Assess the Patient's Motivation: Readiness to Change

People tend to pass through different stages in the process of changing (Prochaska and DiClemente 1982; Prochaska and Velicer 1997). The stages are as follows:


  • Pre-Contemplation: Not thinking about change. Includes those who never thought about it and those who did and decided not to change.

  • Contemplation: Starting to think about change. May want to change and to stay the same at the same time.

  • Preparation: Beginning to make a plan to change. Starting to take some action in that direction.

  • Action: Implementing plan to change.

  • Maintenance: Keeping change over a period of time.

The process of change is often cyclical, with patients who relapse typically returning to the pre-contemplation or contemplation stage (Ingersoll et al. 2000; Rosengren and Wagner 2001).

Motivational interviewing should focus on what a patient needs at his or her current level of readiness in order to change (Ingersoll et al. 2000; Rosengren and Wagner 2001). For instance, someone who is in the contemplation stage may need help examining their ambivalence rather than ways to cope with cravings after quitting. Do not encourage patients to skip a stage.

Monitor the patient's readiness for change on an ongoing basis (Emmons and Rollnick 2001). Assuming greater readiness for change than the patient actually has is likely to produce resistance.


Emmons K, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74.

Ingersoll KS, Wagner CC, Gharib S. Motivational Groups for Community Substance Abuse Programs. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. Richmond, VA. 2000.

Rosengren D, Wagner CC. Motivational interviewing: shall we dance? In: Coombs R, ed. Addiction Recovery Tools: A Practitioner's Handbook. Sage Publications. 2001.

Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19: 276-288.

Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion. 1997; 12: 38-48.