Six Stages of Counselling

We understand that for counselling to be successful, both the client and the counsellor need to understand what change stage they are in. There are six (6) stages of change in counselling, each one having an importance in allowing each and every one of us to move from the unpleasant to the pleasant state of living (the happy life). In an almost perfect world these six stages of change proceed in a linear manner, other times stages may need to be repeated due to various nature/nurture factors that are discovered in the learning and growth dynamics of counselling. Some change stages even occur simultaneously.


Stage 1: Pre-contemplation
This stage is characterized by two distinct elements: a) the person not being able to see or understand what the problem is, and/or b) the client wanting some other person to change (the problem is them, not me). Pre-contemplators usually come to counselling because of some form of pressure from another person (spouse, employer, the courts, school, friends). Concurrently, pre-contemplators also resist change and therefore employ denial-minimization tactics to disown any responsibility for their contribution to the issue(s) at hand. Thus, one of the initial goals in counselling is to determine how much denial or minimization the client is experiencing that prevents change.


Stage 2: Contemplation
This stage is characterized by the client wanting to better understand what the "bump in the road" is, to see the causes and as well to explore what options are available to resolve the demise. The key point to remember here is that even though a person may know what is the issue and what needs to be changed, contemplators are not quite yet ready to make a commitment to action (fourth stage of change). The second stage is a critical time for those in counselling to better understand two (2) key themes before action is undertaken: who am I (their map of orientation) and what strengths and resources do I have to support my journey (map of direction)? Hence, in counselling the client and counsellor will know when the time for action arises when the language and thoughts in counselling focus around the "solution versus the problem" and a "view more about today and the future than the past."


Stage 3: Preparation
This stage is characterized by the client going through additional areas of mindfulness in areas of mindfulness, learning and growth. Sometimes the client needs to improve their communication skills, career goals, parenting behaviors, intimacy practices, and further strengthening their self-esteem. In particular, we use this stage as an opportunity to identify the client's values and supporting behaviors in four key areas of life: defining the self, self-development, work and relationships. The primary goal here is to actualize individual awareness so that a sense of self-control, comfort and security are present when the client goes from preparation to action. In short, a mindful sense of well-being.


Stage 4: Action
Probably the most misunderstood and misapplied stage of all in counselling. The common problem here is that most clients and counsellors believe that change means action, and action now at the onset of counselling. However, if the first three stages of change are not properly addressed in counselling, failure in counselling and/or after counselling can occur (in fact, over 45% of all clients stop counselling before the third session as they feel their therapist or family want action before they are actually ready for action). This stage is characterized by the basic premise in positive psychology and cognitive behavioral sciences that before we can "change" a behavior, we must first change or reframe our thought patterns (our mental tapes we play if you will). While most of us want to "see" some form of change, often times the more important change must occur in the way we think where we often don't see that change until some future point and time. Once the action stage in counselling has allowed us to change our thoughts (reframing), then can we commence with the more visible desired actions, behaviours and feelings in and outside of counselling.


Stage 5: Maintenance
This stage is characterized by the counsellor and client (and in most cases his or her social support network) to identify what possible trigger points or other conflictual issues exist in the work and social/family setting that could cause a relapse. Whether a client is coming in to quit smoking or improve his communications at work or in the marriage, the counsellor and client in this stage shall develop a strong commitment to establishing positive reinforcement activities (validation, cheerleading, acknowledgement, praise, rewards) to sustain the change made in the action stage. In other words, change never ends in the action stage, it merely takes a new form and presence in our life.


Stage 6: After-care
There are some thoughts, behaviors or feelings we wish never return  (the former smoker who doesn't take up smoking again when he gets stressed). However, some healthcare professionals believe there are certain behaviors, thoughts or feelings we never completely remove (traditional 12 step programs for example propose that alcoholics will always remain "an addict in recovery"). This stage is characterized by determining what types of behaviors, thoughts or feelings can realistically be terminated, and equally as well, what types require a lifetime of support and maintenance. The ultimate goal though in the after-care stage is to ensure that the client understands that by embracing lifelong learning he or she increases the chances for a more healthier and happier life. We believe that the lifelong learning process can be experienced both in counselling and other environments. In short, our doors are always open for tune-ups and new learning sessions.




Overall, by using the above mentioned six stage model of how we go through learning and change, our counsellors are able to work in a more understandable and believable way with each and every one of our clients. Our counselling model then ensures each change stage has its own correlating counselling process(es) that allow two short-term goals to be continually experienced in counselling: i) a greater sense of awareness and b) shift from focusing on problems to thinking about solutions.


For example, in the pre-contemplation stage (stage 1), the counsellor may need to work with the client over a period of time with cognitive, gestalt or psychoanalysis to replace the denial mindset with an ownership mindset. Stage 2, contemplation stage, the counsellor may focus more on traditional psychoanalytical and existential processes to allow suppressed feelings and thoughts that often times makes us feel "stuck" in unpleasant moods be identified and understood in counselling. In stage 3 (preparation stage), the counsellor may then shift to a rational-emotive or cognitive-behavioral model (CBT) to challenge non-effective thinking patterns that often times causes non-action or procrastination that often times prevents stage 4, the action stage, from being experienced. Stage 4, action stage, focuses on three areas for movement and change: thoughts, emotions and behaviors. Hence, this stage will require a focus on growth in our thinking patterns as well as modifying behaviors and replacing unpleasant emotions with pleasant feelings. The most effective process used in stage 4 is CBT (cognitive behavioral therapy). Maintenance, stage 5, is a key stage where we ensure the progress made is sustained for a lifetime.


We also focus on not only maintaining the change, but also how to ensure the client continues to use the change processes. The processes of rewarding positive behaviors and developing nurturing relationships are key here. Stage 6, termination, utilizes similar processes like that of stage 5 whereby the temptation or threat of returning to old behaviors/thoughts are removed. Reinforcing the happy life model is key here to ensure the spiraling cycle of change is absent for most of life's "bumps in the road."




Our Professional Affiliations

British Association of Counselling and Psychotherapy (BACP)


As an Organizational Member of the BACP we are bound by its Ethical Framework for Good Practice in Counselling and Psychotherapy, the Ethical Guidelines for Researching Counselling and Psychotherapy (where organizations undertake research) and subject to the Professional Conduct Procedure for the time being in force.



American School Counsellor Association (ASCA)


As a professional member of the American School Counselor Association, St. John's Counselling Service is able to collaborate with one of the largest counselling associations worldwide in working with students, schools and their families in addressing academic, personal/social and career development issues. This collaboration also allows us to remain current with counselling tools and strategies for Hong Kong's schools and families to ensure our children and teens can seek a healthy balance between learning and fun.



National Association of Addiction Treatment Providers (NAATP)


As a member of the National Association of Addiction Treatment Providers (U.S.), St. John's Counselling Service adheres to high standards of care with substance abuse clients, their families and employers to ensure that the latest and most effective treatment methods for substance abuse, internet addiction and other addictive disorders are provided.



American College of Healthcare Executives (ACHE)


Our Executive Director being a long-standing member of ACHE is committed thru the affiliation with ACHE to advance the excellence in healthcare management with the Counselling Service for our clients, stakeholders, employees and the community-at-large.