- Denial / Pre-Contemplation. The patient does not know, cannot see, or refuses (usually out of irrational fear) to observe to notice to recognize his or her actual thoughts, emotions, sensations or behaviors. (Stuck in recognized but rationalized, or un-recognized, defense mechanisms.)
- Contemplation / Consideration. The patient becomes willing and open to at least looking at and thinking about his or her actual thoughts, emotions, sensations or behaviors. (Still largely snagged by defense mechanisms, but at least observing to notice to possibly recognize them.)
- Identification / Acceptance. The patient has looked at and thought about his or her actual thoughts, emotions, sensations or behaviors long enough to at least temporarily recognize, acknowledge, accept and own them. (Some defense mechanisms are seen, heard and/or felt... and temporarily transcended.)
- Commitment / Action. The patient has become motivated enough to engage in the action of detachment and distancing from his or her actual thoughts, emotions, sensations or behaviors in favor of continuing direct observation, noticing and recognition, as well as acknowledgment, acceptance and ownership of what he or she thinks, feels, says and does. (Automatic appreciation and understanding of the purpose -- as well as the price -- of dysfunctional defense mechanisms, as well as the discharge of emotions that had previously locked those defense mechanisms in place, can be achieved in this stage. Reframing and transcendence of the gestalt are possible.)
- Relapse Prevention / Maintenance. The patient has worked with the skills of observing to notice to recognize to acknowledge to accept to own to appreciate to understand his or her thoughts, feelings and behaviors long enough that he or she can now pick up those tools whenever his or her thoughts, feelings and behaviors are recognized, acknowledged, accepted, owned, appreciated and understood to be taking them back into their misery, depression, anxiety, mania or anger. (And the patient can use the tools of self-awareness or mindfulness to spot, process and overcome his or her defense mechanisms with a high degree of functional probability of reaching transcendence.)
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