Stages of Change, Twenty Years On

 

A few weeks ago I was running a session for a programme team, and I found myself showing a PowerPoint I have shown for the better part of forty years. A circular diagram leading from one position to another. Precontemplation, contemplation, preparation, action, maintenance. Someone in the room asked, half joking, whether this was the bit where we tell them the model has been debunked.

 

It was a fair question, and it has stayed with me since.

 

The Stages of Change model, or the Transtheoretical Model if you want its full name, came out of smoking cessation research in the 1980s and 90s. From there it spread into almost every part of behaviour change work, including the family violence and AOD fields most of us are working in now. The idea behind it was a good one. Change is not a single decision made on a single day. People move through a process, often at very different speeds, and they circle back before they move forward again.

 

For our field, that idea fit really well. It gave practitioners a way to talk about relapse without treating it as failure. It gave us a shared language for ambivalence, at a time when a lot of services still expected everyone to be ready to act from the first session.

 

What I had not fully clocked, until I went back and read around it properly, is that there was already a public argument about all this twenty years ago. In 2005, a paper in the journal Addiction suggested it was time to retire the model altogether. Carlo DiClemente, one of the people who developed it, wrote back almost immediately to say the obituary was premature. Twenty years on, that argument still has not really been settled. Researchers who study behaviour change closely have moved a long way from the model. Practitioners, in my experience, have not moved very far at all. We still write that a client is “in the action stage.” We still describe someone as “not ready to change,” as though that were a fixed property of the person rather than a description of one conversation on one day.

 

In DFSV work especially, I have come to be wary of the word “ready.” It is meant to describe where someone is at, but it can quietly start doing a different job. “He’s not ready for the programme yet” can become a reason for a service to step back, rather than a prompt to ask what kind of conversation might help readiness grow. And readiness becomes something we wait for, when often it is something a good conversation helps to build.

 

So where does that leave me, forty years into working with the model?

 

Here is what I have settled on. The five stages, as a staircase that someone climbs in order, I am happy to let go of. People rarely move through their lives that tidily. A man can be well into “action” on his drinking and still firmly in “precontemplation” about how he speaks to his partner. Someone might be ready to leave a relationship long before they are ready to leave the substance use tangled up in it.

 

But underneath those five stages sit ten processes of change, and these I still use constantly. Five of them are essentially emotional. Becoming more aware of your own patterns. Sitting with the discomfort of seeing yourself clearly. Asking how a behaviour fits with the person you want to be. Noticing the effect you are having on the people around you. Seeing your own struggle as part of something wider than just you. The other five are more practical. Changing your environment so old triggers are easier to avoid. Swapping an unhelpful response for a better one. Noticing what is working and building on it. Making a clear, witnessed commitment. And finally, identifying the people who can help hold the new direction when motivation dips.

 

What I find useful now is not asking what stage someone is in, but noticing which of these things is actually happening in the room. Sometimes a person is doing real work, but it is entirely in that emotional register. They are starting to see something about themselves they could not see before. Other times, the emotional work has already happened, and what is needed is something much more concrete, like a plan for what to do the next time things get risky at home.

 

Motivational Interviewing never actually needed the staircase to work. It works with whatever ambivalence is in the room, regardless of what a chart might say about someone’s stage. But MI draws on those processes all the time, often without naming them. A good reflection can do consciousness raising in a single sentence. Helping someone name who they can call when things get hard is helping relationships, whether or not anyone has decided what stage they are supposedly in.

 

So perhaps that is my answer to the question in the training room. The PowerPoint is not wrong, exactly, but it is not the useful part. The useful part was underneath it the whole time, in the different kinds of work that make up real change, emotional and practical, and in learning to notice which one is needed right now.

 

I am grateful, as always, for the practitioners who keep asking these questions. It is how our thinking stays honest.

 

 

Published on Tuesday, August 11th, 2026, under Motivational Interviewing, Programme design & development, What Ken thinks

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