Stages of Change and Motivational Interviewing

The stages of change are precontemplation, contemplation, preparation, action and maintenance: five descriptions of how ready a person is to alter a behaviour. They belong to the transtheoretical model, developed by James Prochaska and Carlo DiClemente from 1983, and not to Motivational Interviewing. Clinicians pair the two so routinely that many assume MI is built on the stages. It is not, and Miller and Rollnick have said so in print: you do not have to place a client in a stage in order to practise MI well.

That distinction is the useful part of this page. The stages are a good way to think about who is sitting in front of you. They are a poor way to run a session, and the gap between those two things opens widest in precontemplation, where the pull to hurry someone along is strongest.

What are the five stages of change?

Prochaska and DiClemente built the model by studying what people did when they changed a behaviour on their own, rather than what treatment did to them. Each stage describes intention and behaviour together, which is why “not ready” and “not trying” turn out to be different states.

Precontemplation

No intention to change in the foreseeable future. The person may not see a problem at all, or may have stopped believing change is possible after earlier attempts. Almost always, someone else in their life is more worried than they are.

“I don’t drink any more than my mates do. My wife’s the one with the problem.”

Contemplation

The problem is recognised and change is under consideration, without commitment. This is where genuine ambivalence lives, and people can stay in it for years. Both halves of the argument are available to them, often inside one sentence.

“I know it isn’t doing me any favours. I just don’t know what I’d do with my evenings instead.”

Preparation

Intention plus early movement. The person means to act within roughly the next month and has usually already tried something in the past year: cut down for a week, looked up a service, told a friend.

Action

The behaviour has changed and the effort is recent and visible. Action is the stage everyone notices, and it is shorter than most people expect.

Maintenance

Holding the change and working to avoid a return to the old pattern. For addictive behaviours the Cancer Prevention Research Center, which holds the model’s research base, describes maintenance as beginning around six months and running on with no fixed endpoint.

Some accounts add a sixth stage, termination, for the point where the old behaviour has no pull left at all. The model’s own centre does not, and treats relapse as regression to an earlier stage rather than a stage of its own. It also records something worth carrying into clinical work: among people who regress on smoking or exercise, only about 15% go all the way back to precontemplation. Most land in contemplation or preparation and set off again from there.

How do the stages of change relate to Motivational Interviewing?

They grew up alongside each other and were never the same thing. Both were presented at the same conference on addictive behaviours in 1984, and the stages handed MI something it needed: a reason why a method aimed at motivation was necessary at all. If most people arriving in treatment were not yet decided, building motivation became part of the clinical job rather than a precondition for starting it.

Miller and Rollnick addressed the relationship directly in a 2009 paper listing ten things MI is not. The first item on the list is the transtheoretical model. They call the two “kissing cousins who never married” (Miller and Rollnick, Behavioural and Cognitive Psychotherapy, 2009). TTM sets out to explain how and why change happens in general. MI is a clinical method for strengthening one person’s motivation in one conversation. Neither depends on the other.

Two consequences follow, and both are stated plainly in that paper. You do not need to explain the stages to a client in order to deliver MI. You do not need to assign anyone to a stage before or during it. The authors took the point far enough that when they revised Motivational Interviewing for its second edition in 2002, they removed TTM from the half of the book they wrote themselves, precisely because readers were conflating the two models. DiClemente and Velasquez then contributed a chapter to the edited half examining how the two actually fit together.

The stages are context. They are not procedure.

What changes in the room at each stage?

Stage does not change the method. It changes what you are likely to hear, and therefore which part of the method carries the session.

Stage	What you tend to hear	Where MI puts its weight
Precontemplation	Sustain talk, disagreement that there is a problem at all	Engaging. Reflection, and no agenda for change yet
Contemplation	Both sides of the argument in one breath	Evoking. Selective reflection of the change-talk side
Preparation	Desire and ability hardening into commitment	Evoking into Planning. Key questions, options rather than advice
Action	Taking steps, and the first setbacks	Planning and affirmation, with evoking still running underneath
Maintenance	Confidence, boredom, quiet drift	Affirmation, and re-evoking when the original reasons go silent

Read down the right-hand column and the pattern is that MI does the same four things throughout: engaging, focusing, evoking and planning. Stage tells you where in that sequence a conversation is likely to need you. It does not tell you which technique to reach for, and treating it as though it does is how stage thinking starts to do harm.

What precontemplation sounds like when it goes well

Precontemplation is where the model is most often misused, so the alternative is worth seeing in full.

Client: “I’m only here because the court told me to be.”

