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Article Excerpt
The authors describe use and development of the University of Rhode Island Change Assessment (E. I. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983) and examine the psychometric properties of scores from incarcerated male adolescents. Cluster analysis revealed 3 unique profiles (Precontemplators, Participators, and Undifferentiated). Implications for clinical use with adolescent populations are discussed.
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In order for behavioral change to occur through counseling or psychotherapy, the client needs to demonstrate some level of readiness for change. It is theorized that clients typically move through a series of sequential stages when reducing usage of undesirable behaviors (e.g., smoking, overeating) or increasing usage of adaptive strategies (e.g., addressing psychological problems, resolving conflict prosocially). Although accurate assessment of a client's readiness for change has significant therapeutic utility, only a few such measures have been developed. The present study examines how appropriate the widely influential University of Rhode Island Change Assessment (URICA; McConnaughy, Prochaska, & Velicer, 1983) is for measuring readiness for change in incarcerated adolescents receiving counseling services.
TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE
Although typically referred to as the "stages of change model," this is only one aspect of the larger transtheoretical model (Prochaska & DiClemente, 1984). As suggested by its name, the transtheoretical model incorporates several theories and aspects related to behavior change, including the processes of changing, potential benefits and drawbacks of changing, temptations, and self-efficacy (Velicer, Prochaska, Rossi, & DiClemente, 1996). The stages of change model is the central component of the transtheoretical model and continues to be popular with clinicians and researchers, primarily in the addictions field (Sutton, 2001).
Some of the earliest published research on the stages-of-change process comes from the addictions and behavioral health fields. Counselors and health practitioners documented the change process as it related to reductions in undesirable or unhealthy behaviors, such as smoking and alcohol abuse. Specifically, Horn (1976) observed that the following four stages were associated with the process of change in health behavior modification: contemplating change, deciding to change, short-term change, and long-term change.
Extending earlier work on the stages of change, other researchers (e.g., McConnaughy et al., 1983; Prochaska & DiClemente, 1982) put forth a more detailed five-stage model of change, which included precontemplation, contemplation, preparation, action, and maintenance (described in detail as follows). Each stage represents a specific collection of attitudes, intentions, and behaviors that are typical of individuals at that stage (Prochaska & Norcross, 1999).
Although it is possible that an individual may proceed through the stages of change in a linear fashion, setbacks or relapses are common. When relapses do occur, the individual may regress to an earlier stage. According to Prochaska and DiClemente (1984), 85% of self-changers (i.e., those attempting change without assistance) recycle back into the contemplation or precontemplation stage. Despite relapses, individuals may learn from their mistakes and again move toward change (DiClemente et al., 1991).
Although most commonly used for making health-related behavior change, such as reductions in substance abuse, the stages-of-change theory and corresponding measures hold promise for use for with psychotherapy clients (Greenstein, Franklin, & McGuffin, 1999; McConnaughy, DiClemente, Prochaska, & Velicer, 1989). Administering a measure of readiness for change early in the therapeutic process may help the clinician gauge the client's acknowledgment of the problem and commitment to the change process. Clinicians can also use the measure to inform treatment plans.
Because most of the research has been conducted on individuals making discrete behavior changes, it is less clear how sufficiently the model generalizes to individuals demonstrating a range of psychological problems. Further complicating the issue, psychotherapy is viewed as a multitude of changes within a process, and clients enter psychotherapy at varying points in the change process and for different reasons. More specifically, some individuals enter therapy because they are forced to by family, an employer, or the justice system (e.g., as a result of a driving under the influence of alcohol conviction or spouse/child abuse charges). Less is known about the utility of the stages of change model or using measures of change readiness when providing clinical services to individuals who are required to enter counseling.
