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Motivational Interviewing: Stages of Change

What is Motivational Interviewing?

Therapist going over the stages of change motivational interviewing with a patient

Motivational Interviewing (MI) is a specific approach in psychotherapy that began when William Miller published an article that covered principles for interviewing individuals who were abusing alcohol. Later, Miller worked with Stephen Rollnick to define the MI technique as well as the stages of change, and many of its principles have subsequently received quite a bit of exposure.

Because individuals with substance use disorders are often at different stages regarding their understanding of their behavior, Motivational Interviewing was originally developed as a method to enhance motivation and understand where a person with a substance use disorder stood regarding their understanding of their need to change their behavior. The MI technique has developed into an overall form of interviewing and even counseling that now is applied under many different circumstances. The core concept of MI is the outline of the process of change (the stages of change). This article will discuss the stages of change according to the MI model.

MI Stages of Change

The developers of Motivational Interviewing accepted the fact that people who enter treatment for a substance use disorder are at different levels regarding their perception of their behavior and the need to change or not the change their behavior. After interviewing many individuals with different types of substance use disorders, the MI stages of change concept was developed and refined to help identify where individuals stood regarding their understanding of their issues as they enter treatment.

Not everyone begins treatment at the same level of understanding. The MI model proposes that the process of change occurs according to the following stages:

  • Stage I – Precontemplation: In the earliest possible stage, the person may be experiencing some negative ramifications as a result of their behavior (e.g. substance use/abuse) but they do not view these issues as being serious enough for them to consider changing their behavior. In the precontemplation stage, individuals have little interest or motivation to change.
  • Stage II – Contemplation: In this stage, the person may realize that their behavior is leading to problems (e.g., substance use/abuse); however, they remain ambivalent about actually changing. The person may have been considering making a change or may even desire to change, but the person has not actually made a commitment to change. In this stage, individuals are often open to the suggestion that they need to change their behavior, but they have not made any efforts toward actually changing their behavior.
  • Stage III – Preparation: During this stage, the person may actually have weighed out the positive and negative aspects of their behavior and concluded that the negative aspects outweigh any benefits they are getting. The person has made a commitment to change and understands that they are responsible for changing. They may have developed a plan or tried to conceptualize how they might make changes, but they have not yet taken any formal action.
  • Stage IV – Action: In this stage, the person is actually involved in an effort to change their behavior. Any effort to change their behavior qualifies as being part of the stage. In this stage, the person understands that they have to change their behavior and they are also the one who must make the changes even if they require assistance from others.
  • Stage V – Maintenance: In this stage, the person has developed a level of efficiency that allows them to change their behavior and may have firmly established new behavioral patterns. These individuals are still working on change, but they have become proficient at whatever actions they need to make in order to change the behavior. Often, sources suggest that in order for an individual to actually qualify to be in the maintenance stage, their changes must have been in place for six months.
  • Stage VI – Termination: In the termination stage, the person has adopted all of the changes they need to make and is able to overcome any new obstacles. They may not actually quit or terminate their participation in a formal treatment program, such as therapy or 12-Step groups, but they have been able to overcome the issues they faced regarding changing their behavior, have maintained their new behavior, and are moving forward.

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It is important to understand that this model does not represent a linear process, such that an individual starts at Stage I and progresses to the final stage. The MI model assumes that different individuals start the process at different points along the stages; individuals can experience setbacks and drop back one or more stages and need to start over; and even individuals in the final stage of the model may still need to make changes and adjustments. Anyone who understands the treatment process understands that few individuals actually change difficult behaviors without setbacks. With respect to individuals with substance use disorders, many individuals often experience a relapse in the mist of being relatively accomplished in changing their behavior and often need to start over.

The model can be used by therapists who can attempt to ascertain where a particular individual stands regarding their understanding of their need to change their behavior, what stage of change they may be in, and then therapy can be individualized to suit the particular situation. Thus, an individual who is forced into therapy in the precontemplation stage would require a different approach than an individual who is already in the action stage.

The model has been demonstrated to have significant utility regarding this aspect of treatment.

Research studies investigating the effectiveness of the applications of Motivational Interviewing indicate that its use does have advantages over standard traditional interviews, and outcomes using MI are at least as effective as other forms of treatment for individuals who have substance use disorders. The principles of MI have also been applied to treatment for individuals with compulsive gambling issues, anxiety disorders, and depression. MI has also been applied in the areas of health education and has been used to identify and understand different styles of parenting.

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