Clinician: “You’d rather be somewhere else, and you turned up anyway.”

Client: “Yeah. And I’m not going to sit here and say I’ve got a drink problem, because I haven’t.”

Clinician: “You want me to hear that from you rather than read it off the paperwork. So tell me how you see it.”

Nothing there labels the client, argues with him, or tries to shift him a stage. The clinician reflects, hands back the autonomy the setting has already taken, and asks. What is being resisted is the righting reflex, the pull to supply the argument for change on the client’s behalf, and precontemplation is where it bites hardest because the distance between what the clinician can see and what the client will say is at its greatest. That gap is widest of all in substance use work, where the visible harm is severe and the client has usually heard the argument already.

Where stage thinking goes wrong

Stage as a label. “He’s precontemplative” becomes an explanation for why a session went nowhere, and it locates the reason entirely inside the client. Sustain talk is usually information about the conversation as much as about the person. When it climbs, the more useful question is what the clinician did in the preceding minute.
Stage matching taken literally. Deciding that a client in contemplation gets technique A and one in preparation gets technique B turns a description into a protocol. Clients move between stages inside a single session, and the practitioner who has committed to a plan based on an opening assessment is the last to notice.
Decisional balance in the wrong place. Weighing the pros and cons of change, codified by Janis and Mann in 1977, is often taught as a contemplation-stage tool. Miller and Rollnick listed it as one of several ways to elicit change talk from clients who offer very few arguments for it, and warned that it can work against MI: a thorough exploration of both sides invites the client to rehearse and strengthen the case for staying as they are. Use it when you genuinely intend not to tip the balance. Do not use it as a routine step because someone is in contemplation.

How to practise reading the room

Noticing a shift in readiness while it is happening is a perception skill, and perception skills do not improve by reading about them. They need repetitions on conversations that actually move.

The MI Practice Lab runs voice conversations with AI clients written to sit at different points on that continuum, including the mandated, flatly precontemplative ones that colleagues in peer practice find hard to play convincingly. Afterwards you get the session mapped against the four processes, your change talk and sustain talk marked up with the moment each appeared, and Critical Moments flagging where the client’s readiness moved and the conversation did not follow. That last one is the reading-the-room skill made visible.

For how the practice methods compare, see how to practise Motivational Interviewing.

Frequently Asked Questions

What are the 5 stages of change?

Precontemplation (no intention to change in the foreseeable future), contemplation (aware of the problem and weighing it up, without commitment), preparation (intending to act within about a month, usually after a recent attempt), action (the behaviour has visibly changed), and maintenance (holding the change and guarding against a return to the old pattern). They come from the transtheoretical model developed by Prochaska and DiClemente from 1983.

Is Motivational Interviewing based on the stages of change?

No. Miller and Rollnick have stated directly that MI was never based on the transtheoretical model. The two emerged in the same period and in the same field, and they fit together comfortably, but TTM is a model explaining how change happens while MI is a clinical method for building motivation in a conversation. The second edition of Motivational Interviewing removed references to TTM from the authors’ own chapters specifically because the two were being confused.

Do I need to assign a client to a stage before using MI?

No, and Miller and Rollnick say so explicitly. Neither explaining the stages to a client nor placing them in one is a necessary part of delivering MI. Knowing roughly how ready someone is will shape what you expect to hear, but MI itself works the same way at every point on the continuum: engage, agree a focus, evoke the person’s own reasons, and plan when they are ready to.

What is the difference between the transtheoretical model and Motivational Interviewing?

The transtheoretical model is a theory of behaviour change that describes stages, processes and decisional factors across many behaviours and settings. Motivational Interviewing is a method for conducting a conversation so that a person voices and strengthens their own arguments for change. One explains why change happens; the other is something you do in a room with someone.

Is relapse a stage of change?

Not in the model as its own research centre presents it. Relapse is described as regression, a movement back to an earlier stage rather than a stage in its own right. That distinction is practically useful, because most people who regress do not return to precontemplation: for smoking and exercise the figure is around 15%, with the majority landing in contemplation or preparation and starting again from there.

Which stage is hardest to work with?

Precontemplation, though usually for the clinician’s reasons rather than the client’s. The gap between what you can see and what the client will acknowledge is at its widest, which makes the righting reflex hardest to suppress. Arguing for change at this point reliably produces sustain talk, so the work is engaging and reflecting rather than persuading.

Want to practise with a client who is not ready yet? The MI Practice Lab includes mandated and precontemplative scenarios, then shows you where the client’s readiness shifted and whether your side of the conversation shifted with it. Start a free trial: 5 minutes, no card required.