MEASURES OF READINESS FOR CHANGE
Only a few published instruments have been developed to measure the therapeutic change process in accordance with the transtheoretical model. These procedures fall into two main groups: staging algorithms and multidimensional scaling approaches (Sutton, 2001). Using a staging algorithms approach, the individual indicates which of the four or five stage descriptions best characterizes his or her typical feelings, attitudes, and/or behaviors. These measures are commonly used to assess readiness for change regarding substance abuse, and the measures typically describe very particular behaviors and specify a timeline of substance use or behavior patterns. For example, the contemplation stage definition on the measure developed by Belding, Iguchi, and Lamb (1996) is the following: used unauthorized drugs in the last 30 days, plan to quit in the next 6 months, but not in next 30 days. This approach locates the individual at a particular stage in the change process. Some researchers have criticized the stage approach for several reasons, including the arbitrary nature of the timelines and a lack of distinction between stages (for a review, see Sutton, 2001).
In contrast, most multidimensional questionnaires provide a score on each of the four or five stage/dimensions (referred to as subscales), thus yielding a readiness for change profile. McConnaughy and colleagues (1983) were one of the first to create a stages-of-change measure, which they apply named the "Stages of Change Scale"; it was later renamed the University of Rhode Island Change Assessment (URICA). The URICA is the most widely studied measure of readiness for change (Sutton, 2001). One reason is likely due to its focus on a general "problem," whereas other measures specify the target behavior (i.e., smoking) and typically provide a timeline or frequency of usage. Consequently, the URICA can be used to assess change readiness regarding a range of problems. The URICA consists of 32 items and provides a continuous measure of differences in attitude for individuals in each of the four distinct stages of change, thus generating a readiness profile rather than discrete placement at any particular stage (Sutton, 2001).
Another multidimensional measure is the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; Miller & Tonigan, 1996). This 20-item measure was developed to assess readiness for change regarding alcohol abuse. The SOCRATES is believed to describe a motivational process rather than a series of stages. A similar measure is the Readiness to Change Questionnaire (RCQ; Rollnick, Heather, Gold, & Hall, 1992). This 12-item measure was developed to assess readiness for change regarding alcohol use.
Some researchers have argued that scores from these three measures do not demonstrate sufficient convergent validity, and thus the scores are not adequately measuring the same underlying stages of change process (for a review, see Sutton, 2001). Despite these criticisms, the multidimensional approaches assessing change readiness, most notably the URICA, continue to be popular among clinicians and researchers.
THE STAGES OF CHANGE
In the following section, we summarize each of the five stages of change, provide a brief description of behaviors and attitudes characteristic of clients at each stage, and offer sample items from the corresponding subscale of the URICA.
Precontemplation
Precontemplation is characterized by lack of problem recognition and no desire to eliminate the behavior. Individuals at this stage are typically unaware (or underaware) of their problem(s); however, their problems are often obvious to family, friends, neighbors, and colleagues. During this stage, individuals tend to put off seeking help or treatment until pressured or forced to by others. They usually feel coerced into changing by those who may be threatening some form of punishment. Although individuals in the precontemplation stage may demonstrate some degree of change when pressured, the problems typically return when the external pressure abates. Prochaska and Norcross (1999) have contended that resistance to recognizing a problem is the hallmark of being in the precontemplation stage. The Precontemplation subscale of the URICA includes items such as "As far as I'm concerned, I don't have any problems that need changing" and "I guess I have faults but there's nothing that I really need to change" (McConnaughy et al., 1983).
Contemplation
Contemplation is characterized by an awareness that a problem exists and by serious consideration of behavioral change. Individuals at this stage acknowledge or "own" the problem and have greater awareness of the negative aspects of the problem. Individuals who score high on Contemplation typically evaluate the options that are available to them, but they can become stuck in this stage for extended periods of time. The Contemplation subscale of the URICA includes items such as "I think that I might be ready for some self-improvement" and "I have a problem, and I really think I should work at it" (McConnaughy et al., 1983).
Preparation
Preparation is characterized by the individual's intention to...
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