Stages of Change

Even when it’s obvious that something needs to change, people often still have trouble putting that change into action. Change is hard, whether that’s forming new habits or quitting old ones. In therapy, Stages of Change refers to an individual’s readiness to embrace the need for change. It also describes the individual’s motivation to take concrete steps toward practicing new behaviors. It is a key concept used in Motivational interviewing (MI), which is a client-centered therapy used to increase motivation and evoke commitment to behavioral change.

When developing MI, Drs. Miller and Rolnick realized that all clients do not enter therapy at the same starting point (Prochaska, 2016). Some clients are easily able to identify their challenges and express their readiness to make behavioral changes. Others, however, may have been mandated to participate in treatment not of their own accord but because of a court or family member mandate. These individuals might not yet accept the notion that their behavior needs to change. A key component of MI is to identify which Stage of Change a client is at when entering therapy.

The concept of Stages of Change can be applied to the following challenges and conditions, as well as more general challenges often addressed in therapy:

Most of these challenges and conditions have a behavioral element to them, as in something physical that the client either needs to do or needs to stop doing. With the above, there is an action that clients take that needs to be addressed.

What are the Stages of Change?

The Stages of Change have 6 key phases:

Stage 1: Precontemplation

In the Precontemplation stage, the client may experience some adverse effects associated with their behavior; however, they do not perceive these negative consequences as detrimental enough to motivate them to consider changing their behavior. In this stage, the client has little or no motivation to change their behavior as they do not view themselves as having a problem. Here’s how that may play out in a few common challenges:

Stage 2: Contemplation

In the second Stage of Change, the client may begin to realize that their behavior is harmful, but they are ambivalent about making any changes. The person may have a desire to change and may even consider changing their behavior, but has not yet invested much time or effort into changing their behavior.

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Stage 3: Preparation

In this stage, the client has committed to changing their behavior and accepted responsibility. Many clients in this stage measure the positive versus negative aspects of their behavior and have drawn the conclusion that the negative ramifications outweigh any perceived benefits. Some clients may attempt to develop a plan for change, but have not taken any concrete steps.

Stage 4: Action

In this stage, the client is actively involved in changing their behavior. Any efforts to change their behavior would be enough to categorize them as being in this stage. Most individuals in this stage understand that they are responsible for changing their behavior and recognize that they require some form of ongoing assistance to help them reach their goal.

Stage 5: Maintenance

In this stage, the client has developed some level of efficiency and consistency that has allowed them to maintain their behavioral change. As a general rule, clients’ behavioral changes must be maintained for a minimum of six months in order to qualify for this stage.

Stage 6: Termination

In the sixth and final stage, the client has made all of the necessary behavioral changes for them to take on existing and new potential challenges in a productive manner. Many clients don’t actually end therapy in the termination stage. Many people in treatment for substance abuse issues continue to participate in social support groups, such as 12-Step programs, AA, or NA, for many years after they have been sober or abstinent. In this stage, the client has been able to make positive changes, maintain new habits, and continue to be on a path toward improvement.

It is important to keep in mind that the Stages of Change model is not linear. Clients may relapse and return to any of the previous stages. Therefore, the termination stage does not always indicate the end of treatment.

Humans aren’t built for change — our brains like to keep the same neural patterns, which makes it difficult to break out of habitual or routine behaviors. Yet, we’re also capable of understanding what’s healthy and what’s not healthy. It may just take some time for us to find an inner sense of motivation to make those changes. The Stages of Change model is a helpful way for therapists to consider the best ways to help their clients.