Stages of Change Model Worksheet for Clients
This one-page handout explains the Stages of Change Model in plain language for clients and caregivers. It shows five stages of changing a habit as a cycle: precontemplation, contemplation, preparation, action, and maintenance. Each stage has a one-line description. Clients then circle where they think they are today.
Use it when a client is working on a new habit or routine and you want to talk about how ready they are, rather than assume it. The handout is based on the Transtheoretical Model from Prochaska and DiClemente, a well-known framework for how people move through behavior change.
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The handout doesn’t name a specific behavior. Before you hand it over, agree with the client on the one habit or routine you’re talking about. You or the client can write it in the margin so the rating has a clear target.
The handout asks clients where they are “today.” Treat their answer as a starting point for conversation, not a formal assessment. Because the stages are drawn as a cycle, it’s worth coming back to the handout at later sessions to see whether anything has shifted.