Behavior Change, Communication, and Client Education
Behavior change models
The Transtheoretical Model describes stages - precontemplation, contemplation, preparation, action, maintenance - and the right intervention depends on the stage. Motivational interviewing supplies the how: the spirit of partnership, acceptance, compassion, and evocation, delivered through OARS (open questions, affirmations, reflections, summaries). Self-determination theory adds that autonomy, competence, and relatedness drive durable motivation, while Social Cognitive Theory contributes self-efficacy, which grows through mastery experiences, modeling, and verbal persuasion.
Communication and education
Use plain language, chunk information, and confirm with teach-back: "tell me how you'd fit your walks into next week." Shared decision-making means presenting options with tradeoffs rather than issuing instructions. Goals should be specific, measurable, and client-owned; a SMART goal written by the coach is a plan for the coach.
Traps
Launching an exercise prescription at a contemplative client (the righting reflex - arguing for change while the client argues against it); confusing education with persuasion; assuming understanding from a signed form; using fear appeals that raise defensiveness; overlooking health literacy, culture, cost, transportation, and caregiving barriers; and labeling a missed session as noncompliance rather than exploring the barrier.
Rule of thumb
Use a confidence ruler: "On 0-10, how confident are you that you can walk three times this week?" A score under 7 means the goal is too big - shrink it until confidence rises, then ask what would help.
Worked example: a client at 4/10 confidence for five 40-minute walks is offered two 12-minute walks instead, then asked what would make the next step easier.