From Doing to Becoming: Supporting Patients in the Action and Maintenance Stages of Change
This article concludes our series on the Transtheoretical Model of Change (TTM) with exploring what happens when patients move beyond intention and into sustained behavior change. For clinicians, these stages present a valuable opportunity to shift from motivating change to reinforcing success. You can view all of the previous articles on our website: https://www.healthychangescripts.com/blog.
The Goal Is Not Just Change. It's Lasting Change.
Throughout our series, we've explored how people move through the stages of change: Precontemplation, Contemplation, Preparation, Action, and Maintenance.
While much attention is often given to helping individuals overcome ambivalence and get started, the real measure of success is whether healthy behaviors become part of daily life.
Our final article focuses on the Action and Maintenance phases, where patients are actively engaging in behavior change and building the confidence needed to sustain it long term.
How can you help the process?
The Action Stage: Turning Intention into Behavior
A patient enters the Action or the “I am” stage when they have begun making meaningful changes to their health behavior. Unlike the Preparation stage, where plans are being made, Action involves visible, measurable activity and it can last for 6 months or longer.
At this stage, motivation is no longer the primary challenge. The patient has already decided to change and has taken steps to do so. They are practicing new behaviors, refining their lifestyles and building up the new behaviors to desired levels.
The clinician's role shifts from helping the patient decide whether to change to helping them succeed in the changes they have already initiated.
Patients in Action often benefit most from acknowledgment of their efforts. You may respond to these positive changes with a quick line like, “Good job!”. However, adding an easy verbal upgrade can help boost the likelihood of ongoing success. Genuine recognition helps patients see themselves as capable and successful.
A Brief Conversation with a Patient Who Is Already Succeeding
Example
Provider: What healthy habits have you been working on?
Patient: “I started taking a daily walk with my husband after dinner. I've been feeling better and have more energy. It's becoming part of my routine."
Provider: "It sounds like you've found benefits that really matter to you. What have you done that helped make exercise part of your routine?"
Patient: "I started leaving the dishes and walking right after we got up from the table. That way I don’t get distracted."
Provider: "That's a strong strategy. What do you think will help you keep that going over the next few months?"
This conversation may last less than two minutes, yet it accomplishes several important goals:
Reinforces the patient's success
Highlights effective strategies
Builds self-efficacy
Encourages planning for sustainability
Identifies personal motivations
Most importantly, the patient leaves the encounter with a stronger sense that they are the one creating success.
It also can help the provider feel uplifted by taking time to celebrate the patient’s wins, gain wisdom for future patients, and develop a strong therapeutic relationship by making patients feel respected. We wrote a blog called “Don’t Keep Doing What You’re Doing” which goes into more detail on this topic.
The Maintenance Stage: Protecting Progress
The Maintenance, or the “I Still Am” stage begins when healthy behaviors have been sustained over time, habitual and are becoming integrated into daily life. The exact timeframe varies, but generally Maintenance reflects consistent behavior that has continued long enough to demonstrate stability, usually 6 months after starting the new behavior.
Patients in Maintenance often:
Feel more confident
Experience fewer barriers
Require less external motivation
View the healthy behavior as part of their identity
Why Relapse Remains a Normal Part of Change
One of the most important principles of the Transtheoretical Model is that change is rarely linear.
Even highly motivated individuals may experience setbacks. These occur due to boredom, vacations, illness, injury, family stress, work demands, or life transitions can temporarily disrupt healthy routines. When patients share that a relapse occurred, effective providers avoid judgment.
Instead of asking:
"Why did you stop?"
A more productive approach would be:
"What did you learn from what happened?"
This shift helps patients view setbacks as learning opportunities rather than failures. Emphasizing that the goal is not perfection, but progress and resilience.
Clinical Conversations in the Maintenance Stage
Patients who are thriving benefit from support around preserving momentum.
If you have the time, helpful questions could include:
"What has helped you stay successful?"
"What benefits have you noticed?"
"What challenges might arise in the future?"
"How would you handle a setback if one occurred?"
"What keeps this important to you?"
These conversations help patients create mental plans for navigating future obstacles before those obstacles appear.
From Behavior to Identity
One of the most powerful transitions during Maintenance happens when patients stop thinking about the behavior as something they are trying to do and start viewing it as part of who they are.
Consider the difference between:
"I'm trying to be active."
"I'm an active person."
Or:
"I'm trying to eat healthier."
"I take care of my health."
This identity shift often predicts long-term success because it requires less conscious effort and less ongoing motivation. Healthy behaviors become integrated into everyday life.
The Provider's Role in Long-Term Success
By the Action and Maintenance stages, patients have often done the hardest work themselves.The clinician's role becomes one of reinforcement rather than persuasion.
Effective providers:
Celebrate progress
Recognize strengths and accomplishments
Reinforce confidence
Normalize setbacks
These brief conversations can be remarkably impactful. A few well-placed questions can strengthen a patient's belief that they are capable of sustaining meaningful change and adding additional healthy behaviors.
Final Thoughts...
The Action and Maintenance stages remind us that behavior change is more than a moment of decision. It is an ongoing process of practicing, adapting, and sustaining healthier choices over time.
When patients are already performing a healthy behavior, the conversation is not about creating motivation. It is about amplifying success. By exploring what is working, recognizing strengths, and planning for sustainability, providers can help transform healthy actions into lasting habits.
As we conclude this series on the Transtheoretical Model of Change, perhaps the most important lesson is this:
People change when they are ready, but they stay changed when they develop confidence in their ability to succeed and it becomes part of their identity and a way of life. That confidence often grows through simple conversations that help patients recognize what they are already doing well.
The gap between providers educating and recommending actions and the follow through of the patient actually doing these behaviors is what we are trying to close. The more providers understand about behavior change and add to their conversations, the more success patients will have.
Providers already spend the time trying to influence their patients.
Why not use the time you already spend with an evidence based approach that benefits both you and your patients?
That is our mission at HealthyChange Scripts, to motivate, inspire, educate, provide tools and coach a better way to convert talk to action to contribute to healthy and happy lives.
We invite you to share your feedback about this article or any article in our series.
References
Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). New York, NY: Guilford Press.
Prochaska, J. O., & Velicer, W. F. (1997). The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion, 12(1), 38-48.
Moore, M., Jackson, E., & Tschannen-Moran, B. (2016). Coaching Psychology Manual (2nd ed.). Wolters Kluwer.
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