The Stages of Change in Motivational Interviewing

With a partner, read the definition of the Pre-contemplation stage and the coach’s goal:

Definition: An associate in the Pre-contemplation stage does not intend to change his or her behavior, and is often unaware of the problem.

Coach’s goal: If the associate is in this stage, your goal is to help the associate consider whether or not he or she has a problem. Explore why the associate does or does not believe it is a problem and help him or her identify discrepancies. However, avoid specifically pointing out the problem.

Then discuss:

• Why can it be difficult to help someone in the Pre-contemplation stage?
• How can you help associates consider whether or not they have a problem, without pointing it out to them?
• What have you done to explore why an associate does or does not believe the issue is a problem?
• What else can you do to help an associate in the Pre-contemplation stage?

Each of you role-play helping an associate who is in the Pre-contemplation stage (with whatever AWARE or other problems the associate may have). Be helpful when providing feedback and discuss additional questions or insights you received during the role-play.

As a group, read the following quote:

“There is a myth . . . in dealing with serious health-related addictive . . . problems, that more is always better. More education, more intense treatment, more confrontation will necessarily produce more change. Nowhere is this less true than with precontemplators. More intensity will often produce fewer results with this group. So it is particularly important to use careful motivational strategies, rather than to mount high-intensity programs . . . that will be ignored by those uninterested in changing the . . . problem behavior. . . We cannot make precontemplators change, but we can help motivate them to move to contemplation” (Carlo C. DiClemente, quoted in SAMHSA/CSAT, “Enhancing Motivation for Change in Substance Abuse Treatment,” Treatment Improvement Protocol [TIP] Series, No. 35 [1999]).

Consider the following questions and record your answers in your learner’s journal:

• Why might someone seek help even though they feel they don’t need it?
• Why is it important to take a careful approach when helping pre-contemplators?
• Why is it so important that the individual needing the change arrives at that conclusion on his or her own?
• Why are high-intensity approaches ineffective with pre-contemplators?
• Whose efforts are primarily responsible for any change that comes from high-intensity treatments and confrontations?

Share your ideas with the group.

Divide into pairs to role-play a motivational interview where you would discuss an associate’s negative behavior. The person playing the associate will select a behavior issue such as attendance, arguments with coworkers, or an addiction. Take turns acting as the job coach trainer and the associate. Follow the guidelines for each role described below:

Associate: The associate is in the Pre-contemplation stage, meaning that the associate has no intention of changing his or her behavior. The associate might even be unaware of the problem behavior.

Job coach trainer: The job coach trainer’s goal is not to convince the associate to change, but rather, to help the associate consider whether or not he or she has a problem. Explore why the associate does or does not believe the behavior is a problem, help him or her identify discrepancies, and help the associate see both positive and negative outcomes of the problem behavior. Avoid specifically pointing out the problem.

The role-play is not meant to be perfect or comfortable, but merely to help you begin thinking about how to apply useful skills and techniques.

After the role-play, discuss the following questions with your partner:

• What did you like about using this approach?
• What did you find difficult about using this approach?
• What did your partner feel was successful?
• What did your partner feel could have been improved?
• How often do you find yourself pushing associates to make certain changes?
• How might this approach help associates to make the decision to change on their own?

With a partner, read the definition of the Contemplation stage and the coach’s goal:

Definition: An associate in the Contemplation stage is aware of the problem and is seriously considering a change, but has made no commitment to take action.

Coach’s goal: If the associate is in this stage, your goal is to raise the awareness of the problem by observing the behavior. Point out the observed behavior, but do not tell the associate that the behavior is a problem.

Then discuss:

• Why is it important to recognize that the associate is already aware of the problem?
• What might be some of the reasons an associate has not yet committed to take action?
• What could you say to an associate to raise the awareness of the problem?
• Why is it important to point out the behavior at this stage, yet refrain from telling the associate that the behavior is a problem?
• What have you done to help an associate in the Contemplative stage to move to a more advanced stage of change without violating their agency?

Each of you role-play helping an associate who is in the Contemplation stage. You may refer to Resource 2 in the “Lesson Resources” section for ideas, or you may come up with a scenario on your own (inspired by a current set of events with an associate). Be helpful when providing feedback and discuss additional questions or insights you received during the role-play.

When a job coach trainer, staff member, or missionary feels that an associate is ready to move from the Contemplation stage to the Preparation stage, the natural instinct might be to set the goal for the associate. However, job coach trainers should resist this instinct. Instead, they should ask, “What’s next?”

