As an ACE certified professional, your role includes effectively working with clients to adopt healthy lifestyle behaviors. The next step is to effectively help clients sustain these healthy lifestyle behaviors. The following is a breakdown of the stages of change and specific strategies to be applied in each. This can be used as a resource to determine what the next best steps are for you and your client to take. Let’s get started!
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, the health coach and exercise professional can align coaching strategies to a client’s current stage of change. The TTM provides strategies for health and exercise professionals 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, these do not change.
- Find ways and strategies to attain each goal, this is your “how.”
Examples of application for each stage:
Precontemplation – 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 when they do change. 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 on when to start walking. How will you know that it is the right time to begin?"
Contemplation – Clients are planning to start the new behavior within the next six months. Even with the knowledge that the behavior has negative consequences, a person 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. Questions to ask might include, “What programs have worked for you in the past?” “Why do you want to change at this time?” "How will this change impact what is most important to you?"
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 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 – 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 an ACE- Certified 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?”
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've been trying to walk more after work, but I wonder if there is something more I could be doing?"
Coach: "Taking action towards 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 6 months.
Strategy Implement a plan and bring awareness about possible relapses. Empower clients to establish social support for long-term change.
Example - Client: “I have been walking 5 days a week for at least 45 minutes for the last 4 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 6 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 avoid burnout for the client. The client should always know their “why.”
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 30's. 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 want 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?
Properly applying the TTM is vital in establishing trust and rapport with your clients. Ultimately, the guidance you provide will help create lasting change in a client’s life. As a health coach and exercise professional, effective application of the TTM happens through the understanding of each stage and the practice and experience that comes in working with clients. For many clients, this is the first time they experience non-judgmental authentic support where they are empowered to become the architects of change in their life.
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