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What are the Stages of Change and Why Are They Important? Part 2

Jessica Pontis, LCSW

In my previous post about the stages of change, I discussed the different stages of change and how they may present within the context of a person’s experience with smoking.  Having outlined the stages, let’s focus our attention in part two of this discussion on how a clinician can appropriately assess where a client is in the change model and stage-appropriate strategies that could be applied.  

Assessing and Assisting in Precontemplation. 

When a clinician first discusses goals with a client it is important to discuss the client’s feelings about certain behaviors.  Going back to the example of smoking if a clinician asks about a client’s feelings regarding this behavior and is met with denial regarding the risks of smoking, feeling like they can’t control their smoking so why bother to try, or believes that the consequences of smoking are not serious, then this client would more than likely fall in the pre-contemplation stage.  

In this stage, some strategies that a clinician can use to support this client would start by gathering a history of how smoking has impacted this client’s life, including how it may or may not hinder the achievement of other goals.  The clinician can also work to provide some education around the risks related to smoking if the client is not already aware and can work to create hope around minimizing these health risks through change.  

Assessing and Assisting in Contemplation.

If a clinician notices that a client is beginning to weigh the pros and cons of smoking, or they begin reporting feeling that smoking is now having more of a negative impact than a positive one then this client would move into the contemplation stage of change.  

Supporting a client in the contemplation stage of change could look like assisting in the client’s analysis of the pros and cons of smoking, and may gently (with respect to where the client is and the client’s ultimate goals) guide the client in the direction of change that supports the client’s wellness.  

Assessing and Assisting in Preparation. 

The clinician may notice that a client is toying with the idea of what change looks like.  In the example of smoking, the clinician may hear things like, “I might try cutting back to only half a pack a day,” or “I feel like I want to come up with a plan to stop smoking entirely.”  These thoughts are a good indication that a client is in the preparation stage of change.  

Here a clinician’s role could look like helping the client determine what their commitment to this change looks like, and help to identify what barriers and support would be to quitting smoking.  A clinician could also provide choices in additional supports (self-help groups, online resources, referrals, etc.) with the consent of the client.  

Assessing and Assisting in Action. 

If a client is now accomplishing steps outlined in their plan and taking direct action to stop smoking, that client has now moved into action.  This may look like actively avoiding triggers or managing stress in a different way or utilizing tools to minimize cravings.  

When a client is in the action stage it is important that the clinician continues to help the client identify and manage hurdles as they come up, and support the client in the development of new coping strategies.  Helping the client track progress and validating efforts are also helpful strategies during this stage of change.  

Assessing and Assisting in Maintenance.  

If a client is presenting with feelings that they have accomplished their goals in changing their behaviors around smoking and is working on the up-keep of newer behaviors, then this client has moved into the maintenance stage of change.  

A clinician’s role in this stage could be continuing to track gains and benefits related to reducing or ceasing smoking. Continue assisting clients in identifying potential triggers as they arise to help prevent relapse and support the client in actively maintaining the changes they have made.  

I hope this information is helpful for both clients and clinicians as they work together to achieve goals and create collaborative change.  If you feel that you would like to connect with someone to walk with you on this journey reach out to one of the licensed therapists with Symmetry Counseling.  You can reach out to us online at, or by calling us at (312) 702-5512 to set up an appointment.

Zimmerman, G. L., Olsen, C. G., & Bosworth, M. F. (2000, March 1). A ‘stages of change’ approach to
helping patients change behavior. American Family Physician. Retrieved October 28, 2021, from

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