Should I know what I want to change before starting therapy?

In 2005, the addiction researcher Robert West wrote a short, pointed editorial in the journal Addiction. His target was the transtheoretical model, better known as the stages of change. That model sorts people into steps, from not yet thinking about change, to thinking about it, to getting ready, to acting, to keeping it up. It became one of the most widely taught ideas in health care. West argued it should be set aside. His main objection was the idea of a stage itself. The model splits a smooth, shifting thing into boxes, and the lines between the boxes are drawn at arbitrary places, often by a clock. Planning to change in the next thirty days puts you in one stage, the next six months in another, with nothing real marking the border. He also pointed out that people in the grip of an addiction rarely hold the steady, coherent plans the model assumes. Change is often sudden and unplanned rather than a march through neat steps. And after decades of study, mostly in smoking, he found little evidence that matching help to a person's stage worked better than help that ignored stages. His suggestion was plain. Go back to simpler questions, how much a person wants to change and how able they feel to do it, or build a better model.