In your learner’s journal, answer the following questions:

• Why is it important for the associate to be the one that makes the decision and sets a goal?
• Why do job coach trainers sometimes make those decisions for their associates?
• What is the main factor preventing you from letting your associates drive this process (time constraints on you or the associates, ingrained habits, desire to help them set the right goals, etc.)?
• What can you do today in order to resist setting goals for your associates?

Share your insights, and discuss any questions you may have about how to help associates who are in the Contemplation stage.

As a group, role-play situations dealing with associates who are in the Contemplation stage. Select three participants to play the role of an associate. Each “associate” will receive a piece of paper with either ready or not ready written on it, and will answer questions accordingly. As a group, ask questions to each of the associates to determine whether or not he or she is ready to move to the Preparation stage of change.

The following tools can aid this discussion with the “associate”:

• Create a list of pros and cons for change.
• Use the “magic question”: “If you stopped ________________ (insert behavior), what would your life look like?”
• Use reflective listening: “It sounds like you are really thinking about this.”
• Be prepared to deal with resistance. Don’t be discouraged if you think the associate might change his or her mind. This is normal.
• Express your confidence in the associate’s ability to change.
• Summarize the discussion and set a time to talk about it again.
• Remind the associate of past successes.

After you are finished with all role-plays, as a group discuss:

• What did you learn from this activity?
• What additional insights do you have about determining whether an associate is ready to move to the Preparation stage or not?
• What insights would you like to share with the rest of the participants about how to help associates who are in the Contemplation stage?

With a partner, read the definition of the Preparation stage and the coach’s goal:

Definition: An associate in the Preparation stage intends to change and makes small behavioral changes.

Coach’s goal: When the associate is in this stage, your goal is to encourage and support the steps the associate takes toward change. If the associate slips back into a previous stage, be aware and patient. This is not a sign of failure; only of conflicting feelings.

Watch the first 3 minutes and 20 seconds of the video “The Prodigal Son” (BibleVideos.org). As you watch, identify the moment when you think the prodigal son entered the Preparation stage. Following the video, divide into small groups and discuss the following questions:

• When does the prodigal son enter the Preparation stage?
• What events pushed the prodigal son from ambivalence about change to intending to change?
• What concerns would the prodigal son be likely to have when contemplating his return (humiliation, prospect of servitude, etc.)?
• When the prodigal son “came to himself,” did he expect to have an easy path of return? Why was he so willing at that point to face the obstacles and work to change?
• What lessons does the Savior offer job coach trainers through this parable? What can this parable teach us about our own associates and their preparation to change?

Individually consider the following questions:

• What if the possibility for change had never been part of Heavenly Father’s plan?
• What would this plan be like?

As a group, read 2 Nephi 2:22–23. Think about how these verses might relate to the changes your own associates are trying to make as they enter the Preparation stage of change.

Discuss the following questions:

• What if change wasn’t part of Heavenly Father’s plan? What would your life be like if change was never possible for you?
• How did the ability to change impact Adam and Eve? How might we consider change as a principle of both temporal and eternal progression?
• What would Deseret Employment be like if change was never part of it?
• What would a job coach trainer be like if change was no longer part of his or her personal development?
• Consider the role that change plays with our associates. How is change a principle of an associate’s temporal and eternal progression?

With a partner, read the definition of the Preparation stage and the coach’s goal:

Definition: An associate in the Preparation stage intends to change and makes small behavioral changes.

Coach’s goal: When the associate is in this stage, your goal is to encourage and support the steps the associate takes toward change. If the associate slips back into a previous stage, be aware and patient. This is not a sign of failure; only of conflicting feelings.

As a group, discuss:

• How hard is it to change?
• Is it natural to fall back into a previous stage of change? Explain.
• Why should you be patient or tolerant with associates as they strive to change?

Divide into small groups and role-play what to do if someone falls back into a previous stage. After you complete the scenario, regroup with all attendees and:

• Share the situations you role-played and the highlights of the interaction.
• Share a key principle or skill you learned or remembered.
• Ask any questions you have about the Preparation stage and how to fulfill your goals as a job coach trainer, staff member, or missionary.

With a partner, read the definition of the Action stage and the coach’s goal:

Definition: An associate in the Action stage takes decisive action to change.

Coach’s goal: When the associate makes it to this stage, the coach can take a more active part in setting goals. The coach makes suggestions, reinforces changes, and provides support and guidance. This stage is usually the shortest; associates will either move quickly from this stage to the Maintenance stage or fall back to a previous stage.

As a group, discuss the following:

• How can you tell that an associate is in the Action stage?
• What are the differences between the Preparation and Action stages?
• What are some effective ways you can help associates make goals and guide them through their change, while still respecting their agency?

