Stages of change worksheets
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Are you a therapist looking for a stages of change worksheet? You’re in the right place.
This guide to the stages of change gives mental health therapists a free stages of change handout that you can save to your electronic health record (EHR) and use with clients in your therapy practice.
In addition to the stages of change worksheet, you’ll find an overview of the change model and suggestions on how to use it in therapy.
What are the stages of change?
The stages of change model, also known as the transtheoretical model of change (TTM), was developed by researchers James Prochaska and Carlo DiClemente in the late 1970s after analyzing data from former smokers who successfully quit on their own.
The researchers wanted to better understand how some people were able to stop smoking on their own, while others struggled. They concluded that the key to stopping smoking was being ready to do so, and that getting to the state of “being ready to stop” involved several stages.
The stages of change worksheet and model can be used in several health-related fields, including substance use treatment and weight management.
The steps involved in the stages of change include:
Precontemplation
During this initial stage, precontemplation, individuals are not yet considering change. They may be unaware of the need for change, may deny the problem exists, and lack awareness of the consequences.
At the precontemplation stage, which usually lasts around six months, clients might resist or be uninformed about their problem. Or, they may underestimate the pros and cons of making a change.
Contemplation
Next is the contemplation stage, when individuals recognize a problem and contemplate change within the next six months. They weigh the pros and cons of behavior change more practically, but have yet to commit to action.
The contemplation stage can last a long time as they contemplate the change, and some individuals may still be ambivalent about it.
Preparation (determination)
During the preparation stage, people are ready to take action and begin developing a plan for behavior change within the next 30 days. They may start taking small steps toward change or gather information on how to make a significant change.
Action
As the name suggests, in the action stage, the person actively engages in the change process and intends to keep moving forward. Using a stages of change worksheet, they can write down and make visible lifestyle changes and acquire new healthy behaviors.
Maintenance
At the maintenance stage, the person has sustained their changes for more than six months and intends to continue the behavior. People in the maintenance stage are actively working toward relapse prevention by identifying and coping with triggers.
People stay at this stage anywhere from six months to five years. One of the reasons the maintenance stage is prolonged is because of a high risk of relapse. For instance, the risk of relapse for people who stopped smoking remains at 43% after 12 months. At the five-year mark, the risk of relapse drops significantly to 7%.
The final stage of the TTM is termination. However, it is often excluded from the model because some experts believe it is challenging to achieve, as it describes experiencing zero temptation for relapse. For example, the consensus of addiction recovery professionals is that to maintain sobriety, individuals will need to remain engaged in recovery activities indefinitely.
Stages of change for addiction example
The stages of change addiction model, or stages of change therapy process, might look like this:
1. Precontemplation: Sara is considered a “high-functioning drinker.” She drinks a bottle of wine every night but maintains her job. She has not experienced any legal or health consequences at this stage but is telling her doctor about feeling anxious and depressed. However, Sara is unable to connect her mental health to substance use.
2. Contemplation: Sara may start going for drinks after work because her partner has started commenting on her drinking at home. While driving home, she is pulled over and receives a citation for drinking while intoxicated. She is starting to become aware of the consequences of her drinking but is not yet ready to stop.
3. Preparation: Sara realizes she has a problem and needs to stop. She might look for a local AA meeting or outpatient program to attend in the near future.
4. Action: Sara talks to her doctor about being referred to a treatment program and takes steps to attend. She stops drinking for several months, but often thinks about returning to use.
5. Maintenance: Sara has completed the outpatient program and regularly attends community recovery meetings. She has been sober for 12 months.
Some stages of change models describing substance use recovery often include a relapse step.
While this is not officially recognized as a stage in the overall TTM, the reality is that relapse can occur during any of the previous stages.
Like other chronic conditions, substance use disorder is defined by the National Institute on Drug Abuse as a chronic relapsing condition. It is important for individuals to understand that setbacks are common and to learn from them rather than feeling discouraged. This is why the stages of change handout includes a section for relapse to reflect and learn from setbacks.
How to use the stages of change worksheet
The stages of change worksheet can be used in sessions with clients to illustrate the change process and develop therapeutic goals and strategies for each step in the TTM.
The stages of change handout can also be used as part of the treatment planning process.
The free stages of change worksheet at the top of this article can be downloaded and used as a tool in your therapy practice—helping individuals identify their behavior and make lasting change.
Sources
- Center for Substance Abuse Treatment. Brief Interventions and Brief Therapies for Substance Abuse. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999.
- Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta-analysis. Journal of clinical psychology.
- LaMorte, W. (2022). The Transtheoretical Model (Stages of Change). Boston University School of Public Health.
- NIDA. (2011). Drug Misuse and Addiction.
- Pacheco, I. (2012). The stages of change. Social work tech.
- Petrocelli, John. (2002). Processes and Stages of Change: Counseling With the Transtheoretical Model of Change. Journal of Counseling & Development.
- Raihan N, Cogburn M. (2023). Stages of Change Theory. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
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