Applying the Transtheoretical Model of Behavior Change
By Araceli De Leon
As a health coach, your role includes effectively working with clients to adopt healthy lifestyle behaviors. The next step is to help them sustain those behaviors over the long haul. The following is a breakdown of the stages of change and specific strategies to apply when working with clients in each stage.
The transtheoretical model of behavior change (TTM) is an integrative model incorporating important ideas from multiple behavior-change theories and models that emphasizes the identification of a client’s readiness to change. By applying the TTM, you can align your coaching strategies to a client’s current stage of change. The TTM also provides strategies to implement with clients at each stage of the decision-making process.
Helpful steps to follow in understanding and applying the TTM:
- Extract main points from each stage definition (the purpose is to differentiate each stage).
- Write down the main traits and goals of each stage.
- Develop strategies to attain each goal.
Precontemplation
In this stage, the client does not intend to change soon (within six months), may be unaware of the need to change, or does not believe a change will benefit them.
Strategy:
Empathetically validate their lack of readiness to change and remind them that they are in control of if and when they do change, as clients in the precontemplation stage may become defensive if they feel like they are being judged, criticized, or forced to act before they are ready.
Example:
Client: “My wife and my family are telling me I need to start walking to help me lose weight and manage my diabetes. I don’t think it will really make that big of a difference.”
Coach: “Your family is worried about you and you don’t believe walking will have any impact on your diabetes. You are in control of when to start walking. How will you know that it is the right time to begin?”
Contemplation
A client in this stage is planning to start the new behavior within the next six months. Even with the knowledge that their current behavior has negative consequences, they may still be ambivalent to change.
Strategy:
This is your opportunity to ask open-ended questions and brainstorm action steps to help the client connect the reasons to change to their values and to evaluate the pros and cons of making a change. Questions to ask might include, “What programs have worked for you in the past?” “Why do you want to change at this time?” and “How will this change impact what is most important to you?”
Example:
Client: “My wife and family are telling me I need to start walking to help me lose weight and manage my diabetes. I know I need to do something, but I’m just not sure walking will do any good.”
Coach: “You’re not sure walking will have any impact, and you know that something needs to change. What would you need to learn more about so that you can make an informed decision?”
Preparation
In the preparation stage, the client is ready to act within the next 30 days. They have begun to take small steps, like joining a gym or consulting with a health coach.
Strategy:
Verify they have the skills necessary for change by asking, “What steps can you imagine taking and what is a good first step for you?” It is also important to collaborate to problem solve obstacles, identify sources of social support and establish goals.
Example:
Client: “My wife and family are telling me I need to start walking to help me lose weight and manage my diabetes. I’ve been trying to walk more after work, but I wonder if there is something more I could be doing?”
Coach: “Taking action toward managing your health must feel great. What additional steps would you like to experiment with?”
Action
In this stage, the client has started to implement changes and has stayed consistent for less than six months.
Strategy:
Implement a plan and bring awareness about possible relapses. Empower clients to structure social support and cues for long-term change. It is also important to help clients identify early wins that will help build self-efficacy and empower them to cope with lapses while also establishing systems of accountability and self-monitoring.
Example:
Client: “I have been walking five days a week for at least 45 minutes for the past four months. I feel great! My A1C is coming down, and I have even lost 10 pounds.”
Coach: “It feels good to stick to your plan and reap the rewards of your hard work! Your family has been a great support for you. What potential barriers do you imagine could derail your continued success?”
Maintenance
Clients feel the most empowered in this stage. They have applied the behavior change for six months or more and they know how to deal with lapses.
Strategy:
Your role here is to reinforce the need to transition from external to internal rewards and to help your client to avoid burnout. The client should always know their “why” and should reevaluate their behavior-change strategies and goals as needed to continue making progress.
Example:
Client: “My A1C is lower than I ever imagined it could be, and I have not been at this weight since I was in my 30s. I feel great, have little to no cravings and have enough energy to bike to work now.”
Coach: “When we first started working together, you told me that you wanted to be the type of person that can reach their goals. Your hard work and diligence have paid off. I also hear that your self-motivation has improved from when we started working together and you can celebrate this as a win! What is the next small step you will implement to make sure you stay on this path?”
Final Thoughts
Properly applying the TTM is vital in establishing rapport with your clients. Ultimately, the guidance you provide will help create lasting change in a client’s life. Effective application of the TTM happens through the understanding of each stage and the practice and experience that comes from working with clients. For many clients, this is the first time they experience non-judgmental and authentic support that leaves them empowered to become the architects of change in their life.
