Contexts of Change

The Third Element in the Transtheoretical Model


In prior Prime Solutions Notes, we addressed the Stages of Change and the Processes of Change as two components of the Transtheoretical Model. The third element is less known and less researched, but familiar to treatment professionals: the Contexts of Change.

Change doesn’t happen in a vacuum. Stages of change and processes of change focus on the individual engaged in an intentional change process.  Context of change addresses how individual differences and situational variables might influence the change process. To ignore this would be akin to saying everyone is the same and every change situation is the same. Of course, we know that is not the case.

Consider two clients of the same age and gender in treatment for similar reasons. While Ajia is employed, has a supportive family, high interpersonal skills, and confidence in her ability to succeed with new challenges, Alicia is unemployed, has little family support, low interpersonal skills, and is highly anxious with new situations.  We would expect their treatment plans and treatment courses to be different.

In his 2018 second edition of Addiction and Change, DiClemente noted the contexts of change, " …surround and interact with an individual’s movement through the process of changing any single behavior pattern” (DiClemente, 2018, p. 42).1 He identifies five contexts: current situation, attitudes and beliefs, interpersonal relationships, social systems, and enduring personal characteristics. We’ll take each of these in turn.

Current situation refers to what is happening both within and outside the individual. Things within could be emotional states, mental health issues, coping skills, educational background, and intellectual skills. Things outside individuals could be their living situation, financial resources, and external challenges. Research consistently shows those with greater distress and fewer resources are less likely to be successful in change efforts.  For example, Alicia might have more education and intellectual resources, but her anxiety and corresponding lack of confidence in this new situation might undermine her ability to bring coping skills to bear.  

Attitudes and Beliefs are obviously internal to the client. These are both specific to the change effort – like beliefs about how people change addictive behavior – as well as attitudes and beliefs in general about the world, religion, family, social structures, and the nature of people. Beliefs could, for example, influence people’s willingness to use external support systems.  For example, Ajia, being outgoing and confident, might hold the attitude that other people can be a good way of finding support and she might believe groups like AA can be of benefit, despite her qualms about the spirituality element.

Interpersonal relationships refer to individual relationships between the client and others. As we all know, these connections can aid or hinder a person’s efforts to change behaviors. Research clearly points out the importance of supportive social networks, and the challenges of unsupportive networks in maintaining change.  Unlike Ajia, Alicia may feel uncomfortable meeting new people and unwilling to share the meaningful things happening in her life with others.  Interpersonal relationships might stay more superficial as a result and be unavailable to her in managing high-risk situations. 

Social systems reflect groups or systems like family, extended kin, work communities, and social groups. DiClemente notes these systems can influence “through persuasion, modeling, social norms, and social reference, as well as providing incentives or barriers” (p. 43). In Prime For Life®, we note “social dependence” as a common characteristic among those making high-risk choices that begins in the Yellow Phase and continues through the remaining phases.  While Ajia’s outgoing nature allows for new connections, it also likely means she has a large cadre of others who use similarly to her and normalize her high-risk use, which becomes a barrier to change. 

Enduring personal characteristics, the final context, refers to the manner in which a person engages the world. Familiar ideas like gregariousness, rebelliousness, impulsivity, and sensation-seeking would fall into this category as would things like identity, self-esteem, conscientiousness, and a tendency to worry; and all affect the change process.  Ajia’s and Alicia’s characteristic ways of engaging the world means each would likely find different ways of finding fun again, with Alicia relying on comfortable and familiar activities, while Ajia would seek new ways of sensation-seeking that do not involve high-risk substance choices.

Of course, these ideas are not new to counselors. When taking a psychosocial history as part of intake, assessing a person’s functioning across these domains is common. AA communicates these things through their familiar sayings, like “Persons, places and things” and “Slippery things happen in slippery places.” Still, it is common for us to underestimate the influence of the contexts of a person’s life in considering behavior. Psychologists have a term for this process, The Fundamental Attributional Error. We overestimate the contributions of personal characteristics and underestimate the influence of situational factors in observing other’s choices and behaviors. DiClemente reminds us to be mindful of these factors and to consider tools we might use as facilitators to address obstacles to initiating and maintaining change efforts.  For example, addressing the myth of addictions as a matter of will power or that some people just can’t change.  We can also raise people’s awareness of context.

In Prime For Life, we incorporate these contexts within the formula. Psychological factors would be those influencing us from within and include things such as attitudes, preferences, beliefs, and characteristics. Social factors influence us from without and include family and friends, social norms, community, and media. In Prime For Life, we note these two types of factors do not cause the outcome, but they do influence choices.  

In thinking about how to account for these things as a counselor, here are a few tips.

  • First, note assessment is not simply an initial task, but rather an ongoing activity for counselors. As part of this, we should be assessing contextual factors.
  • Second, recognize while change will ultimately be up to the individual, these contextual factors are powerful in facilitating and hindering change efforts. For example, beyond identifying social support, asking ourselves how does this person engage with social support opportunities and how can I assist him or her given that knowledge?  Ajia would be very comfortable going to an AA meeting and introducing herself while Alicia would not.  Alicia would likely benefit from more coaching and practice in how to do that task, and would do much better if buddied-up with another person in treatment to take this task on.  Beyond asking what resources this person has in these domains, we also need to actively consider what we are doing to help him or her access these things.
  • Third, when a person struggles to change, look beyond personal commitment to assess how they are doing with the tasks of change, what processes of change might need to be engaged, what contexts of change might be impeding him/her, and which could be accentuated to help. Ajia’s need for novelty may lead her to become bored with recovery and to seek situations that might be slippery, but it could also be used to help her try new activities that might offer new ways to find pleasure.  As we say in the session topic Choose It Again, commitment to change is not a one-time act. In each of those decision points, there are multiple factors potentially influencing that choice and the challenges within those choice points will vary because of contextual factors.
  • Finally, the value of implementation intentions – if-then thinking – becomes even more apparent in helping people continue to move forward on a decision once the decision to change has been made. This manner of thinking prevents these contextual factors from stalling change efforts. But, that’s a discussion for another day.  

1DiClemente, C.C. (2018) Addiction and Change, Second Edition. How Addictions Develop and Addicted People Recover. New York: Guilford Press.