Prochaska and DiClemente’s ubiquitous ‘five stages of change’ seems to offer a scientific system to guide clinicians and therapists on how to work with patients – how to recognise when someone is ready to commit to treatment (or if not to nudge them towards a more receptive stage), and how to avoid wasteful change attempts with those not yet ready to change. Implicitly or explicitly, in services across the UK this system is used to recognise the motivational state of patients and clarify how to promote progression to sustained recovery. Its simplicity is beguiling, but can it really be used to generate change by matching patients to interventions, or does it simply describe one type of change process?