Imagine that a client came to you as a first step, in one of the provided scenarios. It is likely you will need to recommend outside resources, beyond what you would provide, such as counseling, too. Even though you might not provide all the resources for a client as he or she goes through the stages of change, you should be able to predict which stages a client in a given situation is likely to go though.

In your chosen scenario, identify the stages of change that a client would likely go through and questions that you would ask him or her during each stage to help progress. Assess the resources that he or she might need and referrals that you might make for the client to be successful at each stage.

Choose a scenario from the given list and evaluate the stages of change. As part of your analysis, you should identify the culture, ethnicity, and/or country of the client. Analyze the scenario from the viewpoint of a human and social services professional after the client has come to your organization for help.

1. A client who received news of being diagnosed with a sexually transmitted disease
2. A manager of an organization that experienced a large layoff and employee morale is low
3. A community without clean running water
4. A client who is considered obese and obesity runs in the family
5. A client who is 43 and started smoking as a teenager
6. A community that has experienced a natural disaster, which has left many homeless and members of the community are coming to your organization for help

For your chosen scenario, use Prochaska and DiClemente’s Stages of Change. In 1–2 pages: Identify the questions you might ask while interviewing the client during each stage. Assess the resources that he or she might need and referrals that you might make for the client to be successful in moving from one stage to another. Be specific.

Prochaska and DiClemente’s Stages of Change Model

Stage of ChangeCharacteristicsTechniquesPre-contemplationNot currently considering change: “Ignorance is bliss”Validate lack of readinessClarify: decision is theirsEncourage re-evaluation of current behaviorEncourage self-exploration, not actionExplain and personalize the riskContemplationAmbivalent about change: “Sitting on the fence”Not considering change within the next monthValidate lack of readinessClarify: decision is theirsEncourage evaluation of pros and cons of behavior changeIdentify and promote new, positive outcome expectationsPreparationSome experience with change and are trying to change: “Testing the waters”Planning to act within 1 monthIdentify and assist in problem solving re: obstaclesHelp patient identify social supportVerify that patient has underlying skills for behavior changeEncourage small initial stepsActionPracticing new behavior for 3–6 monthsFocus on restructuring cues and social supportBolster self-efficacy for dealing with obstaclesCombat feelings of loss and reiterate long-term benefitsMaintenanceContinued commitment to sustaining new behaviorPost-6 months to 5 yearsPlan for follow-up supportReinforce internal rewardsDiscuss coping with relapseRelapseResumption of old behaviors: “Fall from grace”Evaluate trigger for relapseReassess motivation and barriersPlan stronger coping strategies

Pre-contemplation Stage

“Ignorance is bliss”“Weight is not a concern for me”Goals:

• 1. Help patient develop a reason for changing
• 2. Validate the patient’s experience
• 3. Encourage further self-exploration
• 4. Leave the door open for future conversations

1. Validate the patient’s experience:“I can understand why you feel that way”2. Acknowledge the patient’s control of the decision:“I don’t want to preach to you; I know that you’re an adult and you will be the one to decide if and when you are ready to lose weight.”3. Repeat a simple, direct statement about your stand on the medical benefits of weight loss for this patient:“I believe, based upon my training and experience, that this extra weight is putting you at serious risk for heart disease, and that losing 10 pounds is the most important thing you could do for your health.”4. Explore potential concerns:“Has your weight ever caused you a problem?” “Can you imagine how your weight might cause problems in the future?”5. Acknowledge possible feelings of being pressured:“I know that it might feel as though I’ve been pressuring you, and I want to thank you for talking with me anyway.”6. Validate that they are not ready:“I hear you saying that you are nowhere near ready to lose weight right now.”7. Restate your position that it is up to them:“It’s totally up to you to decide if this is right for you right now.”8. Encourage reframing of current state of change—the potential beginning of a change rather than a decision never to change:“Everyone who’s ever lost weight starts right where you are now; they start by seeing the reasons where they might want to lose weight. And that’s what I’ve been talking to you about.”Contemplation Stage“Sitting on the fence”“Yes my weight is a concern for me, but I’m not willing or able to begin losing weight within the next month.”Goals:

• 1. Validate the patient’s experience
• 2. Clarify the patient’s perceptions of the pros and cons of attempted weight loss
• 3. Encourage further self-exploration
• 4. Leave the door open for moving to preparation

1. Validate the patient’s experience:“I’m hearing that you are thinking about losing weight but you’re definitely not ready to take action right now.”2. Acknowledge patient’s control of the decision:“I don’t want to preach to you; I know that you’re an adult and you will be the one to decide if and when you are ready to lose weight.”3. Clarify patient’s perceptions of the pros and cons of attempted weight loss:“Using this worksheet, what is one benefit of losing weight? What is one drawback of losing weight?”4. Encourage further self-exploration:“These questions are very important to beginning a successful weight loss program. Would you be willing to finish this at home and talk to me about it at our next visit?”5. Restate your position that it is up to them:“It’s totally up to you to decide if this is right for you right now. Whatever you choose, I’m here to support you.”6. Leave the door open for moving to preparation:“After talking about this, and doing the exercise, if you feel you would like to make some changes, the next step won’t be jumping into action—we can begin with some preparation work.”Preparation Stage“Testing the Waters”“My weight is a concern for me; I’m clear that the benefits of attempting weight loss outweigh the drawbacks, and I’m planning to start within the next month.”Goals:

• 1. Praise the decision to change behavior
• 2. Prioritize behavior change opportunities
• 3. Identify and assist in problem solving re: obstacles
• 4. Encourage small initial steps
• 5. Encourage identification of social supports

1. Praise the decision to change behavior:“It’s great that you feel good about your weight loss decision; you are doing something important to decrease your risk for heart disease.”2. Prioritize behavior change opportunities:“Looking at your eating habits, I think the biggest benefits would come from switching from whole milk dairy products to fat-free dairy products. What do you think?”3. Identify and assist in problem solving re: obstacles:“Have you ever attempted weight loss before? What was helpful? What kinds of problems would you expect in making those changes now? How do you think you could deal with them?”4. Encourage small, initial steps:“So, the initial goal is to try nonfat milk instead of whole milk every time you have cereal this week.”5. Assist patient in identifying social support:“Which family members or friends could support you as you make this change? How could they support you? Is there anything else I can do to help?”Source: www.stepupprogram.org