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Stages of Change

"It was Dean Karnazes’s 30th birthday, and he felt trapped. Despite a successful career and a happy marriage, he was lost and disillusioned.

That evening, he was drunk and out with friends at a night club in San Francisco when a beautiful young woman approached him. They hit it off instantly. One way or another, what he decided next would determine his future.

Perhaps unexpectedly, he made his excuses and left. Once home, he rooted through boxes, took out an old pair of sneakers, and did something he hadn’t done since college: he started running (Karnazes, 2006).

And he carried on, and on, becoming famous for winning several ultra-marathons and running across America. He has since been named as one of the “Top 100 Most Influential People in the World” by Time magazine."  PositivePsychology.com

Change can take many forms. Sometimes we choose it, and sometimes life just happens and change comes with it. Sometimes we avoid the obvious that something needs to change, because 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 outlines 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 Motivational Interviewing, 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. Some individuals 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 be ready to accept the idea 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. This helps the client and therapist understand the reason for addressing the situation.

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 challenges and conditions affect and include behaviors, as in something physical that the client either needs to do or needs to stop doing. To address behaviors that negatively affect individuals, 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 see or notice these negative consequences as damaging 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. 

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.

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.

Human beings don't like change, even sometimes when it is good! We find it difficult to break out of habitual or routine behaviors. Yet, we also have the ability to choose and understand what is healthy and what is not healthy. Finding an inner sense of motivation to make those changes can be assisted by therapy and understanding where we might be in the Stages of Change model.