Contemplation – Stuck in Maybe
Helping Prescribers Move Patients from Insight to Intention
Clinical Vignette
Mr. K is a 56-year-old man with COPD and hypertension. He smokes half a pack per day. You’ve discussed it before.
“I know I should quit,” he says, “but it’s the only thing that helps me relax.”
He’s neither dismissing you nor is he unaware; rather, he’s stuck in contemplation, he is ambivalent, and he is aware, but he is not at the optimal level of preparedness to act.
What is Contemplation?
Contemplation is the second stage in the Stages of Change model. The patient is:
Aware that the behavior may be a problem
Weighing pros and cons
Not yet at the optimal level preparedness to act
Often stuck in “analysis paralysis”
This stage can last a very long time without support. Your role is to unstick them.
Clinical Markers of Contemplation
Goal for the Prescriber: Tip the Scale
Your aim isn’t to push; rather, it’s to guide decision-making. People in contemplation often need help:
Strengthening their reasons for change
Addressing fears of failure
Seeing that preparation is not commitment; rather, it’s just the next step
Tool: The Decisional Balance Exercise
Ask the patient to list the pros and cons of both staying the same and making a change.
Staying the Same vs. Making the Change
Pros: comfort, routine | Pros: health, energy, longer life
Cons: health risk | Cons: stress, withdrawal
Script:
“Tell me if it would help to take a moment and look at the benefits and costs of both paths. This would not be to decide today, but to get clearer.”
This helps patients see the internal conflict more clearly, and start to resolve it.
Go-To Scripts for Busy Prescribers
Common Pitfalls to Avoid
🚫 Don’t try to rush to action
🚫 Don’t minimize their fears
🚫 Don’t assume insight = readiness
Instead, slow down and allow contemplation to deepen into intention.
Scientific Citations
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (Eds.). (2015). Motivational Interviewing in the Treatment of Psychological Problems. Guilford Press.
Janis, I. L., & Mann, L. (1977). Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. Free Press.
Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change. Guilford Press.
Reflection Prompt
“Am I treating contemplation like action—and accidentally pushing the patient away?”
“How can I help the patient reflect more clearly—without demanding a decision?”
“What does it look like to trust the process, even in stillness?”