A lot of people go into therapy hoping for a clear roadmap. So it makes sense that one of the most common questions is:

“What are the 4 stages of therapy?”

And while some therapy models do use a four-step structure, this question misses something important. Real therapy isn’t about following a rigid formula. It’s about understanding where you are in the process of change. That’s why many therapists prefer the “Stages of Change” framework—a flexible, research-backed way of understanding your readiness for growth.

Let’s break down where the “4 stages” idea came from, why it’s not universal, and what actually helps people make lasting change.

Where the “Four Stages” Idea Came From

The most commonly referenced version comes from Adlerian therapy, a humanistic approach created by Alfred Adler. Adler organized therapy into four broad phases:

1. Engagement

This is the “getting to know each other” phase—building trust, rapport, and a shared understanding of what you want from therapy.

2. Assessment

Here the therapist gathers information about your history, family background, beliefs, patterns, and how you view the world.

3. Insight

This stage is about making connections—understanding why you feel and act the way you do, and how the past influences the present.

4. Reorientation

This is the action phase. You start trying out new behaviors, new mindsets, and new ways of relating to yourself and others.

Adler’s structure is thoughtful and organized, but it’s just one lens—not a universal roadmap.

Another Example: The Four Stages of DBT

Adler isn’t the only approach with a four-stage model. Dialectical Behavior Therapy (DBT) also uses four treatment stages, but for a totally different purpose.

DBT stages focus on prioritizing the most serious issues first:

1. Stage 1: Life-threatening behaviors
   
   
2. Stage 2: Therapy-interfering behaviors, trauma, emotional suffering
   
   
3. Stage 3: Problems in daily living
   
   
4. Stage 4: Finding meaning, joy, and fulfillment
   
   

DBT is incredibly effective—but it’s designed for specific challenges, not general therapy.

So if these models aren’t universal… what is?

The 5 Stages of Change

While structured therapy models are helpful, the most widely applicable framework doesn’t come from a type of therapy at all.
It comes from research on how people change.

It’s called the Transtheoretical Model, or simply the Stages of Change.
This model is used across psychology, addiction treatment, coaching, medicine, and everyday behavior change.

It’s flexible.
It’s realistic. 

And it centers you—not the therapist.

Here’s how it works:

Stage 1: Precontemplation — “This isn’t a problem.”

At this stage, you’re not thinking about change yet. You may be in therapy because someone else pushed you. You might feel defensive or misunderstood.

The goal here isn’t to jump into solutions—it’s simply to build awareness and feel safe enough to explore your experience.

Stage 2: Contemplation — “Maybe something needs to change.”

You’re starting to see there might be an issue… but you’re torn. You can list the pros and cons of changing, and both sides feel convincing.

This stage can last months or years, and that’s okay. A therapist’s role during contemplation is to help you sort through your ambivalence—not pressure you into action.

Stage 3: Preparation — “I’m getting ready.”

Now you’re leaning toward change. You might be researching therapists, making a plan, or setting small goals.

Preparation is about building confidence and figuring out what resources you need.

Stage 4: Action — “I’m doing the work.”

This is the phase most people imagine when they picture therapy. You’re actively trying new behaviors, practicing skills, and working through emotional challenges. It’s often the most effort-intensive part of therapy.

Stage 5: Maintenance — “This is my new normal.”

You’ve made meaningful changes, and now the goal is to maintain them. You’re solidifying new habits, anticipating triggers, and building long-term resilience.

This stage is where people prepare for eventually ending therapy—and continuing growth on their own.

An actionable self-assessment

One of the most empowering things you can do before starting—or even during—your therapeutic journey is to identify your own Stage of Change. This self-awareness helps you communicate your needs more clearly and have a more productive conversation with your therapist from day one. Read the descriptions below and see which one resonates most with your current situation regarding the issue you want to address.

• Are you in Precontemplation? You might think: "I don't have a problem, but my spouse/boss/parents think I do." "Everyone else is overreacting." "I'm only here because someone made me come." You feel resistant to or defensive about the idea of change.
• Are you in Contemplation? You might think: "I know I probably should change this, but I'm not sure if it's worth the effort." "Part of me wants to change, but another part of me doesn't." "I'll think about starting next month." You feel ambivalent and stuck.
• Are you in Preparation? You might think: "Okay, I'm ready to do this. What's the first step?" "I've started looking up therapists/support groups." "I told my best friend I'm going to start working on this." You feel motivated and hopeful.
• Are you in Action? You might think: "I'm actively practicing the new skills my therapist taught me." "It's hard work, but I'm showing up to my sessions and doing the homework." "I've stopped the old behavior and am trying a new way of living." You feel engaged and challenged.
• Are you in Maintenance? You might think: "I've been consistent with my changes for over six months." "I know what my triggers are and have a plan to deal with them." "This new way of being feels more natural now." You feel confident but still mindful of potential challenges.

Understanding your stage helps manage expectations for what happens in therapy. It's a key part of monitoring your own client progress in therapy stages and collaborating with your therapist on the most effective plan.

