In the world of health and nutrition, everyone thinks they’re an expert. Too many are quick to offer advice like “Just eat this”, “Don’t eat that!”, “Follow my diet”. If eating healthful were easy, we would all be at optimal health. What I realized through my years as a clinical dietitian is that not everyone wants advice. The worst thing to do is to give advice to someone who isn’t ready. Think about it, how many people do we know tell us they want to lose weight? What do we end up doing? Give them advice. Telling them strategies that worked for us. What ends up happening? They do nothing. Then we feel like our effort was wasted. I’m here to tell you that the problem may not be with them, it may be the way we offer our help.
Three lessons I’ve learn from my counseling days:
1) Don’t give advice to people who are not ready. It will just come off as irritating, judgmental, and make you look like a show off (even if you are well intentioned).
2) Never assume. Many of my clients were highly educated and know what to do to take care of themselves. So the big question was always…what are the barriers for change? What’s stopping them? Listen carefully and ask tons of open ended questions.
3) Plans and Goals should come mainly from the client (with the help of the counselor). Strategies that worked for one person, may not work for another.
DiClemente and Prochaska describes six stages through which people pass in the course of changing a behavior. The stages are Precontemplation, Contemplation, Preparation, Action, Maintenance, and Relapse. I’ll explain the stages from a client-counselor perspective so bear with me.
Clients in the precontemplation stage are not ready to make any changes. They’re just not interested in what you have to say. They could care less about your advice. They are at your office because their doctor or family member forced them there. So the worst thing you can do for someone at this stage is to start the session by giving them advice. What works for people in this stage is to just raise awareness. Talk about priorities and how it relates to their dietary problems. Have the client envision how different life would be without the dietary problem. Get them thinking about why change would be beneficial. Raise awareness!
Questions to ask:
What’s important in your life? How does your lifestyle relate to your dietary problem?
How different would your life be if you were to change your eating habits?
How would changing your lifestyle be beneficial to you and your family?
The most common stage of clients is called contemplation. They seesaw between reasons to change and reasons to stay the same. Advice giving at this stage will most likely be ignored. It’s best to discuss the pros and cons, cost and benefit, advantages and disadvantages for change. Talk about the cons for change first and then help clients realize the benefits of change.
Would it be okay with you to explore some of the costs and benefits of making dietary changes?
If you could imagine, what would you like for your life to be like in 5 years?
When the pros for change outweigh the cons and clients ask “What can I do“, they are in preparation stage. This is where the client and counselor work together to come up with a plan. I repeat, the counselor AND the client work together to come up with goals that are acceptable, appropriate, realistic-attainable and affective.
What do you think needs to change?
Ideally, how would you like to be eating?
Where would you like to start making changes? (Breakfast? Lunch? Dinner?)
Stage 4, 5,6-Action, Maintenance and Relapse
The next stages are Action and Maintenance. Clients are making and maintaining changes. Counselors motivate for changes. In the maintenance stage, counselors try to prevent slips or relapses from happening. It’s important to avoid discouragement and demoralization.
So trying to cook a few meals a week at home didn’t work this week because of your busy schedule. What do you think we can do to make it work for you?
You said that you had a little too much to eat and drink at the last party you attended. You have a party coming up this Saturday. Let’s come up with some strategies to prepare for the abundance of food and drinks that will be offered. What do you think?
Take Home Message:
I hope this post sheds some light on using different approaches for helping people. Telling people what to do doesn’t always work. Giving people a piece of paper with a list of “good and bad foods” plus advice may not work. The next time you meet someone who seems like they want your help, assess what stage they are in (mostly in contemplation stage) and motivate appropriately. Here are some questions to help assess readiness for change.
What are your thoughts about changing your eating habits?
On a scale of 1-10 how ready are you to begin to make very small changes in your diet?
I imagine this works not only for nutrition but also for stresses of daily life. Significant other problem? Don’t just tell them to Break up. Assess and motivate! Not happy with current job? Don’t just tell them to Quit. Assess and motivate! You get the point.
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Reference: Nutrition Counseling Skills for the Nutrition Care Process by Linda Snetselaar