Divide into pairs. Think of an associate struggling with a particular issue. With your partner, role-play this associate being in the Action stage, with the job coach trainer being supportive and helping him or her to set goals. Once you are finished, switch roles. After both role-plays, discuss any insights and questions you may have about how to help associates who are in the Action stage.

Read the following quote:

“What a thrill it is to see people all around achieving, conquering, and overcoming through proper daily action, self-discipline, and total commitment. Progression and achievement belong to those who have learned to use the opportunity of now. Our strides of today will determine our locations tomorrow” (Marvin J. Ashton, “The Time Is Now,” Ensign, May 1975, 86).

With a partner, share an experience when you saw an associate take decisive action to change. Then discuss:

• What triggered this change?
• How does Elder Ashton’s quote (above) apply to this associate’s change?
• What additional attributes and resources contributed to the associate’s success in changing?
• How can you support an associate in the Action stage of change?

After the discussion, write in your learner’s journal one personal goal to help an associate who is in the Action stage of change.

Remember that though it may be frustrating, reverting to previous stages is normal. The following are common triggers:

• Negative emotions such as anger, depression, frustration, or feelings of inadequacy
• Social pressures, including displays of or participation in the unwanted behavior
• Physical and other concerns such as stress, low energy levels, or apprehension

As a group, discuss:

• What additional triggers could cause an associate to revert to a previous stage of change?
• How can knowing common triggers help an associate avoid reverting to a previous stage?
• Why is it important to remember that reverting to previous stages is common?
• What can you do when an associate has reverted to a previous stage in his or her path toward change?
• How can you help associates to keep progressing even if they revert to previous stages of change? Feel free to share an experience.

Individually, take time to ponder and write in your learner's journal the answers to the following questions:

• Which of my associates are currently reverting to previous stages of change?
• What could be some of the triggers causing this reversal?
• What can I do to support these associates in their positive change? Write three specific ideas you can implement.

With a partner, read the definition of the Maintenance stage:

Definition: An associate in the Maintenance stage is working to prevent relapse and focusing on improvements.

Individually, take two to three minutes to write in your learner's journal:

• The names of associates you may have that are in the Maintenance stage of change, along with the undesirable behavior or relapse that each of these associates is currently working to prevent.
• List improvements the associates have made since first taking action and working to maintain their positive changes.

As a group, review the coach’s goal:

Coach’s goal: During the Maintenance stage, your goal is to help the associate maintain improved behavior. Monitor the behavior and help the associate avoid triggers. At this stage, follow-up should be scheduled and consistent, but decreasing.

Keeping in mind what you have previously written in your learner's journal, as a group, discuss:

• How can you help associates maintain improved behavior?
  • What tools and skills can you use?
  • What attitudes will help associates maintain improved behavior?
• How can you help associates avoid triggers?
• How often should you follow up with associates on their maintenance?

Feel free to write down impressions or ideas you have as other people speak that might apply to the associates you have been thinking about.

Then, individually, take a minute to write in your learner's journal the best ways to fulfill your goals with these associates.

Take a moment to individually ponder:

• Have you ever relapsed or gone backwards in your progress, even if you had set a clear goal?
• How did you feel at those times?
• What helped you overcome relapses or setbacks?

As a group, discuss the following:

• Why is relapse often a part of change?
• How can understanding that a relapse might occur be helpful as you assist a “relapsed” associate?
• How can remembering your own relapses help you develop a more helpful approach toward an associate who is having a setback?
• How long does it take to change a habit, behavior, or attitude?
• What has helped you overcome relapses?
• How can having someone follow up with your goals help you achieve them more easily?
• What are some of the best practices for following up with an associate?
• How can sharing successes motivate others to set and work on their goals?
• How beneficial is it for an associate to share his or her success with others?

Prevention is an important part of the Maintenance stage. Divide into small groups. Consider the idea of prevention from the different perspectives below, and discuss the following questions:

• Why would prevention of particular diseases (cardiovascular, diabetes, hypertension, etc.) be important to a doctor?
• What do doctors do to try to prevent particular diseases?

• Why would prevention be important to a building contractor?
• What kinds of undesirable things would a contractor work to prevent?

• Why might prevention be important to an associate?
• What kinds of undesirable things would an associate work to prevent?
• Why does an associate who has made a new and difficult change need to work so hard to prevent a relapse?
• How might a job coach trainer’s perspective be similar to an associate’s perspective about the importance of prevention?
  • Should the job coach trainer’s goals for prevention be the same as the associate’s?
  • How might their goals differ?