How a skilled therapist adapts to your stage of change

This is where the true art and science of psychotherapy come together. A good therapist doesn't use a one-size-fits-all process. Instead, they meet you where you are. The client-therapist relationship development is tailored to your readiness. Research strongly supports this approach; in stage-matched care, clinical interventions are selected and adapted based on a person’s Stage of Change, an approach supported by research to help implement health-behavior changes.

Therapy in Precontemplation & Contemplation: Building a foundation

If you're in an early stage, a therapist's primary job is not to push you into action. Doing so would likely create resistance and damage the therapeutic alliance. Instead, the focus is on creating a safe, non-judgmental space for exploration. The goals of the initial phase of therapy in this context are about building trust and gently raising awareness. A therapist might use techniques from motivational interviewing to help you explore your own ambivalence, without pressure. The work is about emotional processing, not behavioral change. This is the delicate beginning of the therapeutic relationship life cycle.

Therapy in Preparation & Action: Building skills and momentum

Once you're ready to move, the therapeutic approach shifts. During the preparation and action stages, therapy becomes more goal-oriented and skill-based. This is where structured approaches like Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT) can be incredibly powerful. A therapist will work with you on a concrete CBT treatment plan, help you set realistic goals, teach you new coping mechanisms, and support you as you navigate the challenges of making real change. Client and therapist goals alignment is critical here to maintain momentum.

Therapy in Maintenance: Building resilience

In the maintenance stage, the therapeutic work often becomes more nuanced. The focus is on solidifying your progress and preparing for long-term success. The conversation might shift to identifying potential high-risk situations, strengthening your support system, and refining your coping strategies. This is also when the conversation about what happens in the termination stage of therapy begins. The goal is ending the therapeutic relationship properly, empowering you to continue your personal growth through counseling independently.

Structured Models vs. the Stages of Change: What’s the Difference?

Structured Models (like Adlerian or DBT)

• Follow a set sequence
  
  
• Work best for specific types of clients
  
  
• Provide clarity and predictability
  
  
• Can feel rigid if you’re not ready for action
  
  

Stages of Change

• Completely flexible
  
  
• Works with every level of readiness
  
  
• Allows the therapist to adapt moment-by-moment
  
  
• Normalizes setbacks as part of growth
  
  

This is why many modern therapists rely on the Stages of Change to guide the overall process, even if they pull techniques from many different therapy models.

Common Questions About the “Stages” of Therapy

What are the 4 phases of therapy, technically?

This usually refers to Adler’s model—Engagement, Assessment, Insight, and Reorientation.

What are the “4 C’s” or “4 P’s”?

These aren’t stages.
They’re tools:

• 4 C’s: Courage, Commitment, Compassion, Consistency
  
  
• 4 P’s: Predisposing, Precipitating, Perpetuating, Protective factors

Both help guide case formulation or mindset—but not therapy stages.

Making the right choice for your needs

Ultimately, how to know when therapy is working depends heavily on the fit between you, your therapist, and the approach. The best process isn't one that's universally "best," but one that's best for *you*, right now. Here is some tailored advice based on your potential Stage of Change.

For the Skeptic in Precontemplation

If you don't believe you have a problem and are only considering therapy due to pressure from others, your greatest need is a safe space to be heard without judgment. Look for a therapist who emphasizes the therapeutic alliance development in their approach. You need someone who won't push you to set goals or demand immediate change. An approach grounded in the Stages of Change is ideal, as the therapist will understand their first job is simply to build rapport and explore your perspective. The orientation stage of counseling for you should be slow, gentle, and focused on trust.

For the Ambivalent Contemplator

If you're stuck weighing the pros and cons of change, you need a therapist who is skilled at exploring motivation. You're past denial but not yet ready for a boot camp. A therapist who rigidly adheres to an action-oriented model may overwhelm you. Instead, look for a therapist who can help you explore your values, clarify what you want for your life, and gently examine what's holding you back. This is where a therapist skilled in client-centered methods and motivational interviewing will excel, helping you move from ambivalence to a confident decision to prepare for action.

For the Determined Action-Taker

If you are ready and motivated to make a change, you will likely thrive with a therapist who can provide structure, skills, and accountability. This is where evidence-based, practical approaches like CBT, DBT, and ACT shine. You need a collaborative partner who can help you with concrete goal setting in counseling, teach you practical coping skills, and help you create a plan for relapse prevention. While a flexible framework is still important, you will benefit from a therapist who can provide a clear plan and support you through the working stage of psychotherapy.

Understanding the therapeutic process is the first step toward reclaiming your mental and emotional well-being. At Chris McDuffie Counseling, my approach is eclectic and deeply personalized, grounded in the belief that therapy must adapt to your unique needs and readiness for change. By integrating evidence-based Western methods with Eastern wisdom, I meet you exactly where you are on your journey—whether you're just beginning to consider change or are ready to take decisive action. If you're seeking a compassionate, experienced partner to navigate your path to growth, I invite you to contact my office in Carlsbad, CA, to schedule a consultation.

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