Client Behavior Change: A Key to ND Success (Understanding the Transtheoretical Model)

by Mark Young | Follow on Twitter

Increase adherence, get your clients better results, and ultimately make more money by understanding the Transtheoretical Model.

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Editors note: This article was originally published on thePTDC. The word “client” and “patient” are used interchangeably.

WE’VE ALL HAD PATIENTS WHO JUST CAN’T SEEM to stick to their treatment protocols.

Whether it’s adhering to nutritional changes, doing extra lifestyle changes on their own, or even showing up for their scheduled appointments…

There seems to be a disconnect between what clients say they want and their actions.

You’ve probably even asked yourself why they even spent the money if they’re not going to follow through on the plan. Given that you’ve gone to great lengths to study and learn everything possible about medicine and nutrition, you’d expect that they actually follow through on the advice they’ve paid for, right?

In this article, I’d like to share a few things about behavior change that might explain some of your clients’ actions and help you to better address their needs and get them results.

1.  All change goes through phases.

According to the Transtheoretical Model of Behavioral Change, we go from precontemplative (not thinking about it) to contemplative (thinking about it) to preparation (getting ready to do it), action (doing it), and finally maintenance (still doing it).

And, unfortunately, with most types of behavior change the final possible phase is relapse where we can fall back to any of the previous phases. In fact, at any point we can technically revert back to an earlier stage which explains why a patients may have booked appointments (preparation stage) and then not showed up or really isn’t committed (precontemplative/contemplative stage).


2.  Stages of change are not personality traits.

It’s important to realize that stages of change are not traits of people in general.

While they might seem to be stuck in the preparation stage with regards to their diets (“I’m going to get my nutrition on track when…”), this doesn’t mean that they will never progress to the next stage. More importantly, it doesn’t mean that they don’t WANT to change or that they are lazy.

Stages vary in length, but they are not unchangeable. Give them confidence by allowing them to succeed in one area and you may be able to advance them to the next stage in terms of nutrition.

3.  People can be in different stages for different things at the same time.

For example, it’s entirely possible for someone to be in the action stage with regards to exercise (i.e., they hit every workout with enthusiasm), but in the precontemplative stage with nutrition and aren’t really open to your suggestions. Stay with them and be patient.

Also remember that a major change in your client’s work or family life can throw them right back to the precontemplative stage for exercise. You’ll recognize these as the clients who “need to take some time off to sort some things out”, but they never come back. Make sure to stay in contact with them as they’ve not necessarily given up on you, their stage of change has just shifted. When they decide to move back into the action phase again, you want to be the first on their mind.

4.  Moving through stages is not just about education.

All too often we seek to educate patients about proper nutrition, batch cooking, lifestyle habits and later get frustrated and blame it on them when these conversations fail to provoke change.

When a patient eats something they’re “not supposed to”, have you ever showed them the number of calories in the item only to have them continue eating the same thing the next week? I know I have. It doesn’t work.

5.  Belief is a major driver of change.

Self efficacy is defined as the belief that one is capable of performing in a certain manner to attain a certain set of goals. In other words, if a client has high self efficacy they are very confident that they have the ability to follow through on the plan you give them to achieve their goals. On the other hand, if a client has low self efficacy it means that they do not have a lot of confidence that they’ll be able to execute your plan to get where they want to be.

Note that this doesn’t mean that they don’t think your plan works. It also doesn’t mean that they don’t want to achieve the goal they have laid out. What it does mean is that they’re not confident that they’ll be able to stick to the plan so they are unable to commit to action.

The key here is to continue to encourage the client that they are, in fact, capable of following through on the plan you’ve given. Trying to change a client’s whole life all at once can lead to low self efficacy and the client may fail to adopt any changes at all.

On the other hand, by setting them up for small successes and delivering the plan one change at a time you can applaud them as they achieve each success and their confidence will grow.  As a result they’ll be more willing to invest themselves into your plan and results will follow.

Self efficacy: The key to your client’s success

Self efficacy: The key to your client’s success

Side Note

I think some of the stuff that trainers and doctors post on Facebook about their extreme diet and training practices (as a way of impressing their other health friends) has created a kind of “fitness elitism” that is intimidating to others who are thinking about getting involved and reduce their self efficacy.

Wrapping Up

Behavior change is a dynamic process that can move forward and backwards as a result of a number of different influences. Being aware of the process and things that influence change is a huge step towards becoming a skilled practitioner and bringing results for your clients.  Be patient, motivate, and include small step-wise changes and even your least promising clients can have amazing results.

Photo Credits: SidPix

About the Author
Mark Young

Mark has 12 years of experience and well over 10,000 in-person training hours under his belt. On top of this, Mark has provided services to one of Ontario’s only government funded bariatric medical programs for the treatment of obesity. Mark Young is the continuing education overlord at thePTDC.