As health coaches we have a responsibility to facilitate a client’s plans for personal growth, supporting them as they navigate the winding roads of change. Thankfully, behavioral psychologists have theorized the skills, principles, and processes that contribute to successful change outcomes.
Today we’re focusing on one of the most revolutionizing behavior change theories called The Transtheoretical Model (TTM) by James Prochaska and Carlo Di Clementi (1977).
At its core, TTM provides coaches with an explanation behind why some people struggle or fail to follow through with a desired change, while other people—or the same person having a different experience—persevere, succeed, and even sustain the new behavior.
According to this framework, there are 6 stages of change that, ideally, a person would progress through in a linear fashion, but most people bounce around the stages in a more winding or regressive fashion. This non-linear tendency is completely natural and perhaps the most important aspect for coaches to understand.
Research shows that when a person is rushed into taking action before they are ready, they’re more likely to get discouraged, quit, or fail. That’s why it’s important for health coaches to identify the phase a client is in, and meet them right where they’re at.
The 6 Stages of Change Are:
- Precontemplation: “I don’t need to or want to change anytime soon,” or “I can’t.”
- Contemplation: “I’d like to make changes soon, but I feel conflicted about it.”
- Preparation: “I will make this change, and I’m ready to start planning for action.”
- Action: “I’m actively attempting this new change, working through setbacks, and displaying goal-oriented behavior.”
- Maintenace: “It’s been over 6 months since I started my new behavior and it feels pretty automatic now. I may experience temporary lapses, but I’m mastering how to get back on track and be consistent.”
- Termination: “This is who I am now, and I have zero desire to return to my old way.”
When the coach uses important skills such as active-listening, reflections, affirmations, and open-ended questions, it supports the client as they weave their way through the stages of change.
Let’s look at 15 strategic open-ended questions a coach can ask to help a client progress through their current stage—which, according to Prochaska, is a great idea because of what he calls the “stage effect,” meaning, the sooner one progresses to the next stage, the more likely they are to have success overall.
From Precontemplation to Contemplation
Scenario: Your client has been working with you on nutrition to help burn excess body fat and reduce her fasting blood sugar levels. She says her doctor and her partner are always pushing her to start exercising, but it doesn’t appeal to her at all.
Note: It’s crucial for the coach to meet a client where they are at, especially during precontemplation. Many of our clients will teeter on the edge of precontemplation and contemplation regarding a certain change—and you’ll know they’re on the edge simply because the client raised the topic up in conversation with you while simultaneously expressing an aversion to change.
Example Open-Ended Questions:
- What are some of the reasons your family or doctor feel so strongly about adding exercise into your life?
- What would need to change in your life, or change about exercise, in order for exercise to be a fit for you?
- Sometimes it helps to get all of the pros and cons where we can see them. [Asking permission first] Would it interest you to brainstorm a list together? [If yes] So, what are the positive effects exercise would have on your life and relationships? Next, what are some positive effects you experience or will continue to experience by staying the same or avoiding exercise in your life?
From Contemplation to Preparation
Scenario: Your client says he wants to start exercising again, but he just doesn’t have the energy, time, or motivation to start doing it yet. He’s also concerned about his back injury acting up again.
Example Open-Ended Questions:
- What have you learned from your doctor, or from past experiences regarding which exercises are likely to cause injury and which ones are safe to do with your history of back pain?
- Looking back on a time when you did exercise more regularly, what were some of the resources or people that helped you get motivated and prioritize exercise?
- Imagine you’re back into working out again, and you’re feeling pretty good. How would this affect your relationships or areas like work and home life?
From Preparation to Action
Scenario: This client is ready to start intermittent fasting. They like the idea of it and want to start on the 1st of the month because it feels like an official start date that they can prepare for now. They tell you they’re excited but nervous because “What if it doesn’t work for me, or I can’t do it?”
Example Open-Ended Questions:
- What sort of information or opportunities could support you in feeling more confident about starting I.F.?
- Think back to another time in your life when you started something new and you weren’t sure you could do it. What strategies and strengths got you across that bridge?
- Imagine that I am the client now, and you are the coach. What would you say to me if I told you I was nervous about trying I.F. and I wasn’t sure it would work for me?
From Action to Maintenance
Scenario: Your client started cooking two weekly dinners for her family, and she takes Sundays to plan meals and grocery shop for the week. This has helped her reach her goals of eating more whole foods, spending more time with her family, and reducing the stress around what to eat throughout the week. How can you support her in turning this into a habit that lasts?
Example Open-Ended Questions:
- Sounds like things are going really well! What do you think about brainstorming together some ways to keep it interesting and turn this into an ongoing way of life?
- What’s something you’ve done with, or for, your family that you eventually made into a regular thing? Looking back on that, what helped you stick with it even when you hit some roadblocks?
- What sorts of cues can be put into place to help make this process more effortless for you so that it becomes more automatic? This can include sharing or outsourcing tasks involved, setting reminders, batch planning, etc.. In other words, what ideas might you come up with to make this even easier to stick with?
From Maintenance to Termination
Scenario: Your client now loves the primal lifestyle. He has adopted an 80/20 primal diet, his family is pretty cool with it, and he has added other primal-inspired aspects to his life like spending more time in nature, creating enriching relationships, and adding more frequent activity in his everyday life. He says, “I can’t even imagine going back to the way things were before. This is a part of who I am now.”
Example Open-Ended Questions:
- In what ways does your primal lifestyle contributes to who you are now as a person, a friend, dad, and partner? Describe them to me.
- What’s something in your life that can, or does, serve as a vivid reminder of how far you’ve come?
- Let’s play with our imagination for a moment if you’re open to that…[wait for the okay]…If you were writing a letter to your current self, from your future self 10 years from now, what sort of obstacles did life throw at you, and how did you stay committed to a primal lifestyle as you overcame those obstacles?
The TTM stages of change are relevant in all that we do as health coaches because they serve as a roadmap for effective, client-led health-behavior change. If you’re feeling inspired by this introduction to behavior change psychology, check out what else you’re missing from our new Level 2 Certification program.
