Stages of change in Motivational Interviewing, with example patient language
The stages of change come from the transtheoretical model (Prochaska and DiClemente). They are not part of Motivational Interviewing itself, but they are taught alongside it because they give a useful shorthand for where someone stands, and because the MI conversation should sound different at each one.
Treat the stages as a description, not a diagnosis. People move back and forth, sometimes within one conversation, and the same person can be in different stages for different behaviours.
Precontemplation
The person does not see a problem, or does not see it as theirs to solve right now.
What it can sound like
- “I don’t know why everyone keeps bringing this up.”
- “My grandfather smoked until he was ninety.”
- “I’m here because my partner made the appointment.”
What to practise
- Engaging before anything else: open questions about their life, not the behaviour.
- Reflecting sustain talk accurately without adding a “but”.
- Asking permission before offering any information.
- Emphasising autonomy explicitly.
Avoid: Making the case for change. The louder the argument, the stronger the counter-argument.
Contemplation
Ambivalence. The person can argue both sides and often does, in the same breath.
What it can sound like
- “I know I should, but…”
- “Some days I think about it. Then work happens.”
- “It’s not like it’s ruining my life. It’s just… not great.”
What to practise
- Double-sided reflections that end on the change side.
- Evoking DARN change talk: desire, ability, reasons, need.
- Summaries that lay out both sides and ask “where does that leave you?”
- Resisting the righting reflex when the “but” arrives.
Avoid: Rushing to a plan. A plan the person has not argued for is a plan they will argue against.
Preparation
The decision is largely made. The person is thinking about how, when, and what could go wrong.
What it can sound like
- “I’m going to do it after the holidays.”
- “I looked up the clinic. I just haven’t called.”
- “What actually happens in the first week?”
What to practise
- Asking for their plan before offering yours.
- Affirming the steps already taken, however small.
- Elicit–provide–elicit when information is wanted.
- Strengthening commitment language: “What will you do first?”
Avoid: Coaching ambivalence that is no longer there. Re-opening “whether” when the person is on “how” reads as not listening.
Action
Change is under way. The conversation is about effort, obstacles, and slips.
What it can sound like
- “Day twelve. The evenings are the hardest.”
- “I had one on Saturday. Does that mean I’ve failed?”
- “My sister keeps offering me a glass.”
What to practise
- Affirmations that name specific effort, not generic praise.
- Reframing a slip as information rather than failure.
- Open questions about what is working and what has surprised them.
- Supporting their problem-solving rather than supplying solutions.
Avoid: Cheerleading. Applause is not an affirmation, and it can make a later slip harder to admit.
Maintenance
The new pattern has held for a while. The risk is drift, complacency, or a stressor that reopens old habits.
What it can sound like
- “It’s mostly automatic now.”
- “I don’t really think about it, except at weddings.”
- “If my job goes, I honestly don’t know.”
What to practise
- Reflecting the identity change underneath the behaviour.
- Open questions about high-risk situations they can foresee.
- Summaries that connect the change to the values that drove it.
- Leaving the door open without implying you expect relapse.
Avoid: Treating the conversation as finished. Maintenance is a stage, not an exit.
Practising by stage
Most learners find one or two stages far harder than the rest. Precontemplation is hard because everything in a helper wants to argue. Preparation and action are hard in the opposite direction: the temptation is to take over the plan.
Deliberate practice works best when you choose the stage on purpose. If your practice partner or simulation lets you set the patient’s stage, spend a week on the one you avoid, with one focus skill for that week.
For how to hear the change talk and sustain talk that mark each stage, see change talk and sustain talk. For a week-by-week plan, see practice after a workshop.
Questions, answered plainly.
What are the five stages of change?
Precontemplation (not seeing a problem), contemplation (ambivalent), preparation (deciding how and when), action (changing), and maintenance (sustaining the change). Some presentations add termination or treat relapse as a stage; MI training usually works with these five.
Are the stages of change part of Motivational Interviewing?
No. They come from the transtheoretical model and were developed separately. They are taught with MI because they help a clinician match the conversation to where the person is, but MI can be practised without them.
How do I tell which stage a patient is in?
Listen to how they talk about the behaviour rather than asking them to pick a stage. Sustain talk with little change talk suggests precontemplation; both sides at once suggests contemplation; talk about how and when suggests preparation; talk about effort and slips suggests action or maintenance. Expect it to shift.
What should I practise for a precontemplation patient?
Engaging without an agenda, reflecting sustain talk accurately, asking permission before information, and naming the person’s autonomy. The hardest part is not arguing, which is why it rewards deliberate practice with a partner or simulation that will actually hold the position.
Should a clinician stop using MI once a patient reaches the action stage?
No. The spirit and skills stay the same; the content changes. Reflections and affirmations support effort, open questions explore obstacles, and the person still owns the plan. What should stop is exploring ambivalence that has already resolved.
Practise the precontemplation patient who won’t cooperate.
MI Mastery generates a new patient for every session and plays them at the stage of change you choose, holding their reasons back until you earn them. Three short sessions a month are free.
Also see: Practice MI after a workshop·MI glossary