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Revisiting the Stages of Change — What Social Workers Need to Know
By James E. Phelan, PsyD, MSW, MBA, BCD

According to psychologists James Prochaska, PhD, and Wayne Velicer, PhD, individuals in their quest to stop or reduce unhealthy behaviors and adopt newer, healthier behaviors move through a series of five stages: precontemplation, contemplation, preparation, action, and maintenance.

Everyone needs change in some form or fashion during their lifespan, and sometimes clients get messages from others or within themselves (usually both) of this need. But how do our clients identify where they stand in this process? What can we do to help them? Take a look at the stages of change to learn more.

Precontemplation
The message they tell themselves: “I’m not convinced I have a problem; why do they keep saying I do? What’s wrong with the way I’m doing things?”

The message others might give: “You don’t see it, but I do. You have to change or something bad is going to happen.”

Precontemplation is the stage where individuals start to hear external messages telling them that change needs to happen—a behavior has to stop or be reduced. They may not be quite ready to change, but the messages are becoming louder and louder. Perhaps they are using substances and consequences occur.

What to do: First off, ask them to listen very carefully to the messages. Help them to decipher whether there are any truths to these messages. Ask them to start to think about what change might look like. You can walk them through the process of soul-searching and change options. While you might offer guidance through the process, in the end, a desire for change has to come from them. You can usually tell they want change by listening for cues in what they say, known as change talk. Feeding this information back to them helps them to process it and to see whether they want to move toward another stage, or not.

Contemplation
The message they tell themselves: “Maybe I do have a problem … but, what do I need to do to get it fixed?”

The message others might give: “I’m glad you see it too. You have to change before things get worse.”

Contemplation is the stage where they start to believe they need change. What’s unique is that while they see change is needed, they feel a bit stuck. They are not really sure how to define all the issues involved and definitely not sure how to fix them, or even whether they want to, or have the energy to do so. They are still hearing external cues. One question they might ask is, “What do I need to do?” These are all signs of the contemplation stage of change.

What to do: Even though they are ambivalent to some degree about changing behavior, this is a good time for them to consider weighing the pros and cons of change. For example, have them ask, “What will happen if I keep doing it this way?” or “What are the possible consequences of continuing doing what I’m doing?”

Preparation
The message they tell themselves: “I am ready to change. I want to make this count. I’m going to take the steps necessary for change.”

The messages others might give: “I’m happy you are looking to change! I’m glad you are going to do something about it.”

The preparation stage is where they start to take some steps toward change. For example, if they want to lose some weight, they might start to download exercise apps and some recipes, and when affordable, consider hiring a coach. The key here is that they switched from thinking about it to actually taking some steps, planning some ideas, making appointments, etc.

What to do: When preparing for change, ask clients to stick with it or they will never move to the next stage, the action stage. Help them gather materials necessary for change and help prepare them for some more work ahead.

Action
The message they tell themselves: “I’ve made that commitment to change and I’m finally doing something about it.”

The message others might give: “I’m glad you are doing the work needed to change.”

Action is the stage where they take charge and do something about their desired behavioral change. They are working hard toward change. They attend self-help meetings, exercise, or engage fully in counseling, for example, when accessible and affordable. Here, they may actually make changes and start to see the fruits of their labor. It’s not always easy, but they keep on pushing practically for change.

What to do: Encourage them to keep at it and then continue to work on a plan. Suggest making a plan for accountability. Encourage them to do whatever is necessary to stay on track.

Maintenance
Finally, in the maintenance stage clients will continue to stay focused and on target to sustain their goals and recovery. They could find an accountability partner, continue to attend support groups, or stay engaged in counseling. Maintaining is doing whatever it takes to reach their goals and stay active and alive. If a client returns to an old behavior, remind them that they changed once, and that change can be a reality. Guide them back to the action stage to get on track again. Remind them they are human, so encourage them to be kind to themselves.

— James E. Phelan, PsyD, MSW, MBA, BCD, is a program coordinator at the Veterans Health Administration in Columbus, Ohio. Phelan is an Internationally Certified Drug and Alcohol Counselor. He is the author of The Stages of Change Workbook: Practical Exercises for Personal Awareness and Change.