Motivational Support & Stages of Change

Clients need motivational support appropriate to their stage of change. If the clinician does not use strategies appropriate to the stage the client is in, treatment resistance or noncompliance could result.

• To consider change, clients at the precontemplation stage must have their awareness raised.
• To resolve their ambivalence, clients in the contemplation stage must be helped to choose positive change over their current circumstances.
• Clients in the preparation stage need help in identifying potential change strategies and choosing the most appropriate ones.
• Clients in the action stage need help to carry out and comply with the change strategies.

The clinician can use brief interventions to motivate particular behavioral changes at each stage of this process. For example, in the contemplation stage, a brief intervention could help the client weigh the costs and benefits of change. In the preparation stage, a similar brief intervention could address the costs and benefits of various change strategies (e.g., self-change, brief treatment, intensive treatment, self-help group attendance). In the action stage, brief interventions can help maintain motivation to continue on the course of change by reinforcing personal decisions made at earlier stages.

Understanding these stages helps the clinician to be patient, to accept the client’s current position, to avoid “getting too far ahead” of the client and thereby provoking resistance, and, most important, to apply the correct counseling strategy for each stage of readiness. Effective brief interventionists quickly assess the client’s stage of readiness, plan a corresponding strategy to assist her in progressing to the next stage, and implement that strategy without succumbing to distraction. Indeed, clinician distraction can be a greater obstacle to change in brief intervention than time limitations. Regardless of the stage of readiness, brief interventions can help initiate change, continue it.

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