Maintenance, Relapse, Termination
By: MI science staff: June 2016
Behavior change often does not go smoothly. Even when a young person has moved to the point of taking action to stop participating in sexual activity, maintaining that action can certainly be difficult. The fifth stage of change is called maintenance and the same processes of contingency management, helping relationships, counterconditioning and stimulus control that were needed in the action stage must continue for successful maintenance. This stage of change can last from 6 months to about 5 years and the message to others is, “I keep moving forward.”
The end line of the Transtheoretical Model of Change is termination. When the termination stage is reached, it is as if the individual never engaged in the risky behavior to begin with and no amount of stress will induce that person into the behavior again. When a person reaches this final stage of change, their message to others is, “home free”.
We do not have any studies to show what percentage of individuals who take action to return to a sexual risk avoidance or abstinent lifestyle reach the termination stage of change. What we do know is that relapse is expected to occur at some point in the process of change, when dealing with other undesirable behaviors. The process is circular, not linear. It is helpful to remember that the adolescent brain has not reached full maturity and the thought process that the teen goes through may seem completely unreasonable to the adult helper. Additionally, the previous sexual behavior has produced brain chemicals that work against change, molding the brain toward the risky behavior, rather than away from it.
A teen may relapse and return to the pre-contemplative stage, indicating that he/she is no longer interested in changing at all. Or the adolescent may return directly to the planning stage with more insight and wisdom regarding obstacles that must be faced. It is important to view attempts that do not result in permanent change as positive learning opportunities rather than failures. The health practitioner, sexual health educator, or youth worker’s attitude toward the incomplete behavior change can be either encouraging or detrimental to the individual who is trying to change. With each attempt of sexual abstinence, a pregnancy or a sexually transmitted infection or an emotional pain may have been avoided. For the professional, relapses can stimulate a search for a better referral system, or a better support system, to help insure a better chance for goal attainment.
Relapses from risk avoidance or abstinent lifestyles may also reveal hidden addictions. A careful review of “what went wrong” may reveal an alcohol or substance addiction, or even a pornography or sexual addiction. In such situations, a stay at a rehabilitation facility or dedication to a 12 step program may be advisable. Again there is a need to Ask, Assess, Advise, Assist and Arrange on the part of the professionals who are involved.
Below is a graphic of the Transtheoretical Model for change that puts together the stages of change with the processes that assist the young person through the process.
Medical Institute would like to encourage our readers to consider using the Transtheoretical Model of Change to help young people return to a risk avoidance, sexually abstinent lifestyle, until they are in a long-term mutually monogamous relationship, such as marriage.