Stages of Change

In their research on when changes occur for people in changing unhealthy behaviors, Prochaska, DiClemente and Norcross (1992) identified five stages of change: Precontemplation, Contemplation, Preparation, Action, and Maintenance.

Precontemplation stage. This is when the client has no intention of changing because he or she may not perceive their alcohol or drug use as problematic. Also, the problem behavior is seen as having more positives than negatives (Connors, DiClemente, Velasquez, & Donovan, 2013). People in this stage may also be “unaware or underaware of their problems” (Prochaska, DiClemente, & Norcross, 1992, p. 1103). Oftentimes, when precontemplaters show up in therapy it is because they are coerced by family, friends and court-ordered directives (Prochaska, DiClemente, & Norcross, 1992).

People in the precontemplation stage are not engaged in any change processes, such as cognitive/experiential or behavioral processes, nor are they likely to engage in any change process at this stage (DiClemente, 2003). However, other people (family, friends, co-workers, boss) are often quite aware of the problem(s).When individuals or clients remain stuck in this stage, it may be the result of any one of the following four “R”s as described by DiClemente (2003, pp. 116—120): reluctance (“I really don’t want to change”), rebellion (“No one can make me change”), resignation (“No matter what I do, I can’t seem to change”) and rationalization (“I’m not that bad, therefore I don’t need to change because ...”).

Contemplation stage. Here, people are not ready to change, but are thinking about changing.They may seek information about the problem behavior as well as examine the pros and cons of said behavior. At the same time, they are ambivalent about change.They see both the risks, costs and harms of their behavior but at the same time are attached and attracted to their behavior. They want to change, but then they don’t want to change (Miller & Rollnick, 2002).

Preparation stage.This stage entails readiness to change in terms of both attitude and behavior. People are making or have already made the decision to change. People are engaged in the change process (e.g. may have already tried cutting down). People in this stage are ready to develop a plan (Connors et al., 2013).

Action stage. In the Action stage, people decided they want to change, select a date, demonstrate/verbalize a commitment to change, make efforts to change the behavior or modify the environment, and are involved in behavioral change processes. In this stage, people are willing to take advice and suggestions on change strategies and activities (Connors et al., 2013).

Maintenance stage. In the Maintenance stage of change, people are continuing their change/changes. They work to prevent relapse and “consolidate the gains attained during action” (Prochaska, DiClemente, & Norcross, 1992, p. 1104). Maintenance involves sustaining change for an extended period of time and avoiding slips and relapses into old behaviors (DiClemente, 2003, p. 192).

Motivational Interviewing

Motivational Interviewing (MI) is “a skillful clinical method, a style of counseling and psychotherapy” (Miller & Rollnick, 2002, p. 35). The spirit of motivational interviewing focuses on collaboration over confrontation, evocation over education, and autonomy over authority. In referring to collaboration, the client and counselor are in a partnership relationship. The counselor focuses on creating an atmosphere that is conducive (as opposed to coercive) to change. In terms of evocation, the counselor is invested in eliciting from the client (that is, drawing out from the person), instead of imparting information (wisdom, insight, reality). Finally, there is autonomy with the decision to change being left to the client. S/ he can choose to change or not to change (Miller & Rollnick, 2002, p. 34).