What to do when your patients are “too busy” for lifestyle interventions
One of the greatest challenges for lifestyle practitioners is guiding our clients through successful behaviour change.
But it can be hard for both sides. For a practitioner it can be tempting to jump in boots and all because we have the knowledge and understanding of all the benefits adopting healthy lifestyle habits can bring. But being over enthusiastic and ready to leap into action mode can backfire if the person concerned isn’t ready.
Whether it’s their smoking or drinking habits, weight or lack of exercise to be managed, assessing an individual’s readiness to change can be achieved using the transtheoretical model of behaviour change as originally outlined by Prochaska and Di Clemente back in 1977.
The five stages of change
Precontemplation – (Not ready) The person doesn’t necessarily see their behaviour to be a problem and they’re not intending to take any action in the foreseeable future.
Contemplation – (Getting ready) The person is starting to realise their behaviour is a problem and they’re more prepared to consider the “pros’ and “cons” of their continued behaviour.
Preparation – (I’m ready) They are starting to be more intentional in working towards the first small steps of behaviour change.
Action – (Taking positive steps) They are taking active steps to modify their behaviour, shifting towards a healthier lifestyle.
Maintenance – (Sustained positive change over 6 months) They have been able to sustain the positive changes for more than 6 months and are working towards preventing relapse.
While a useful guide, the problem is this isn’t how life works. Life is messy, busy and complex, never smooth and linear. While it would be lovely to take a client from one stage to the next, the reality is many will be chopping and changing between different stages at any given moment.
When setting goals, what we hope for is this:
The reality looks more like this:
With false starts, abandonments, revisits and a few side tracks along the way.
“Sorry, I’m too busy” suggests the person is stuck in precontemplation.
If a practitioner isn’t prepared to tackle the “too busy” answer, it’s an opportunity lost to get curious about what this means for the person concerned. It’s easy to get lost in our own assumptions of what their busy is, listing disinterest, lack of motivation or resistance to change as our chief suspects.
Busy is just a euphemism.
It could be that they are currently prioritising other things in their life right now. They genuinely don’t have the mental space to consider their lifestyle.
It could be they want to avoid what you’re proposing, being “too busy” allows them to maintain the ostrich position of denial, keeping their head firmly in the sand.
It could be they are afraid of failing, having already experienced previous failed attempts.
It could be they lack the confidence in their own ability to bring about the desired change, or perceive it as too big, too hard, too scary, too time consuming, they’re not sure they understand what it entails or even if they want it.
It could be they don’t believe you.
Unless you ask, you won’t discover their truth.
Tackling precontemplation is about giving the individual the time and space to share where they are currently at. This links back to the premise stated in James and Janice Prochaska’s book Changing to Thrive that “Where ever you are now, we can work with that.”
Many people are quite happy with the status quo, they may not have given any particular thought to their own need to change, so your enquiry or suggestion can induce the automatic reflex reaction of “I don’t think so” potentially shutting down further conversation. The gold here is to nurture the idea of how they could imagine implementing the proposed idea could help them and to use the “what if” question to motivate them to consider different options.
Why did they attend?
It’s a reasonable question and what better time to ask?
“My wife said she would divorce me if I didn’t come to see you about my drinking.”
“My boss has told me that if I want to keep my job, I have to do something about my fitness level.”
“I want to have a baby, but my partner thinks I should give up smoking first.”
Let’s start at the beginning and have a conversation.
This is the time to develop trust and rapport. Let them know that anything discussed stays in the room. They need to know they are safe and won’t be judged.
Ask their permission to discuss the subject further – this provides a sense of autonomy. They are not being told what to do.
Share you just want to find out more about their situation and their feelings.
Be the guide towards contemplation.
By demonstrating your willingness to listen and not judge, they may be more open to taking in any relevant information you share, helping to nudge them towards developing their own insights into what’s possible.
This is where explaining how behavioural change and habits work can assist in showing this to be a normal process.
Working with someone who isn’t ready yet, is about establishing a deeper understanding of their situation and who they are as a person. What are their greatest fears and desires?
Create the first ripple for change.
Because everyone will be at a different level of readiness to change, being willing to work with a person at any level means that “too busy” is then simply seen as an indicator for the foundational work for future change to be laid down.
Being busy is just life, this is about helping the person who hasn’t considered behavioural change for themselves as an option before to overcome the commonly erected psychological and emotional barriers that otherwise can keep them stuck.
- Treatment Improvement Protocol (TIP) Series, No. 35.
- Center for Substance Abuse Treatment.
- Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999.
- Chapter 4 – From Precontemplation to contemplation: Building readinesshttps://www.ncbi.nlm.nih.gov/books/NBK64968/
- Changing to Thrive: Using the Stages of Change to Overcome the Top Threats to Your Health and Happiness James and Janice Prochaska Hazelden Publishing 2016
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.
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