#107 Mandated Clients

What to do when faced with a client who is forced to meet with you?

  • A teen is dragged in by a parent to address overeating.
  • An insurance company requires a pre-op program before covering bariatric surgery.
  • An employee with health risks is required to meet with you or be docked some pay.
  • A soldier or firefighter is required to lose weight to keep his position.

Life is what we make it,
always has been, always will be.

Grandma Moses

God does not require that you succeed.
He only requires that you try.

Mother Teresa 

This puts you in a difficult situation. Even before meeting you, the client will likely be resistant. So you are behind from the start. There is no guarantee that you will be able to enlist this client in a change process. All that is asked of you is to do the best you can to engage this person to work on something that has meaning for him.

Get your responsibilities and the client’s clear before the first contact. Do you need to report to someone? Are you simply required to report that the person attended or will you need to provide more information? Make sure you know what the client is mandated to do. Is he required to speak with you a certain number of times, to attend a program or to lose a certain amount of weight? Those who have enrolled in research may have agreed to be tested annually and must show up for those visits. The research program’s lifestyle intervention may not be required, only offered. Stay clear about what is mandated and what is the client’s choice.

It is normal for you to get anxious or stressed when you encounter these situations. The stress may result from taking on responsibility for making this person change certain behaviors. This is an unrealistic expectation and learning to let it go will make burnout less likely. Review Tip #44, the Expectations of Others, and Tip #33, What We Can Do and What We Can’t (both available in Practice Workbook, Vol 1.)

Take a bit more care than usual to engage the client, as a person, at the first contact. Tip #102 describes some ways to do this.

Make sure the client knows what is required of you and of him. Respectfully ask him what he understands about the situation. If you must report to someone, review this with him. Make sure the consequences to him are clear. It will be useful to reflect these consequences in a simple, factual manner. “So, I hear that if you don’t meet with me three times by the end of June, your employer will deduct a fee from your paycheck,” or “Your insurance company requires attendance at our pre-op program monthly for six months in order to pay for the surgery,” or “Your job requirements include a weight limit. You have been given three months to get within this limit. If not, you will be transferred to a different position.”

Attend carefully to resistance and roll with it. You are very likely to hear resistance from these clients. The more you roll with it from the very beginning of the first contact, the more likely you are to engage the person in some meaningful counseling. Reflecting what you hear or see takes some power away from the resistance. “You are angry about being forced to see me,” “This was not your idea,” or “You do want to lose weight and you don’t like being forced to.” See Tip #103 for more on how to roll with resistance.

Make clear what choices the person still has. “It’s entirely your choice whether you make any changes at all in your eating habits,” or “You don’t have to like this,” or “How we use this time together is up to you.”

Keep to a stance of offering your help rather than forcing anything.  “I hear you that you don’t like being forced to lose weight. My job is to help you with this goal if you wish to take it on,” or “I know you don’t like that $50 taken out of your paycheck every month until your blood pressure comes down. How can I help you get this resolved soon?”

Ask for direction and permission even more than with other clients. “Well, we have 30 more minutes together. We can use this time in whatever way you want. Is there anything you want to talk about?” or “I hear that you are willing to use this time to your advantage. What would be most useful for us to address today?” or “I have some thoughts about how we could move toward what you want out of this. Would you like to hear them?” or “You’ve said that you do want to get some of this weight off. What ideas do you have to begin with?”

When clients are belligerent or rude, it is easy to take it personally or feel devalued as a professional. It’s not about you. An attack on you and your expertise is just one form of resistance. (See Tip #32, When a Client Challenges Your Expertise (available in Practice Workbook, Vol 1.) I invite you to take this as an opportunity to practice all the skills that are useful with any client. Regardless of whether real change occurs, you will have done what you could (and gotten some practice). A few more Tips that may be useful in these situations are Tip #50, What We Know to Be True (available in Practice Workbook, Vol 1,) and Tip #96, Developing Discrepancy.

Many colleagues provided input for this Tip. I want to particularly thank Linda Ber, RD; Juliet Mancino, RD; Helen Seagle, RD; and Jill Whisler, RD.

Posted in Tips