Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change

Abstract

Counseling patients on behavior change is an important skill that traditional medical training does not emphasize. Most practitioners are trained in the expert approach to handle problems, which is useful in the acute care setting. However, in the case of chronic disease, a coach approach is more effective. This approach allows the patient to reflect on his or her own motivators for change as well as obstacles hindering the change. Changing from the expert approach to the coach approach is contingent on the lifestyle medicine practitioner sharing information when the patient is ready to receive it, listening mindfully, asking open-ended questions, treating problems as opportunities to learn and grow, and encouraging patients to take responsibility for their actions. By collaborating with the patient, the practitioner can guide patients to find solutions to the problems they are facing and foster an environment that leads patients to self-discovery, accepting responsibility for their behaviors, and ultimately, achieving goals that result in healthier daily habits. As a framework and a guide, lifestyle medicine practitioners can use a 5-step cycle of collaboration and a ladder of behavior change when working with patients on behavior change.

Keywords: behavior change; coach approach; health coaching; lifestyle medicine; motivational interviewing.

Figure 1.

Five-Step Cycle in the Coaching Model.^a Abbreviation: SMART, specific, measurable, action oriented, realistic, and time sensitive. ^aReprinted with permission from Frates et al.

Figure 2.

Ladder of Behavior Change.^{a a}The sides of the ladder represent the person’s priorities, principles, visions, and values—the framework on which to base his or her SMART (specific, measurable, action oriented, realistic, and time sensitive) goals. The rungs of the ladder are the individual SMART goals, both short and long term, that will lead a person toward his or her ultimate vision or dream. Motivators, both intrinsic and extrinsic, serve as the driving force that propels patients forward along their climb to success.