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Stages of Change

How Do We Address PreContemplating Individuals?

Establish Rapport

♦ Build trust first – you may need to begin that with some issue other than the “problem” behavior.

♦ Explain that you will not be telling them what to do or how to change.

♦ Explain that they will be doing most of the talking because you want to know what is happening in their life and how they feel about it.

♦ Invite comments about what they hope to achieve.


♦ Discuss the events that precipitated treatment.

♦ Acknowledge strong emotions by using reflective listening.

♦ Ascertain what they see and believe to be true.

Contemplating Individuals?

Help the person tip the balance scales towards change by:

♦ Eliciting and weighing the pros/cons of changing vs. not changing

♦ Shifting the focus from extrinsic motivation to intrinsic motivation

♦ Examining personal values and how they fit or don’t fit with use/current behaviors

♦ Other issues: Loss and grief, reservations/resistance, premature decision making

♦ Emphasizing free-choice, responsibility and self-efficacy (I can do this!) for change

Preparation Individuals?

♦ Clarify the person’s own goals and strategies for change.

♦ Offer options for change or treatment.

♦ With permission, offer expertise.

♦ Consider barriers to change and lower them.

♦ Help the person enlist social support.

♦ Explore treatment expectancies & person’s role.

♦ Elicit what worked in the past

♦ Negotiate and problem-solve potential barriers (transportation, finances, etc).

♦ Have the person publicly announce a plan to change.

Action Individuals?

♦ Engage the person in treatment and reinforce the importance of remaining in recovery.

♦ Support a realistic view of change through small steps.

♦ Acknowledge difficulties in early stages of change.

♦ Help them identify high-risk situations and develop appropriate strategies.

♦ Assist with finding new reinforcers of positive change. Maintenance Individuals?

♦ Do not imply that relapse is the same failure; this implies there are only 2 outcomes, success or failure.

♦ Provide support when the person is feeling discouraged to avoid quitting.

♦ Ask for the person’s perceptions of their use and their own reasons for still wanting to change.

♦ Have your person talk about the advantages of sobriety.

♦ Revisit values, hopes, purpose and goals in life.

Recurrence Individuals?

♦ Recurrence is not considered a stage but rather, an event that can occur at any point along the recovery path.

♦ Be supportive and curious - avoid lecturing or framing it as a failure.

♦ Use reflective listening.

♦ Normalize the experience as common.

♦ Explore what was learned from the experience, perhaps within a functional analysis.

♦ Encourage discussion of the advantages of abstinence.

♦ Elicit self-motivational reasons for change, the reasons to get back on track.

♦ Explore the Client’s values, hopes, purpose and life goals.

♦ Assess the person’s current stage of readiness for change. Use interventions that are matched to this stage.

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