Creating a Desire for Change: Part 3

Medical Institute Science Staff: May 2016

This article is the third part of MI’s series on the Transtheoretical Model of Behavior Change. Our previous articles focused on the pre-contemplative and the contemplative stages of readiness for change. The third stage is known as preparation. When an adolescent or young adult reaches this stage of readiness, it means that they are poised to take action. It is very important that helping adults guide the adolescent in a process called self-liberation to make a firm commitment to change.

In the self-liberation process, the individual comes to believe that they can make a change in their behavior. This belief that change is possible for them is a crucial element for making a firm decision to change.  Re-enforcing the idea that they can learn to say “no” to sex  and that they indeed have the right to say no, even if they have previously engaged in sexual behavior can be an important form of encouragement.

How can we identify a young person who has reached the stage of preparation? First of all, we must Ask questions. People in this stage know that change is best and they are ready to take specific action, usually within the next month. Their message to others is: “I’ll start tomorrow.” Often, the person has already taken some significant step within the last year in preparation to change.  Perhaps they have checked out or bought books on “secondary virginity” or on “how to say no”. They may have visited with a youth leader, health care worker or some other mentor and engaged in a conversation about making changes.

In working with young people who are engaging in risky sexual behavior, it is helpful to realize that about 40% of them are in the pre-contemplative phase, approximately 40% in the contemplative stage, and only about 20% in the preparation stage. When we Assess that an individual may be in the preparation stage, we should be ready to Advise and Assist that individual toward a commitment to change.

Our goal for young people who are engaging in risky sexual behavior is to help them return to sexual abstinence until they are in a long-term mutually monogamous relationship in which both partners are disease free. However, if there are other behaviors that are making the turn to abstinence difficult, those must be addressed, as well. Alcohol and drug use are major contributors to risky sexual behavior. An abusive sexual partner can be a strong deterrent to permanent change, and a history of sexual abuse may complicate the issue even more. As anxious as we may be to have the young person return to abstinence, other risky behaviors may have to be addressed first.

The health educator, youth worker or health professional needs to have a plan in place for young people who are preparing to return to abstinence. Although the message to others is “I’ll start tomorrow,” it may be wise to bring the individual to a more reasonable time commitment. The action of changing sexual behavior is going to require several other processes: helping relationships, counterconditioning, contingency management and stimulus control. The next step is to Arrange some appropriate follow-up. One suggestion is to ask the young person to return in one week with a list of steps they plan to take. Another approach would be to give the person a brochure, such as MI’s What if You Could Start over?, and making a return appointment to discuss the brochure. Referrals for counseling or support groups can be made at this time. Health professionals can receive insurance reimbursement in a primary care health setting for 2 twenty to thirty minute appointments per year for assisting patients in avoiding risky sexual behaviors.

How exciting it is to see a young person reach the preparation stage of change regarding risky sexual behavior! Even better is to watch the preparation turn to action. What a privilege it is to assist that individual in making a firm commitment to change.