The Health Coach’s Role in the Six Stages of Change

Prochaska and DiClemente’s Six Stages of Change can help you identify, based on cues, what stage your patient is in and, as a health coach, you can then gain insight into how to guide your patient through the remaining stages together. Resistance comes into play when the patient is in a different stage than you. If you are in the Action stage and he or she is not yet, he or she could feel pressured, unheard, and unimportant in the process.

So, we have outlined the stages below and offered a few tips for each stage:

Stage 1: Pre-Contemplation

  • In this stage, the patient is not considering change
  • The health coach should discover concerns and build rapport with the patient

Stage 2: Contemplation

  • In this stage, the patient acknowledges his or her health concerns
  • The health coach should recognize ambivalence, review the “pros and cons”, and be encouraging

Stage 3: Preparation

  • In this stage, the patient is committed to change
  • The health coach should identify co-behaviors, clarify goals, and reinforce accountability

Step 4: Action

  • In this stage, the patient has begun taking steps to change
  • The health coach should reinforce the behavior and develop coping strategies

Step 5: Maintenance

  • In this stage, the patient has achieved some goals and is working to maintain this change
  • The health coach should affirm self-afficacy and review long-term goals

Step 6: Termination – Success versus Relapse

  • In this stage, the client has made the change and may attempt to terminate the relationship, potentially leading to a relapse
  • The health coach should re-label failure, express empathy, and review the patient’s accomplishments thus far

This is just a basic overview of the Six Steps of Change process from a health coaching perspective, but the key is to identify what stage your patient is in without pushing your own agenda. If you push, whatever resistance you are already facing will increase, your job will be a lot harder, and the patient will have a less positive experience. Work with the patient, not against him or her.

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