Stages of Change vs. Motivational Interviewing

Substance use counseling is a complex field that demands the use of effective, evidence-based approaches to help clients navigate their recovery journey. Two widely recognized methods in this domain are the Stages of Change model (also known as the Transtheoretical Model or TTM) and motivational interviewing. Although the Stages of Change offers a systematic method for measuring and identifying readiness to change, motivational interviewing uses an active, person-centered, yet direction-giving interface to address and overcome ambivalence. In both approaches, the client’s self-direction is valued, and choice is viewed as essential for long-term behavior modification: Stages of Change vs. Motivational Interviewing.

However, the main differences exist in the theoretical approach adopted, the type of interventions used, and the role assumed by the counselor. These two approaches are discussed in this paper in terms of the theoretical basis of the interventions, the phases of treatment, how change is attained positively, approaches used to deal with difficulties, and the role of the counselor. Drawing from the discussion of the advantages and disadvantages of both the traditional approach and the personal construct approach, counselors can establish a synergy that tackles the intricacies of substance use recovery and devise powerful intercessions that will assist clients.

Theories Overview

Stages of Change

The Stages of Change model, developed by Prochaska and DiClemente, outlines six phases individuals undergo when modifying behaviors: precontemplation, contemplation, preparation, action, maintenance, and termination. These stages outline a readiness to change model, which reflects the fact that change is not always gradual (Raihan & Cogburn, 2023). Precontemplation is when people are either oblivious or indifferent to a problem. Contemplation brings awareness of the problem, but it is characterized by indecision. Evaluation particularly includes devotion and scheduling of the change process, and implementation is the process whereby behavioral alterations take place.

In the maintenance stage, clients are concerned with the long-term preservation of the change and preventing any future backslaps, while in the termination stage, clients hold long-lasting change and the ability to demonstrate new behaviors. Since the model is cyclical, the counselor can revisit any of the previous stages, making it practical and usable for counseling interventions.

Motivational Interviewing

Motivational interviewing (MI), pioneered by Dr. William Miller and Dr. Stephen Rollnick, is a conversational approach designed to enhance intrinsic motivation by resolving ambivalence. MI is based on four principles: empathizing, creating a difference between the desired and the current state, handling competition, and promoting the client’s competence (Bischof et al., 2021). The counselor uses motivational interviewing in which clients are encouraged to express their values, goals, and reasons for change.

Some concepts include the use of reflective listening, affirmation, and open-ended wondering. Unlike directive approaches, MI focuses on working with the client and puts the client center of the process. Due to its active permission approach, MI is highly appropriate at early recovery time, during which the client is highly likely to be ambivalent.

Theoretical Concepts, Principles, and Agents of Change

Similarities

The Stages of Change model and MI share a foundation in client-centered principles that emphasize the client’s autonomy and intrinsic motivation as the driving forces behind meaningful and lasting change. In both models of treatment, clients are considered to be the driving force of the change process, and the counselor just helps the client to take charge or be in control of the process of change (White, 2012). Acceptance and cooperation are core to both approaches because they include and encourage clients without passing judgment on them and addressing their thoughts, actions, and aspirations.

Additionally, both models insist that resistance is expected in any change process, especially in substance-using clients. Instead of seeing conflict or resistance as threats or issues that need to be overcome, both models embrace them as chances to get the client involved and explore them more thoroughly. In addition, the two models aim to educate clients about specific behaviors that they will change, with clients being the primary drivers of the process through self-motivation. This common core value for all teams and clinicians guarantees that clients will be listened to, understood, and valued by their clinician at all phases of their therapy management.

Differences

Despite these similarities, the Stages of Change and MI differ significantly in their frameworks and approaches. The Stages of Change is a structured framework that outlines six distinct stages of readiness for change: precontemplation, contemplation, preparation, action, maintenance, and termination (PsychotherapyNet, 2009). This covers all the guidelines needed to assess progress and determine whether the client is in the early, middle, or late stage of recovery. The Stages of Change are valuable to counselors, particularly at each stage of the change process; awareness raising in the precontemplation stage or support in the maintenance stage.

On the other hand, MI is a technique-based method that aims at addressing attitudinal ambivalence while it is ongoing. In contrast to the conventional conceptualization of motivation, MI utilizes skills such as reflective listening, open questions, summarized empathic reflections, and “change talk,” motivating the client to navigate through their internal barriers. The non-Jungian and non-cognitive nature of MI enables counselors to access the client at any stage of change they may be at, with the main focus set on achieving initial and immediate resolution of the client’s ambivalence in order to gain more subscribers to the process of change.

