The Stages of Change

By Joe Nelson | September 13, 2006 11:28 am

Dear S.,

For the last two weeks, I have responded to your letter by addressing issues related to mental health and emotional eating. This week, I’d like to discuss the final area of concern you identified: motivation.


As I begin to write this, I have just finished reading the responses to my blog entry from two weeks ago related to depression and diabetes. I am well aware that motivation and self-care are seriously affected by mental health issues. I also want to say that although in these blogs we can offer advice or ideas for help, these ideas will never work for everyone. The advantage to this format, however, is you will also get ideas from readers who have found their own ways to deal with similar problems.

The model of behavior change and motivation I will discuss today is known as the Stages of Change. This model was developed as the result of responses from people who were successful at changing their behavior. The initial research involved people who were successful at quitting smoking. This research has since been expanded to the topics of eating, exercise, and taking medicines to treat diabetes. While these behaviors differ from each other, behavior change is similar across all behaviors.

According to the Stages of Change, the first stage of the process of change is being OK with our behavior just as it is. This is known as the pre-contemplation stage, and in it, we are usually comfortable with things just as they are. We might say “I like things just as they are—I don’t need to change.” People in this stage often need more information about the problem, including why it is a problem and the negative effects it can have. They often need a reason to start thinking about change. A little encouragement—or fear of the consequences of not making a change—helps this thinking to start.

When someone begins to think about change, they have moved to the next stage: contemplation. In this stage, people are twice as likely to get to a point where they take action. Contemplation is a time of emotional struggle. This is when you may want to change, but you may also continue to be quite attached to the old behavior (most of us are). This state of ambivalence, or mixed feelings, leaves us feeling confused and uncertain of the path that is best. We may say “Yes, but…” to a lot of the suggestions others may give us about behavior change. S., this is probably the stage you are in: You want to change, but you can’t get the energy to alter your behavior.

I wonder if you could answer these questions:

Another important question to ask yourself is, what are the benefits related to changing your eating habits? What are the costs? Can you begin to do something about this balance, so that the benefits of change outweigh the costs?

During the contemplation stage, it’s often helpful to seek support. The most helpful support is not a support group that accepts everything you do, but rather one that will offer some accountability for you. In other words, you want not just emotional support, but encouragement to do well and achieve your goals.

The next stage is called preparation. This is a time of clear goal setting. Make sure to keep your goals simple, measurable, and very specific so that you know when you have completed the task. Do not expect too much of yourself here—this stage is not about working yourself to death. It’s really about setting yourself up for success.

The next two stages are action and maintenance, in which we are busy working toward the goals we’ve set and figuring out how to keep it up. While we often think our work is done here, it is just beginning. This is when we have to be aware of faltering and moving back to an earlier stage, which is actually very likely to happen. This is known as recycling and is an opportunity to learn from earlier efforts by keeping the things that worked and tossing out those things that were not helpful.

As you can see, motivation and behavior change are not magic—they really come about through efforts that you make on your own. You can learn more about behavior change and the stages of change by looking it up on the Internet (for example, has a helpful overview of the Stages of Change) or talking with a Certified Diabetes Educator about it.

I hope you find this useful.

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Joe Nelson: oe is a psychotherapist in private practice in Minnesota, where he specializes in the psychology of chronic disease and sexual problems and works with couples, families, children, and teens. He has been a Licensed Psychologist since 1985 and has earned a master’s degree from St. Mary’s College Winona, a bachelor’s degree in social work from the University of Minnesota, and an associate’s degree in human services from the College of DuPage in Glen Ellyn, Illinois.

Joe has worked with troubled youth in Chicago and Minnesota and on a special project on Turtle Mountain Reservation in North Dakota. He was the first social worker hired by an affiliate of the American Diabetes Association. He worked at the International Diabetes Center for 20 years, directing psychological services there for 12 years. A Certified Sex Therapist, Joe co-developed the Sexual Health Center at Park Nicollet Clinic.

Having practiced meditation for over 30 years, Joe offers instruction in mindfulness-based meditation to patients in groups and as individuals. Joe is married, has a 23-year-old daughter, and enjoys scuba diving, motorcycling, golf, and being outdoors doing almost anything.

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