Stages of Change and Motivational Interviewing: Practice Lessons from Mary Marden Velasquez

Talking to Change: MI Practice Companion

In Episode 62 of Talking to Change: A Motivational Interviewing Podcast, Glenn Hinds and Sebastian Kaplan talk with Mary Marden Velasquez, PhD, about the Transtheoretical Model, the Stages of Change and their relationship with Motivational Interviewing.

This Practice Companion focuses on using stages as a way of understanding change without turning them into fixed labels or a rigid recipe. It also looks beyond the familiar stage names to the processes of change, decisional balance and self-efficacy, and considers what these ideas can contribute to MI practice.

More than a set of stages

The Stages of Change are probably the best-known part of the Transtheoretical Model. Mary explains, however, that the model also includes processes of change, decisional balance and self-efficacy. The popularity and intuitive appeal of the stages can make these other components easier to overlook.

For practitioners, this shifts the question from simply Which stage is this person in? towards What is happening in this person’s change process, and what might be useful now?

Change is not a linear journey

Mary challenges a common interpretation of the stages as a staircase that people climb in sequence. People can move in different directions as circumstances change, and the same person can be at quite different points in relation to different behaviours.

This matters in MI because labels can tempt us to decide what a person needs before listening carefully to them. A stage can offer a useful orientation, but the conversation still needs to be responsive to this person, this behaviour and this moment.

Do not rush people into action

Mary discusses research suggesting that people who moved into behavioural change without completing important earlier experiential work were less likely to sustain the change. She describes that earlier work in terms of questions such as why the person is making the change, how life might be different and how the change may affect people around them.

The practice implication is not that everyone must complete a prescribed sequence of exercises. It is a reminder that action can be premature when the meaning, reasons and personal significance of change have not yet developed sufficiently.

Match the conversation to what the person needs

Mary describes MI as particularly powerful alongside the experiential processes. As someone moves into preparation and action, MI remains relevant, including its Spirit and attention to change talk, but the person may increasingly need practical direction and behavioural strategies rather than further attempts to increase motivation.

This connects closely with the Four Tasks of MI. Evoking is not something we should continue indefinitely when the person is ready to plan. Skilled practice involves recognising when the conversation needs to move with the person.

When someone is already motivated

Later in the conversation Mary describes research in which people who were already more ready to change did less well when practitioners continued trying to boost motivation. Her point is practically important: MI is not synonymous with continually exploring motivation.

A person who has decided to act may need help with how, when, where and with whom. Continuing to reopen reasons for and against change can become mismatched to their needs.

MI and TTM: “kissing cousins”

Mary recalls Bill Miller describing the Transtheoretical Model and Motivational Interviewing as “kissing cousins”. The connection felt natural because TTM highlighted the challenge of helping people who were not yet preparing for or taking action, while MI offered a way of having those conversations.

The important distinction is that TTM and MI are related but separate. The stages do not form part of MI, and MI does not require practitioners to assign people to a stage before using it.

Decisional balance and client language

Mary also connects TTM’s decisional balance with later developments in MI around sustain talk and change talk. Exploring what a behaviour provides for someone can help us understand why the status quo has value, while listening for the disadvantages of the status quo and the attractions of change can reveal change talk.

For MI practitioners, the aim is not simply to complete a symmetrical list of pros and cons. What matters is how we respond to the language that emerges, including acknowledging sustain talk without inadvertently strengthening it and giving appropriate attention to change talk.

Self-efficacy is more than confidence

Mary explains that within TTM, self-efficacy includes both confidence and temptation. These are related, but she cautions against treating temptation as simply the mirror image of confidence.

This adds useful nuance to MI confidence rulers. Asking how confident someone feels can be valuable, but practitioners can also become curious about the situations in which maintaining change may be particularly difficult or tempting.

Using stages without labelling people

A practical way to use the model is to keep the behaviour specific. Rather than saying, “She is in precontemplation”, consider: “At the moment she is not considering changing this particular behaviour.” That leaves room for movement, context and other areas of her life where she may already be acting differently.

The stage becomes a tentative description of a change process rather than a description of the person.

Practice takeaways

1. The Stages of Change are only one part of the Transtheoretical Model.
2. Stages are not necessarily linear, and people may be at different stages for different behaviours.
3. Use stages as tentative orientation rather than fixed labels.
4. Do not rush into action planning before the person’s own reasons and meaning for change have had room to develop.
5. MI can be particularly useful during experiential change processes.
6. When someone is ready for action, continuing to try to increase motivation may be unnecessary or unhelpful.
7. Match your response to what the person needs now rather than mechanically applying a stage-based intervention.
8. TTM and MI complement one another, but they are not the same model.
9. Decisional balance, self-efficacy and the processes of change deserve attention alongside the familiar stage names.
10. Good practice remains individual and flexible.

Episode guide

• 00:00 – Introduction and episode preview
• 05:37 – Mary’s early TTM and MI story
• 17:50 – The 10 Processes of Change
• 21:21 – Consciousness raising
• 24:08 – Emotional arousal
• 26:21 – Self-evaluation
• 28:57 – Environmental re-evaluation
• 30:52 – Social liberation
• 33:31 – The Stages of Change
• 39:35 – Experiential processes linked to long-term change
• 47:25 – Stimulus control
• 48:13 – Counter conditioning
• 49:23 – Reinforcement management
• 51:01 – Self-liberation
• 52:09 – Helping relationships
• 55:05 – Applying the model flexibly
• 1:00:35 – The Stages of Change and MI: the “kissing cousins”
• 1:02:25 – Decisional balance and self-efficacy
• 1:10:43 – Temptation
• 1:12:25 – Spending time with giants in the field
• 1:16:57 – End of episode

Show notes and resources

The original episode cites the study Pregnancy smoking cessation: a case of mistaken identity by Stotts, DiClemente, Carbonari and Mullen, and the book Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual by Velasquez, Crouch, Stephens and DiClemente. The episode page also links to the Health Behavior Research and Training Institute.

See the full Episode 62 show notes and resources →

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Motivational Interviewing Knowledge Centre · Change Talk in Motivational Interviewing · Sustain Talk in Motivational Interviewing · Motivational Interviewing in Healthcare · Talking to Change: MI Practice Companions

Discover related podcast conversations

• Episode 85 – Ambivalence and Motivational Interviewing – explore ambivalence directly through an MI lens.
• Episode 3 – The Four Processes – revisit how an MI conversation develops through engaging, focusing, evoking and planning.
• Episode 88 – Using Motivational Interviewing in Crisis Response – consider how MI remains responsive to the person and situation when pressure and urgency are high.

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Sebastian: sebkaplan34@gmail.com

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About this series

Talking to Change: MI Practice Companion turns selected podcast conversations into practice-focused learning resources, connecting guest discussions with established Motivational Interviewing principles, the Knowledge Centre and deliberate practice.