Another key difference lies in how each approach addresses resistance. The Stages of Change approach resistance as a property of the specific stages, like precontemplation, and deals with it implicitly by developing the interventions that would help the client progress to the other stage. MI, however, has a direct and dynamic way of handling resistance in its process. Recognizing and managing resistance is a key component of MI.

Through “rolling with resistance,” clients’ views are changed in order to decrease defensiveness. It empowers its clients to consider values that are ideal to set, behaviors that should be adopted in order to meet set goals, and ultimately makes clients feel that they are capable of bringing about positive change. Stages of Change may not be as “present-centered” as MI, although they are both aimed at helping a person recover—the former is more of a general guide to recovery, while the latter is designed to guide a therapist and a client in the present change process.

Stages Associated with Treatment

Similarities in Treatment Stages

The Stages of Change and MI both recognize that treatment should be tailored to the client’s readiness for change. For instance, the first phase of the development may enroll clients who need reinforcement based on motivation to increase awareness and decrease precontemplative attitudes, and the last phase deals with post-action, relapse, problem-solving, and maintenance of motivation (López et al., 2021). They also both show consideration for the client’s progress and, consequently, treatment planning since clients go through the different phases at different rates and may have to return to previous phases. Both recognize that recovery is not a smooth process and relapse is expected to occur before or during recovery at times, so it needs to be addressed as well.

Differences in Treatment Stages

The Stages of Change provides a more detailed and structured progression through six stages, with each stage requiring specific interventions to support the client’s transition. For example, participation and action planning, as well as motivational interviewing, are the key strategies taken at the contemplation level as clients are uncertain of change, while relapse prevention and planning for maintenance are central at the maintenance level to ensure progress is retained. MI, on the other hand, does not conform to a stage-based model.

One is more flexible and is applicable independently of the phase and focuses on the leading of ambivalence and motivation issues in the case with the client. This makes MI particularly useful at the early stages, that is, precontemplation and contemplation, since clients are indecisive or even rebellious, by crafting reflective discussions that are safe and can promote self-narration.

Creating Positive Change to Promote Recovery

Similarities

Both approaches prioritize empowerment as a key element in fostering positive change. They urge their clients to think about personal interests and needs and then create an association between the two and the change wanted for behavior. A core focus on self-awareness allows clients to embrace more responsibly the recovery process.

Differences

The Stages of Change emphasizes promoting recovery by aligning interventions with the client’s stage of readiness. For instance, clients in the precontemplation stage may need to be provided with information that they may need for them to change while those in the action stage will want to change their behavior as quickly as possible. MI instead uses “change talk,” as it assists clients to vocalize and, therefore, justify their reasons for a change. This technique is less concerned with the client’s stage and is aimed primarily at getting the person’s commitment and motivation here and now.

Approaching Obstacles in the Treatment Process

Similarities

Cognizance of the existence of ambivalence and space for resistance as characteristics of change and appropriate strategies for navigating them are shared in both approaches. This type of relapse is also viewed not as a trial but as a training experience that forms part of the recovery process.

Differences

MI takes a proactive approach to obstacles, using techniques like reflective listening and rolling with resistance to explore the client’s perspective and reframe challenges. This helps counselors to interface with clients in a more kinetic way and assist them in dealing with resistance likely to surface at one point. The Stages of Change, on the other hand, deal with the barriers more implicitly because the first step, resistance, is associated with a particular stage, such as precontemplation, and strategies are given that fit well within the work being done with the client at that specific stage.

The Human Service Provider’s Role

Similarities

In both models, the counselor’s role is to create a safe, empathetic, and supportive environment for the client. They serve more as facilitators instead of dictating how the entire process of addiction recovery will go; clients are instead given the power to decide. Similar aspects of counselor intervention in the two approaches include active listening, empathy, and collaboration.

Differences

According to the MI approach, the counselor has to be more prescriptive. Techniques such as eliciting “change talk,” summarizing, and scaling questions are used to move the client toward action. In comparison, in Stages of Change, the counselor’s task is to determine a client’s stage of change and then work according to their requirements. They also help the counselor to facilitate the client to move through the six stages of change systematically.

Additional Noteworthy Similarities and Differences

Integration Potential

A major advantage of such approaches is that they are closely interrelated and can be combined for the best results. Some MI skills like reflective listening and the use of change talk can be used when adopting Stages of Change, particularly at the contemplation stage, whereby the user seems to be overwhelmed by the process. It can enhance the bringing together of the Stages of Change with the lower level of conversation, which is MI, for better treatment.

Flexibility and Adaptability

The MI approach is especially helpful to clients experiencing change: this is because there is a lot of cross-over in the beginning, and desire is still a big issue. Though less flexible in terms of model construction, the Stages of Change models have an easily traceable path in the course of action and entail precise matching of interventions to the client (Arbuckle et al., 2020).

