Engagement and Motivation: Applying the Stages of Changes in Practice

Authors

Frederick Shack, LMSW^1,4
Mardoche Sidor, MD^1,2,3
Gary Jenkins, MPA¹
Jose Cotto, LCSW^1,5
Karen Dubin, PhD, LCSW^2,4
Lesmore Willis Jr, MPA, MHA¹

Affiliations

¹Urban Pathways, New York, NY
²SWEET Institute, New York, NY
³Columbia University Center for Psychoanalytic Study and Research, New York, NY
⁴Columbia University, School of Social Work, New York, NY
⁵New York University, Department of Social Work, New York, NY

Correspondence concerning this article should be addressed to Mardoche Sidor, MD, Urban Pathways, at msidor@urbanpathways.org

Abstract

The Stages of Change model offers a critical framework for understanding motivation, yet staff often struggle to align interventions with residents’ level of preparedness. The Four-Stage Engagement Model—Sitting, Listening, Empathizing, Collaborating—integrates seamlessly with motivational science, providing staff with tools to meet residents where they are. This article explores how engagement and the Transtheoretical Model (TTM) together guide stage-matched interventions, prevent staff frustration, and support sustainable behavior change. Composite case studies from Urban Pathways illustrate how aligning engagement with level of preparedness, has the potential to reduce reluctance and enhance collaboration in supportive housing.

Keywords

Engagement, Motivation, Stages of Change, Transtheoretical Model, Motivational Interviewing, Supportive Housing, Behavior Change, Trauma-Informed Care, Level of Preparedness

Introduction

Motivation for change is not static but dynamic, shifting across stages of preparedness (Prochaska & DiClemente, 1984). Staff often become frustrated when residents appear “unmotivated,” but such perceptions typically reflect mismatched interventions (Miller & Rollnick, 2013). The Four-Stage Engagement Model provides relational practices that align with stages of change, transforming staff perspective from blame to partnership. By embedding motivational science into engagement, Urban Pathways ensures interventions are resident-centered, trauma-informed, and sustainable.

Theoretical Framework

The integration of engagement and motivation is supported by:

1. Transtheoretical Model (TTM): Identifies stages of change—precontemplation, contemplation, preparation, action, maintenance (Prochaska & DiClemente, 1984).
2. Motivational Interviewing (MI): Enhances motivation by evoking residents’ own reasons for change (Miller & Rollnick, 2013).
3. Self-Determination Theory: Collaboration supports autonomy, competence, and relatedness, fueling intrinsic motivation (Deci & Ryan, 2000).
4. Trauma-Informed Care: Recognizes that level of preparedness may be impacted by trauma, requiring relational safety first (SAMHSA, 2014).

Application/Analysis

At Urban Pathways, engagement is being aligned with stages of change through:

• Sitting (Precontemplation): Presence without pressure communicates acceptance, reducing defensiveness.
• Listening (Contemplation): Open-ended questions evokes ambivalence and surfaces resident goals.
• Empathizing (Preparation): Corrective emotional experiences strengthens trust and preparedness.
• Collaborating (Action & Maintenance): Shared goal setting and accountability sustains motivation.

Composite Case Example: A resident reluctant to substance use treatment was initially met with empathic presence (sitting). Over time, listening revealed ambivalence (“I hate how it makes me feel”). Staff empathized with his struggle, and collaboration eventually supported harm-reduction goals, aligning with his level of preparedness.

Implications

• Practice: Staff ought to view “lack of motivation” as an engagement challenge, not resident failure.
• Supervision: Supervisors can help staff identify mismatches between engagement strategies and stages of change.
• Policy: Programs are to embed motivational and engagement training as core competencies.
• Research: Studies need to test combined engagement + stage-matched interventions for long-term housing and health outcomes.
• Systems: Aligning engagement with stages of change provides a replicable framework for diverse human service settings.

Conclusion

Motivation emerges from alignment, not coercion. The Four-Stage Engagement Model provides staff with a relational roadmap for applying the Stages of Change, ensuring interventions match readiness, reduce resistance, and foster sustainable transformation.

References

• Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
• Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Dow Jones-Irwin.
• Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. U.S. Department of Health and Human Services.

This article is part of a collaboration between SWEET Institute and Urban Pathways.

Read the full scientific version HERE