From Ambivalence to Action

Where’s my client at?


What I mean by this title is ‘what stage of the change process is your client sitting at’. When people make a behaviour change the stages of change model (Prochaska and DiClemente) suggests that they go through various stages before successfully achieving the desired behaviour change. My research has highlighted that clients will employ a personal trainer (PT) even if they are not ready to change psychologically. The risk for the PT in this scenario is that there is a strong possibility that ultimately this client will fail in their attempt to lose weight. Worse still they will blame the trainer for the failure. What can a PT do to avoid this scenario?

The ideal answer is to psychometrically screen each client, so you understand where they are sitting in terms of their readiness to change. You can take this type of testing one step further in that by regularly testing you can assess the clients progress (from a psychological perspective). You can learn the skills required to do this type of assessment on the psychometric testing workshop. If you can’t do a psychometric assessment, then perhaps the next best option is to try and get a handle on their decisional balance state.

Decisional balance theory was first proposed by Janis and Mann (1977). They posit that when individuals are making a decision they adopt a balance sheet approach. They weigh up the pros and cons of changing and if the pros sufficiently outweigh the cons then they will make that change. This can be assessed using a psychometric test but if you don’t have this available to you then you can get some idea of what the client is thinking by getting them to do some brain storming. Get two sheets of paper and on one sheet get them to write down all the pros for changing. Do not give them any hints or suggest any pros if you do this they do not own the comments. When they have totally exhausted these get them to turn that sheet over so it not visible. Now on the second sheet get them to record all the cons for changing. Again, do not make any suggestion that will influence what they record. The reason you do it this way is that if the client can see the first list it will influence the second list. It is most probably better if you are not present when they do this as they may feel under pressure to record lots of pros. Once they have completed both sheets you can now compare them. If the pros outweigh the cons, then they are possibly ready to change. If the lists are fairly even, then the client is still experiencing some ambivalence about change. In this scenario motivational interviewing comes into its own as this is designed to help ambivalent clients move forward. You can assist this process by highlighting to clients where things they have listed as cons may not be true. For instance, they may have put ‘I will feel hungry if I reduce my intake or I will have to give up my favourite foods’. Neither of these statements is necessarily true when following a healthy eating regime.

The one piece of advice I would offer in this scenario is make sure you ask the clients permission to offer advice on such things. You must respect the client’s autonomy at all times and ploughing in with well meaning advice may well be counterproductive. Respecting a client’s autonomy (right to choose) is paramount in all scenarios. Failure to do this may add unnecessary barriers to change and also reduce the client’s self-efficacy. Building up the client’s self-efficacy is also key to helping the client progress through the stages of change as this is positively correlated to forward movement in the change process. We know that education helps increase self-efficacy, but the client must want this education and not have it foisted on them.

Behaviour change is a complex process and understanding what is under-pinning any change is crucial for a good trainer. Ultimately it is the goal of any PT/coach to help clients make positive changes to move them towards their goals. If you understand what is going on at a psychological level this process can be made a whole lot easier.

Welcome to Stages of Change