Conclusion

The Stages of Change and motivational interviewing are two strong and compatible techniques in substance use counseling. The Stages of Change gives a context for conceptual and practical analysis of the readiness for change, while MI offers kinetic approaches to negotiate change and increase self-produced propel to change. Both have elements of empathy, working in partnership and client-led approaches with a focus on client recovery self-management. Thus, by combining the two models, counselors can develop treatment strategies that work on different levels and help the client eliminate all forms of abuse.

References

Arbuckle, M. R., Foster, F. P., Talley, R. M., Covell, N. H., & Essock, S. M. (2020). Applying motivational interviewing strategies to enhance organizational readiness and facilitate implementation efforts. Quality Management in Health Care, 29(1), 1–6. https://doi.org/10.1097/qmh.0000000000000234

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Aerzteblatt Online, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014

López, G., Orchowski, L. M., Reddy, M. K., Nargiso, J., & Johnson, J. E. (2021). A review of research-supported group treatments for drug use disorders. Substance Abuse Treatment, Prevention, and Policy, 16(1), 1–21. https://doi.org/10.1186/s13011-021-00371-0

PsychotherapyNet. (2009, April 6). Motivational interviewing (MI) with William Miller Video [Video]. YouTube. https://www.youtube.com/watch?v=cj1BDPBE6Wk

Raihan, N., & Cogburn, M. (2023, March 6). Stages of change theory. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556005/

White, W. (2012). The psychology of addiction recovery: An interview with William R. Miller, PhD. Counselor, 13(4), 64-73. https://www.chestnut.org/resources/3fbdce0f-6f4d-4196-b992-142dcf7936e8/2012-Dr.-William-Miller-v2.pdf

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Written Assignment 1
Students will be required to complete two papers during the 8 week module. Your first paper is due at the end of Unit 4 and the second paper is due at the end of Unit 7.

Rubrics will be used to grade your work. Assignments should be written in the format of the most current edition of the APA manual. Each paper must be submitted via Blackboard (Safeassign link in unit) and emailed copies will not be accepted. Please use a Microsoft Word format to submit papers (no PDFs or other programs please). Policies in regard to turning work in late also apply to these assignments.

Each written assignment will consist of a paper that is at least 6 full pages. Each paper must be double spaced with size 12 Times New Roman font and 1 inch margins on all sides. You will need to follow the example provided under course information and need a title page, body (at least 6 full pages), and reference section all in APA style.

Please use complete sentences, appropriate grammar, spelling, and references. You will also be required to use in-text references in your work in accordance with APA style to avoid plagiarism. Information to help with your writing is provided under the APA resources section of the course information tab.

Please be sure to avoid using internet sources such as Wikipedia or other web-based  resources that do not have strong academic backing. You must use at least 3 additional scholarly sources not used in this course. Plagiarism detection software will be used to scan each paper and any paper that is determined to have academic integrity issues will earn a score of 0 automatically. Students are encouraged to use University support services for writing and review closely all information in regard to academic integrity.

DO NOT REUSE ANY INFORMATION FROM THIS OR ANY COURSE IN YOUR PAPER (e.g. discussion board contributions OR information about a theory used in a previous paper)

Paper Topics:

NOTE: You cannot resubmit any previously written information on your WA #1 when turning in WA #2. This is not allowable and considered an academic integrity and University violation.

For each paper, please choose an option # (listed above on the graph) for your first paper and another for your second.

After choosing an option, please provide a brief (1 paragraph for each theory) summary of the key aspects of the theory. Afterwards, please COMPARE and CONTRAST the two theories chosen by addressing the following:

• • Similarities and differences in general theoretical concepts, principles, and agents of change
• • Similarities and differences in stages associated with treatment according to teach theory (e.g. beginning, middle, and termination stages, etc.)
• • Similarities and differences in creating positive change to promote recovery through the concepts of the theories.
• • Similarities and differences in approaching obstacles in the treatment process.
• • Similarities and differences in the human service provider’s role in the treatment process.
• • Other similarities and differences in the treatment process that are noteworthy

Please title your paper listing the names of both theories such as, “Matrix Model vs. Solution Focused Therapy.

Unit 4 Readings:

• Please read Stevens & Smith (2018) 
• Please read White’s (2012) article on The Psychology of Addiction Recovery by viewing: https://www.chestnut.org/resources/3fbdce0f-6f4d-4196-b992-142dcf7936e8/2012-Dr.-William-Miller-v2.pdf
• Please view this short video where Dr. William Miller discusses Motivational Interviewing by clicking HERE.
• Please read Bundy’s (2005) article on Changing Behaviour: Using Motivational Interviewing Techniques by clicking HERE
• Please view a short clip demonstrating the principles of Motivational Interviewing by clicking HERE.