Laura Schoenfeld: All right, so that’s a great question. One thing to keep in mind when you’re working with clients is that at the end of the day it is one hundred percent up to them what they choose to do. So if he, okay, I shouldn’t say “he.” Oh, yeah, it is a he. So, if he decides that he doesn’t want to exclude these groups from his diet, you can try giving him more information about why it would be helpful. That may or may not make any difference. It sounds like he’s pretty well informed, so I don’t know if the information piece is going to make any difference to his decision.
There is a technique that I was taught in my graduate school program that I’ve mentioned before, and I was also trained outside of my program a little extra in this technique. It’s called motivational interviewing. So I can put a link to this on the Facebook page. But the woman who trained me is Molly Kellogg, and she’s a dietitian and a licensed social worker and she has a bunch of books and trainings on motivational interviewing. She’s got some free tips that she sends via email if you don’t necessarily want to pay for some of her workbooks and that kind of stuff. But basically motivational interviewing is a way of discussing health issues with a client and talking to them and asking questions that actually help them potentially move towards a more motivated state of mind. So there’s a bunch of different topics that get covered, but basically if somebody’s in the complete, like, not interested in changing there’s different stages of change and I’m pretty sure, I can actually get that open too. Let’s see changes, stages of change. I can tell you exactly what they are. Let’s see, I’ll send you guys a link to this too.
But basically it goes everywhere from precontemplation, which means that the person doesn’t even acknowledge that there’s a problem behavior, to contemplation, which is acknowledging that there’s a problem, but not ready or sure that they’re ready to make a change. All the way up to maintenance, which is maintaining their behavior change, and then there’s another one called relapse, which could be that the person actually returns to old behavior. So the stages of change model is something involved in the motivational interviewing technique and basically you want to try to figure out where in the stages of change this client is. It sounds like he’s probably in the contemplation stage. I’d say he’s past the precontemplation stage because he has obviously come to see you, so he knows that there’s something wrong.
Precontemplation would be that the person doesn’t even realize there’s an issue that needs to be dealt with. So this man sounds like he’s in the contemplation stage, and in this stage, people are more aware of the potential consequences of their habit, and they might think about it a little bit more. And they might even consider the possibility of changing. They still tend to be either ambivalent about the change itself or may be feeling like no I’m not interested in changing. So this is something, this stage is kind of challenging because it can take some people a very short amount of time to get through this stage because they’ll realize that their health issues are a problem enough that making the change is worth the results. Or this person could never get out of this stage. They may decide that things like gluten and sugar and dairy and that kind of stuff are never worth getting rid of and that they’d rather have the food that they like to eat and deal with the health problems. And the thing that you have to remember is that is totally okay. That’s that person’s prerogative to make that decision. And the best that you can do is, like I said, make sure that they’re fully aware of the consequences of their decision.
And then also you can use techniques where you can get them thinking about why giving up some of these habits that they don’t want to give up could actually be a positive thing for them. So you can talk about their motivation, you can talk about how important it is to them, a lot of people will use a 1 to 10 scale, and they’ll say on a scale from 1 to 10, how important is it to you that you fix your gut issues? One being not important at all and 10 being the most important thing in my life right now. And say he answers a seven, and you say, okay, well, seven is pretty high. Why is it a seven and not a four or something lower? And then he’ll say, well, you know it’s a seven because this is really impacting my life and it’s causing me to feel ill all the time, and you know he’ll answer why he made that number. And then you’ll say, okay, well, so what would it take to take that seven and turn it into a nine, so something higher. And then he’ll say, oh, well, you know I just don’t really want to give up these foods, I really enjoy them, I just don’t think it’s worth it, and you know I think I can handle being sick like this.
So that’s one of the strategies that is used in motivational interviewing to help clients start to think about why they feel the way they do about whether or not they’re going to change their behavior. There’s a lot of other techniques that are involved. So you have to really listen to what the client is saying, reflect what they’ve said back to them, and then ask another question that kind of expands on what they said or gets them to address some of their barriers to the change. So this technique is somewhat, I don’t want to say it’s complicated. It’s definitely worth learning if you’re someone that’s doing a lot of counseling. So if you’re a nutritionist or if you just happen to have a practice where there’s a lot of counseling involved, then this kind of training is actually really helpful. I was really glad I did it, and honestly, I feel like I need a refresher because I don’t exactly remember all the different ways that you can use motivational interviewing to get people to change. Luckily, a lot of my clients are pretty motivated, but there’s always the handful of people who think they’re motivated, and then when the rubber hits the road, they don’t want to make the changes.
So like I said, I can give you guys a link to Molly’s website because she’s got a lot of really great information about how to do motivational interviewing and how to do counseling in general. So I can share that with you. But I would say that that’s going to be your best strategy is getting this person to talk more about why they don’t want to make the changes. And then like I said, if it turns out that this man is just not going to change and he doesn’t want to and nothing you say will convince him, then accepting that and telling him then okay, I’m sorry to hear that. I don’t think I can help you in that situation and you might have to fire him as a client if he won’t actually follow the recommendations that you’ve made. So just something to keep in mind. It’s okay to let people make these decisions even if you know that it’s not best for their health.