What Are the Stages of Change? Part 1

Jessica Pontis, LCSW

As a provider one thing that I see that can significantly impact a client’s ability to meet their goals is ambivalence.  It’s not uncommon for someone to question whether or not changing certain behaviors is really necessary to hit certain goals, and this type of thinking can be a normal process during therapy.  After all, humans are typically creatures of habit, and any type of change (even positive change) disrupts our homeostasis and can feel distressing in some ways.  There are times when I’ve working with ambivalent client’s and one approach I find helpful is motivational interviewing. 

What Are the Stages of Change and Why Are They Important? Part 1

Motivational interviewing was initially developed to provide treatment for substance use disorders, where it helps clinicians to identify where a client is regarding their understanding of their substance use.  This framework can be generalized to other behaviors that are negatively impacting a client as well, including eating and feeding related disorders, anxiety disorders, conduct disorders, and more.  It’s important to recognize that not everyone comes into therapy in the same stage of change, and therefore is important for the clinician to appropriately determine in which stage the client currently exists.  The goals of this are to increase the positive outcomes for individuals by gradually decreasing resistance to creating new behaviors that work towards client goals.

To correctly identify where our clients are in the stages of change, we first need to know what these stages are and what they mean:

Stage 1: Precontemplation

The earliest stage is precontemplation, where an individual may be experiencing some negative outcomes associated with a behavior, but not so much so that they feel motivated to consider changing that behavior.  This could be an individual who smoke cigarettes regularly and is noticing it’s getting harder to breathe when doing any physical activity, but they don’t feel it’s directly related to their smoking or aren’t bothered enough by it to act.  

Stage 2: Contemplation

  In contemplation the smoker may begin to recognize that the negative outcomes are starting to be understood as more problematic than initially thought.  Maybe they recognize that they struggle to play with their children or exercise in the way they enjoy and recognize that smoking isn’t particularly helping.  There is still ambivalence that exists in this stage and the smoker may still be on the fence about cutting back or quitting, but they are thinking about what it would be like to invest in change.  

Stage 3: Preparation 

In this stage the smoker is now invested and committed to making some change in relationship to their cigarette use.  They begin to really weight the benefits and costs of what changing their smoking habits would do.  The smoker may do some light research into ways to reduce cravings or begin to develop a plan, though they have not taken official action. 

Stage 4: Action

In this stage the rubber hits the road, and the smoker begins to demonstrate an active effort to quit smoking.  This may look like cutting back from a full pack a day to only half a pack, or even trying to cut out smoking all together.  The smoker may start chewing nicotine gum or using a patch to reduce cravings, or develop new coping tools to soothe themselves in different ways that smoking had previously accomplished.  This is a stage that may include some trial and error, and encouragement on the part of the clinician can be helpful.  

Stage 5: Maintenance

In the maintenance stage the smoker has found a new routine that works for them and feels confident they are creating changes that they wanted to make.  They still may actively be working through change, but they feel proficient enough to confront new challenges or historically triggering circumstance that might have led them to smoke previously.  

Stage 6: Termination 

Now that the smoker has found new and alternative ways of coping, no longer feel strong urges or cravings to smoke, and has been able to successful navigate triggers they feel that they have completed all their goals and is no longer seeking outside support from a provider or sponsor.  While many people may reach this stage of change, they still may want to remain connected to treatment of some sort in order to continue feeling supported and accountable.  

Now that the stages of change have been outlined, in part 2 of this conversation I will go into how clinicians can assess what stage of change a client is in and ways in which they can support that client through their individual stage of change.  If you feel that you would like to connect with someone to walk with you on this journey reach out to one of the licensed therapists with Symmetry Counseling.  You can reach out to us online at symmetrycounseling.com, or by calling us at (312) 578-9990 to set up an appointment.