Stages of Change

When thinking about change, considering how ready a person is for change at the present time. This is referred to as where they are in the stages of change.

Observing where people are allows you to respond appropriately based on their current needs.

Precontemplation

The patient is not yet recognizing the problem or considering change.  The clinician’s goal is to build rapport and raise awareness. The task is to inform and encourage. This sets the stage for future conversations by showing empathy and building trust.

Examples of what the client/patient might say:
  • My husband says you need to refer me to somebody that can help me slow down my drinking.
  • I don't have a problem with anything. I share a few beers with my buddies on the weekend that's all.
Examples of what a clinician might say:
  • "We have a program that you might find helpful and is recommended by doctors, nurses and social workers."
  • "If you would ever like to talk about available options, I would be happy to meet with you."

Contemplation

The patient is evaluating reasons for and against change. Clinician's goal is to build motivation. Clinician's task is to explore and resolve ambivalence - a good time to address pros/cons.

Examples of what the client/patient might say:
  • I just don’t know what to do...I know I should quit.  Maybe talking to someone might help. I've been thinking I might try to stop drinking so much when I go out with my friends.
  • I don't have a problem with anything. I share a few beers with my buddies on the weekend that's all.
Examples of what a clinician might say:
  • You said your children are very important to you and want you to stay home with them after work more often. You also said you enjoy going out drinking with your girlfriends most nights.  Have you thought about how you can manage more time with your family?
  • It's clear that you enjoy your job and yet you have had a number hangovers that have gotten in the way of completing your work or even getting to work.

Preparation

The patient is planning for change. Clinician's goal is to negotiate a plan. Clinician's task is to facilitate decision-making.

Examples of what the client/patient might say:
  • I don't want my kids to think I’m a drunk.  Can you tell me where I can go to get help?
  • My best friend went to XYZ's outpatient recovery program.  I'd like for you to refer me so that I can get some help.
Express empathy:
  • "Your commitment to change your drinking really shows."
  • "It's clear that you are trying to change."
Examples of what a clinician might say:
  • "I would be happy to work on a plan with you."
  • "I can make a call to set up an appointment today for you to see someone who can help."

Action

The patient/client is making the identified change(s). The clinician's goal is to support implementation of the plan. Clinician's task is to support self-efficacy.

Examples of what the client/patient might say:
  • I've been going to AA every day for the past 5 weeks.  I have a sponsor now.  It's working...I haven’t had a drink in over a month.
  • My family is very important to me so I attend group at  XYZ on Tuesday and Thursday nights.
Examples of what a clinician might say:
  • You have a lot on your plate right now. It's good to hear that you are in IOP and have not had a drink in 3 weeks.  Congratulations.
  • I can see that you have been working on your goal not to drink alcohol. You have stopped drinking in the last month and are attending meetings regularly.  With your dedication I'm sure you will be successful.

Maintenance

The patient is working to sustain change(s). Clinician's goal is to help maintain change and the clinician's task is to help prevent relapse.

Examples of what the client/patient might say:
  • I have recently become a sponsor in AA.  It has helped me to stay sober.  I haven't drank in over 18 months.
  • In the past year I have stopped going to bars with my buddies and am now going out with my wife more.   We are friends with two other couples and we take turn having pitch-in dinners during football season.
Examples of what a clinician might say:
  • "It's good to see you.  You have maintained your commitment not to drink alcohol for nearly a year. I can see that you have been working very hard."
  • "It sounds like you are feeling great and getting out more with your family. Nice work. I know it hasn't been easy. The benefits are really paying off."

Relapse

Event(s) trigger the individual to return to previous behaviors. Re-engage the patient. Review goals and strategies. Recurrence does not equal failure.

Examples of what the client/patient might say:
  • I slipped up last weekend and went to the bar with a couple of my former drinking buddies.
  • My mom started lecturing me at my sister's wedding.  I ended up at the bar downing a few drinks.
Examples of what a clinician might say:
  • A number of things can trigger someone to drink. You developed a plan that worked for you in the past. What are your thoughts about that?
  • Let's go over what has worked for you in the past and review those strategies.

Next: Decisional Balance -->