Reading: The five stages of change
Precontemplation, contemplation, preparation, action and maintenance: what each sounds like, and what each asks of you.
Reading: The five stages of change
What you’ll learn
- Name the five stages of change and recognize each one in a client’s own words.
- Match your focus to the stage the client is in now, not the stage you hope they’re in.
- Treat moving back and forth, including a return to use, as a normal part of change.
Change rarely happens in a single decision. People think about it, put it off, try, slip, and try again, and many do this without any professional help at all. In the 1980s, James Prochaska and Carlo DiClemente studied how people actually change and described the journey as a series of stages. Their transtheoretical model, usually called the stages of change, is the most widely researched model of its kind.
The stages of change are not a counseling method. They’re a map. Knowing where a client is on it tells you which conversations will help right now, and which ones will only push them away.
- 1PrecontemplationNot considering change
- 2ContemplationWeighing both sides
- 3PreparationPlanning to change soon
- 4ActionMaking the change
- 5MaintenanceKeeping it going
Precontemplation: “I don’t have a problem”
The client isn’t considering change and doesn’t intend to any time soon. They may not see a problem, may not think they need to change, or may feel too discouraged to try. Often someone else, such as a court, an employer or a family member, is more worried than they are.
Your focus is the relationship. Build rapport and trust, ask how they see things, and explore what led them to you. With permission, share information or personal feedback, and raise doubt gently. If they aren’t ready, express your concern and leave the door open. Arguing at this stage almost always backfires.
Contemplation: “Maybe, but…”
The client sees that there may be cause for concern and reasons to change, and at the same time reasons not to. They’re ambivalent. They may look for information or weigh pros and cons, and they can stay here for a long time, sometimes years, going back and forth.
Your focus is to normalize the ambivalence and help the client resolve it. Explore both sides openly, shift the conversation from outside pressure to their own reasons, revisit what they value, and summarize the change talk you hear. Let the client tip the balance; don’t push it.
Preparation: “I’m going to do something soon”
The balance has tipped. The client intends to change very soon and may already be making small changes, such as cutting down or telling people close to them about the plan. They’re deciding what to do, and their confidence that they can do it matters a great deal.
Your focus is a plan the client owns. Help them clarify their own goal, ask what they think would work, offer a menu of options, look at barriers, and enlist support. Early goals should be short-term, measurable and realistic, so the client can see progress.
Action: “I’m doing it”
The client is actively changing their substance use and their lifestyle, and is committed to the process. They may face temptations, withdrawal and hard situations, and they may start to see themselves differently. The change is real but not yet stable.
Your focus is supporting their steps. Review what’s working and what isn’t, change strategies as needed, solve problems as they come up, and affirm effort as well as results.
Maintenance: “Keeping it going”
The client is working to sustain the gains made in action and to prevent a return to use. They learn which situations trigger the urge to use, build coping skills, and create a life that no longer revolves around the old patterns.
Your focus is stabilizing the change. Build a coping plan, reinforce new behaviors and relationships that support recovery, and strengthen family and social support. If use resumes, help them get back on track as quickly as possible.
- Precontemplation
- What you might hear“My drinking is fine. I’m only here because of the court.”
- Your focusBuild rapport, raise doubt gently, leave the door open
- Contemplation
- What you might hear“I know I should cut back, but it’s how I deal with stress.”
- Your focusExplore both sides, draw out their own reasons
- Preparation
- What you might hear“I want to stop before the baby comes. I just don’t know how.”
- Your focusClarify their goal, offer options, build a plan
- Action
- What you might hear“It’s been three weeks. Friday nights are the hardest.”
- Your focusSupport the steps, adjust what isn’t working
- Maintenance
- What you might hear“It’s been eight months. I don’t want to lose what I’ve built.”
- Your focusPlan for triggers, strengthen support
| Stage | What you might hear | Your focus |
|---|---|---|
| Precontemplation | “My drinking is fine. I’m only here because of the court.” | Build rapport, raise doubt gently, leave the door open |
| Contemplation | “I know I should cut back, but it’s how I deal with stress.” | Explore both sides, draw out their own reasons |
| Preparation | “I want to stop before the baby comes. I just don’t know how.” | Clarify their goal, offer options, build a plan |
| Action | “It’s been three weeks. Friday nights are the hardest.” | Support the steps, adjust what isn’t working |
| Maintenance | “It’s been eight months. I don’t want to lose what I’ve built.” | Plan for triggers, strengthen support |
A spiral, not a straight line
Most people move through the stages in a circular or spiral pattern. They go back and forth, at different speeds, and setbacks are common. Most setbacks don’t send people all the way back to precontemplation, though, and someone in precontemplation won’t jump straight to maintenance.
A client can also be in different stages for different behaviors. Someone may be in action on their drinking and in precontemplation about their cannabis use. Ask about each one rather than assuming.
A return to use is treated as a normal part of the process, not a failure. Many people cycle through the stages several times before the change holds, and each attempt teaches them something they carry into the next. Your job is to help them reenter the cycle quickly. Module 6 covers how.
My wife thinks I drink too much. Maybe she’s right, but it’s how I relax after work.
A drink helps you unwind, and part of you wonders if she has a point.
Yeah. I don’t know. I just don’t want to give it up completely.
Giving it up completely doesn’t feel right to you. What, if anything, would you want to be different?
The counselor reflects both sides and asks about the client’s own goals instead of suggesting a quit date. That fits someone in contemplation.
This client is in precontemplation. Write a response that builds rapport without arguing.
ClientI’m only here because my probation officer made me. I don’t have a drug problem.
Show a model answer
“Coming here wasn’t your idea, and you don’t see your drug use as the problem. I appreciate you showing up anyway. What would make this time worth it for you?” It reflects their view without agreeing or arguing, recognizes that they came, and gives them some control over the conversation.
Key takeaways
- The stages of change are a map for choosing what to do next, not a label for the client.
- Match your focus to the stage the client is in now. Getting ahead of them creates discord.
- People move back and forth, and a return to use is a chance to learn and reenter the cycle.
Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapters 1–2. Public domain. Open TIP 35, the stages of change