Stages of Change


  • Patient’s (usually) don’t suddenly wake up one day and decide to make huge lifestyle changes
  • People may be at very different places with how ready they are to make a change, and it is important to be aware of this

Pre-contemplative: comfortable with the unhealthy behavior, unaware of (or not willing to admit) drawbacks to the status quo

Contemplative: ambivalence, can see both the pro’s and the con’s …  “yes I know, but…”

Planning: ready and willing to change behavior, figuring out the “how”

Action: able and doing

Maintenance: action for 6 months

Relapse: may occur at any stage, normal part of change process





  • Consider it a win if your patient is able to move one step forward during your visit… even if you don’t see it immediately, after the visit they are thinking about the conversation
  • Pushing too much may have negative effects, and make the patient less likely to change
    • repeating negative outcomes about the health behavior (which the patient is likely already aware of) may backfire–making the patient more resistant to change
    • you can pick up on when this is happening by recognizing resistance
  • It is important to be able to diagnose the Stage of Change in order to most effectively tailor your counseling towards the patient who is sitting in front of you
    • e.g. talking about how to do calorie counting with a pre-contemplative patient will be counterproductive!


In the example videos starting in Lesson 4, you will see patients in different stages of change and observe how the clinician tailors their counseling tools & techniques during the interview.