Stages of Change Basics
What are the five stages of change in the Transtheoretical Model in order?
Precontemplation, Contemplation, Preparation, Action, Maintenance
A client says: "I've been going to the gym three times a week for the past two months and I feel so much better — I just need to figure out how to keep it going when things get busy." What stage is this client in?
Action
A client in precontemplation says: "I don't think my drinking is really a problem." What is the MOST appropriate coach response?
Acknowledge their perspective without arguing, build rapport, and raise awareness gently without pushing for change; avoid the righting reflex
A client who relapses after six months of behavior change is back to square one in the precontemplation stage.
False — relapse does not automatically send a client back to precontemplation; many relapsing clients remain in contemplation or preparation and the experience of relapse often provides important information about barriers and triggers
A client in precontemplation says: "I don't think my weight is really a problem." The coach responds: "Actually, your BMI indicates you are in the obese range and that puts you at serious risk for diabetes and heart disease." Is this an appropriate coach response?
No — this is the righting reflex in action; the coach is arguing for change and presenting unsolicited health information which will likely increase the client's defensiveness and resistance; a more appropriate response would acknowledge the client's perspective with curiosity and build rapport without pushing
In which stage is a client actively making changes to their behavior and has been doing so for less than six months?
Action
A client says: "My doctor keeps telling me I need to exercise more but honestly I feel fine. I don't really see why it's such a big deal." What stage is this client in?
Precontemplation
A client in preparation says: "I've decided I'm going to start exercising — I just don't know where to start." What should the coach do next?
Affirm the decision to change, help the client develop a specific SMART goal, build a concrete individualized action plan, and identify potential barriers and implementation intentions
The action stage is the most important stage because it is when real behavior change is happening.
False — all stages are equally important; without successfully moving through precontemplation, contemplation, and preparation, action is rarely sustained; and without maintenance, action stage gains are often lost
A client in contemplation says: "I've been thinking about quitting smoking but I'm not sure I'm ready." The coach responds: "It sounds like part of you is considering this even if another part is not quite there yet — what makes you say you've been thinking about it?" Is this an appropriate coach response?
Yes — the coach reflects the client's ambivalence without taking sides and uses an open-ended elaborating question to invite the client to share more; this is a person-centered response that honors where the client is without pushing
What does it mean when we say behavior change follows a spiral rather than a linear path?
Most people do not move straight through the stages from precontemplation to maintenance; they cycle back and forth between stages multiple times before achieving lasting change, and relapse is a normal and expected part of the process
A client says: "I know I should quit smoking — I really do. But I also love it and I'm not sure I'm ready to give it up. Some days I think I will and other days I think I won't." What stage is this client in?
Contemplation
A client in the action stage misses their exercise goal for an entire week due to a family emergency. They come in feeling guilty and discouraged. What is the MOST person-centered coach response?
Normalize the setback, affirm that one difficult week does not erase two months of consistent effort, explore what happened with curiosity rather than disappointment, revise the plan collaboratively, and develop a specific if-then plan for managing future high-risk situations
A client can be in different stages of change for different health behaviors at the same time.
True — a client might be in action for physical activity, contemplation for diet changes, and precontemplation for reducing alcohol use all at the same time; stage of change is behavior-specific, not a general characteristic of the person
A client in preparation says: "I've decided I want to start eating better and I've already cleared out my pantry." The coach responds: "That's great — now let's also work on your exercise habits, your sleep, and your stress levels while we're at it." Is this an appropriate coach response?
No — while the coach's enthusiasm is understandable, trying to address multiple behavior changes at once is overwhelming and reduces the likelihood of success on any of them; the coach should affirm the steps already taken and focus on one realistic goal at a time
What is the key difference between the contemplation stage and the preparation stage?
In contemplation the client is thinking about change but has not committed or taken any steps; in preparation the client has decided to change and has typically already taken some small steps toward action, usually within the next 30 days
A client says: "I've already cut back on soda this week and I signed up for a yoga class that starts next Monday. I feel like I'm finally ready to really commit to this." What stage is this client in and what specific language tells you that?
Preparation — the client has already taken concrete steps (cut back on soda, signed up for yoga) and has a specific plan for the near future; language like "already," "signed up," and "finally ready to commit" all signal preparation rather than contemplation
A client has been in contemplation for three sessions and keeps expressing both change talk and sustain talk without moving toward preparation. A new coach feels frustrated and wants to push the client toward setting a goal. What should the coach do instead and why?
The coach should continue exploring ambivalence, deepening importance, and building confidence without pushing for premature commitment; a goal set before the client is ready produces shallow commitment that will not hold when things get difficult; rushing a contemplation stage client toward action is a stage-mismatched intervention that typically increases resistance rather than motivation
If a client is in the preparation stage, the most effective coaching approach is to immediately develop a detailed action plan covering all of their health behavior goals at once.
False — even in preparation, the coach should focus on one realistic goal at a time; trying to address all health behaviors simultaneously overwhelms the client and reduces the likelihood of success on any of them
A client in the action stage says: "I've been exercising three times a week for two months but I missed all my workouts last week because work was crazy." The coach responds: "Missing a full week is a real setback — let's make sure that doesn't happen again by adding more accountability to your plan." Is this an appropriate coach response?
No — the coach is treating the setback as a crisis and placing blame rather than normalizing and exploring with curiosity; a more appropriate response would affirm the two months of consistent effort, normalize the difficult week, explore what happened with genuine curiosity, and collaboratively develop a plan for managing high-stress weeks in the future
According to the Transtheoretical Model, what distinguishes the maintenance stage from the action stage and what is the primary focus of coaching at this stage?
The maintenance stage begins after six months of sustained behavior change; the primary coaching focus shifts from sustaining momentum to relapse prevention, managing high-risk situations, and building long-term coping strategies
A client says: "I quit drinking fourteen months ago after trying for years. I still think about it sometimes when I'm stressed but I have a plan for those moments and it works. Last month I went to a work event where everyone was drinking and I got through it." What stage is this client in and what would you NOT do as their coach in the next session?
Maintenance — the client has sustained the change for fourteen months, well past the six month threshold, and has developed effective coping strategies. The coach should NOT withdraw support or assume the work is done; maintenance stage clients still need ongoing support focused on relapse prevention and managing high-risk situations
A client in contemplation has been coming to coaching sessions for three weeks and keeps going back and forth without moving toward preparation. The coach says: "I think it's time we set a goal today — you've been thinking about this long enough." Is this an appropriate coach response?
No — this is a stage-mismatched intervention; pushing a contemplation stage client toward goal setting before they are ready produces shallow commitment that will not hold when things get difficult; the coach should continue exploring ambivalence, deepening importance, and building confidence at the client's own pace
The Transtheoretical Model suggests that the best predictor of whether a client will successfully change a behavior is how motivated they feel at the start of coaching.
False — the TTM suggests that stage of change, not motivation alone, is the best predictor of behavior change success; a highly motivated client in precontemplation is less likely to change than a moderately motivated client in preparation; matching the coaching approach to the client's stage is more important than the client's level of motivation
A client in the maintenance stage says: "I've been smoke-free for eight months and I feel amazing — I think I've got this under control now." The coach responds: "That is incredible and you should be so proud. Since things are going so well I think we can wrap up our sessions — you clearly don't need coaching anymore." Is this an appropriate coach response?
No — while the affirmation is appropriate, withdrawing support entirely because a client is doing well in maintenance is premature and risky; maintenance stage clients still benefit from ongoing support focused on relapse prevention, managing high-risk situations, and sustaining long-term change; the coach should celebrate the progress while continuing to provide support