When considering how lasting change works, we tend to think that it depends on culture, setting, demographics, and the specific problem the change is intended to fix.
But what if there were principles of lasting change that held anywhere: any person, any problem, any setting?
That is the question Dr. Deborah Teplow, our co-founder, put to a room of nutrition coaches this summer: "Are there universal principles of behavior change true no matter the person, the problem or the setting?"
She answered it with three stories from three different continents, and one finding from brain science that explains why they all work.
Uganda: The Dream Came First
At its peak in parts of East Africa, HIV/AIDS wiped out nearly an entire generation. In Uganda, grandparents were left to raise the grandchildren the epidemic had orphaned.
In 2014, a group of those elders dared to dream thirty years into the future, not just about surviving, but about aging in dignity. Despite facing poverty and vulnerabilities, they came together to help themselves, protecting and amplifying the practices that were already working for them: checking in on each other, and using exercise and dance as powerful forms of expression and social connection.
These weren't solutions imposed on them from the outside. As Deborah put it, they were "owned, built together and sustained by individuals and the community that created them." Change started with a shared dream, and with what was already working.
When you're coaching, opening with what went wrong this week and needs fixing or opening with what your client wants their life to look like when this is working can make a big difference. The dream isn't a warm-up before the real conversation starts. It's what makes the rest of the conversation make sense.
India: Identity Predicted the Behavior
Hans Mosler, a Swiss researcher working on scaling sustainable behavior change, studied a project promoting chlorinated drinking water in India. He compared those who used water treatment with those who didn't.
What's important to note is that health knowledge barely differed between the two groups. What predicted the behavior, in Deborah's words, "was the desire of some women to be good mothers. The key to change wasn't what they knew. It was what they wanted to be true about themselves, the kind of people they wanted to be and how they wanted to be seen in the community."
In a coaching session, this shows up as a shift in what you get curious about: Not what the client knows, but who they are working to become, what would be different in their better future, and what this change would say about them.
Vietnam: They Went Looking for the Exceptions
In 1990, Jerry and Monique Sternin were sent to Vietnam by Save the Children to reduce child malnutrition in four of the country's poorest villages, where up to 65% of children under three were malnourished. The Sternins had six months, almost no budget, and a government official who told them plainly: prove this works or your visa won't be renewed.
But that wasn't all. As Monique put it years later: "We didn't speak the language. We had no staff. No office. No budget. And we weren't even nutritionists. So what could we do?"
They started by asking the village mothers to weigh and measure every child. Then they asked just one question: are there any very poor families here whose children are bigger and healthier than everyone else's? In every village, the answer was yes.
The mothers of those children were feeding them smaller amounts of rice, their staple, more often, and adding tiny shrimp, crabs, and sweet potato greens, foods most people considered inappropriate for young children at the time. The villages then set up hearth sessions where other mothers cooked and fed their children exactly the way the healthiest families already did, led by a local volunteer, not by the Sternins.
Within two years, malnutrition dropped 65 to 80% in the original villages. The approach eventually scaled to 265 villages across Vietnam, a combined population of 2.2 million, including more than half a million children whose nutrition improved. Years later, researchers found children born in these villages long after the Sternins had left were just as well nourished as the children from the original program.
Deborah draws attention to what the Sternins didn't do: "They didn't come in with their own ideas about what poor families with few resources should do. They simply were curious about only one thing. The exceptions to the problem. Who was already doing well and what were they doing differently from everyone else. That's what made the difference in millions of lives."
Why all three worked
Brain science offers a reason. Richard Boyatzis, a professor in the departments of organizational behavior, psychology and cognitive science at Case Western Reserve University, found that thinking about your ideal future lights up the brain network tied to imagination and creativity, the same state that lets you notice and discover possibilities and options you wouldn't otherwise see.
Starting instead by thinking about problems, what you should do to fix them, change strategies, or even small steps to take, triggers a threat response. The brain shifts into survival mode, narrowing its focus to doing what it can to keep you safe.
In Deborah's words: "If you start with the problem and what people need to do to change, which is where most helping approaches begin, the brain loses access to the very imagination and creativity it needs to turn dreams of a better future into reality."
The five principles
Three stories, three continents, lasting change built on the same set of principles:
- Start with the dream.
- Build on what's already working, one small step at a time.
- Look for exceptions to the problem.
- Anchor change in identity and values, not just knowledge.
- Locate change within relationships and community, and help people own their own solutions.
As Deborah summarized it: "Whether it's the elderly in Uganda or moms in India and Vietnam, change starts with hope and a dream for a better future."
One approach reflects all five
These stories have their beginnings decades ago, as far back as the early 80s, the same period when the science of habit formation and the evidence-based therapeutic approaches now adapted for coaching were developed. Those include Solution-Focused practice, motivational interviewing, and cognitive behavioral therapy.
Of those three, only Solution-Focused practice reflects all the universal principles above.
It starts with the destination the client wants to arrive at and works backward from there. It helps clients notice exceptions to the problem, what's already working even slightly, "because that's evidence that a better future is already present to some degree." And it treats the client's relationships as part of the structure rather than an optional topic. As Deborah puts it: "Change never occurs to the client outside of a social system and their future always includes it."
It's important to note that a practitioner can follow another approach to the letter and never once ask who else would notice a change. Here, that question isn't optional.
You can also watch Deborah teach this live: Beyond Motivational Interviewing, the full session this series comes from.
The Series
Drawn from Dr. Deborah Teplow's summit session, Beyond Motivational Interviewing.
- Your Clients Are Motivated. So What Builds Follow-Through?
- Every Solution-Focused Conversation Has the Same Three Parts
- Three Continents, One Pattern: Where Lasting Change Actually Starts (you are here)
- Solution-Focused Practice and Motivational Interviewing: Four Points of Departure
The five principles in this post are built into the structure practitioners learn in Foundations in Solution-Focused Health Coaching certification.
See the Difference in Action
Watch the Free Training Demonstration
See the three-part conversation that puts all five principles into practice, taught step by step, with the exact questions ready for your next session.
Watch the Free Training →This post is part of a deeper comparison. For a full side-by-side breakdown of how the Solution-Focused approach and Motivational Interviewing differ in assumptions, conversational structure, evidence base, and when each fits best, read our complete guide: Solution-Focused vs. Motivational Interviewing.
References
- Jack, A. I., Boyatzis, R. E., Khawaja, M. S., Passarelli, A. M., & Leckie, R. L. (2013). Visioning in the brain: An fMRI study of inspirational coaching and mentoring. Social Neuroscience, 8(4), 369-384.
- Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.). Guilford Press.