Two Minds Blog

I have written previously about the stages of change and the processes of change , two important components of James Prochaska's transtheoretical model (TTM). The original TTM also had a third concept, the levels of change, which captures another feature that differentiates between psychotherapy schools. In this case, Prochaska was getting at the idea of a "theory of problem causation" that seen as the focus for psychotherapeutic efforts. Prochaska differentiated these theories of why people have problems from separate "theories of change," which represent the ways in which problems can be fixed. The TTM's processes of change are theories of change, while the levels represent theories of problem causation. Compared to the other two components of the TTM, the levels of change have received minimal research and have not proven strongly predictive of treatment outcomes. Perhaps for that reason, this construct has not been widely used in the health care arena.

I have written previously about the enduring popularity of James Prochaska’s Transtheoretical Model (TTM), which gave us the “stages of change” concept, despite its somewhat inconsistent empirical support. The TTM, however, includes more than just the stages of change. The TTM was originally developed in 1979 as one of several attempts to integrate diverse psychotherapeutic traditions such as psychoanalysis and behavior therapy (e.g., Paul Wachtel's Psychoanalysis and Behavior Therapy in 1977). Thanks to funding from the National Cancer Institute it was first tested in the area of smoking cessation , and thereby entered the addictions literature. The model's initial successes were mostly in quantifying the stages of change for various health behavior problems .   The concept of "stages of change" provided a formal theoretical rationale for the common clinical observation that many patients are not yet ready to talk about change -- a fact that tends to be ignored in