The Relationship of Client Stages of Change to Working Alliance and Outcome in Short-Term Counseling.

This study evaluated the relationship of J. O. Prochaska's (1984; J. O. Prochaska & C. C. DiClemente, 1992) transtheoretical model of change with the process and outcome of short-term counseling in college help seekers. Participants completed measures of readiness to change, psychological symptoms, and working alliance. Clients in the precontemplation stage evaluated the working alliance less favorably and experienced less improvement regarding symptoms than clients in other stages. Counselor working alliance did not differ as a function of clients' stage of change. ********** For more than 20 years, research generated from the transtheoretical stages of change model (McConnaughy, Prochaska, & Velicer, 1983; Prochaska, 1979; Prochaska & DiClemente, 1983) has provided clinicians with empirically supported suggestions for how to work with different types of clients. The model assumes that clients occupy different levels of readiness to identify and address problems in their lives. Although several versions of the model have been outlined (Smith, Subich, & Kalodner, 1995), the most common conceptualization includes four stages: precontemplation, contemplation, action, and maintenance. Each stage "represents specific constellations of attitudes, intentions, and/or behaviors that are relevant to an individual's status in the process of change" (Prochaska & DiClemente, 1992, p. 300). Clients further along in the stage model have been described as more likely to benefit from therapeutic interventions (Prochaska & DiClemente, 1992). Consistent with early theoretical formulations, the majority of research to date on the stages of change model has focused on its relevance to behavioral concerns, including smoking cessation (DiClemente, Prochaska, & Fairhurst, 1991; Keller, Nigg, & Jakle, 1999; Prochaska & DiClemente, 1986), dietary issues (Povey, Conner, Sparks, James, & Shepherd, 1999; Rossi, Rossi, Velicer, & Prochaska, 1995), bulimia nervosa (Franko, 1997), problematic exercise (Burn, Naylor, & Page, 1999; Marcus et al., 1998; Peterson & Aldana, 1999), sexual practices (Grimley, Prochaska, & Prochaska, 1993) and substance abuse (Al-Otaibi, 1999). These studies have provided support for the usefulness of assessing a client's readiness to change when addressing behavioral problems in counseling. Based largely on this data, interest in extending the model's application beyond behavioral issues to a broader array of concerns has grown (e.g., Derisley & Reynolds, 2000; Satterfield, Buelow, Lyddon, & Johnson, 1995). The purpose of our study was to evaluate this proposition with a large sample of college counseling center clients. First, we review related research. Satterfield et al. (1995) examined the relationship between client stages of change and expectations of counseling among a sample of 88 clients seeking services at an outpatient clinic. The results suggested that clients in the precontemplation stage have lower expectations for counselor acceptance, genuineness, confrontation, and trustworthiness than do clients who are in the higher stages of contemplation, action, or maintenance. In addition, Satterfield et al.'s study found evidence that clients entering counseling in the contemplation and maintenance stages may expect counselors to take greater responsibility for directing the course of counseling than do clients in the precontemplation and action stages. Although this study provides useful information about how stage of change is related to client expectations for brief counseling across a range of concerns, it does not make clear whether these expectations are related to the process or outcomes of counseling. Several studies have addressed the relationship between premature termination and stage of change. Using a sample of 74 counseling center clients, Smith et al. (1995) found that the stage of change in which participants entered counseling was related to premature termination, defined as attending no more than one appointment. …