styles of intervention match best with particular stages of change (Miller & Rollnick, 2002; Perz et al, 1996; Thornton et al, 1998).
The five experiential change processes have been demonstrated to be most effective for people in the pre-contemplation or contemplation stages. They accord with non-confrontational interventions that are delivered with empathy and take account of young people’s perspective.
Processes that are behavioural in nature (i.e., counter-conditioning, stimulus control, contingency management) have been found to be more effective for individuals in the preparation, action or maintenance stages. These processes accord with action-oriented interventions that focus on the development of skills and strategies that support and reinforce change.
The same researchers found that adopting a passive, non-action approach with people in later stages of change is likely to be counterproductive. Conversely, applying action-oriented, behavioural approaches with people in the pre-contemplation or contemplation stages is unlikely to win cooperation. “Confronted with the need for change, an ambivalent person naturally responds with the other side of the decisional balance, with the end result being a misinterpretation of this response as ‘denial’ or ‘resistance’ ” (Giovazazolias & Davies, 2005) (p174).
Each of the Levels of Change identified by Prochaska, DiClemente and Norcross (1992) can influence and are influenced by the changes people make. The levels are situational and symptomatic, relating to the cognitions of the person making changes and interpersonal problems they may experience, including family and system conflicts.
- Consciousness Raising [Increasing awareness] involves increased awareness about the causes, consequences and potential ways of dealing with problematic substance-using behaviour.
- Dramatic Relief [Emotional arousal] involves people being moved emotionally by the impact of substance use in their lives. This might stem from a growing or sudden awareness of the connection between their actions and consequences experienced as negative. Strong grief reactions often result which, if dealt with constructively, can be a catalyst for change.
- Environmental Re-evaluation [Social reappraisal] combines both affective and cognitive assessments of how substance use affects one’s social environment.
- Social Liberation [Re-engineering] requires an increase in social opportunities or alternatives, especially for people who are relatively deprived or oppressed.
- Self Re-evaluation combines both cognitive and affective assessments of how substance use shapes one’s self-image and one’s image in the eyes of others.
Action Oriented / Behavioural Processes
- Stimulus Control removes cues or triggers for unhealthy substance-using behaviour and adds prompts for healthier alternatives. It involves creating the conditions that support change and reduce risks for relapse.
- Helping Relationships [Supporting] provide support for healthy behaviour change. These relationships most commonly feature openness, trust and acceptance.
- Counter Conditioning [Substituting] requires substituting problematic substance use with rewarding healthy behaviours.
- Reinforcement Management [Rewarding] provides predictable consequences for taking steps in a particular direction. This includes both rewards and punishments. Philosophically, the Transtheoretical Model orients practitioners to working in harmony with how people change naturally. This involves enabling young people to understand the logical consequences of particular decisions, actions and consequences.
- Self-liberation [Committing] relates directly to the belief that change is possible, stemming from both enhanced self-efficacy & the perception that social and environmental conditions are conducive to change. Self-liberation involves a continuous process of committing to act on the belief that change is beneficial possible.