In a recent email, a dietitian asked me what to do when a return client says he is doing everything he is supposed to do and yet a careful assessment shows he is hardly following any of the recommendations. The client actually seems to believe that he is doing just what he is supposed to do. The dietitian wrote, “I feel there is a disconnect somewhere.” There is indeed a disconnect. Your job is to help the person see it and to support a move toward change.
I don’t necessarily agree with everything I say.
Nobody can stand truth if it is told to him.
Truth can be tolerated only if you discover it yourself because then,
the pride of discovery makes the truth palatable.
It is tempting to see this as deliberate lying. This could be true in some cases. Some of the reasons people lie are to avoid criticism from you or others or a desire to be seen as doing the right thing. (There is more on lying in Tip #36.)
Perhaps the client’s belief that he is following the recommendations is based on misinformation about specifics. In this case, there is a lack of information. You can offer to provide more information. When this is done in an MI style, your client will mostly likely take it in. This includes asking permission and then offering the information in a neutral manner. (More on this in Tips #59 and #147.)
Let’s assume here that instead it is a case of denial. Denial is an unconscious negation or refusal to accept aspects of reality. The human mind has a truly amazing capacity to do this. Because it is not conscious, the person is not deliberately lying and feels comfortable. There is no perceived discrepancy for this client. For example, he wants to be healthy and he perceives that he is doing what is needed. End of story. People don’t make changes unless they see a discrepancy between the situation now and how they wish things to be. What our clients choose to do in the face of a discrepancy is always up to them. Our job is simply to help them see it more clearly.
What not to do:
Confrontation will bring up resistance. For example, just saying, “Cheese isn’t allowed on this diet” or “That’s four carb servings right there” is unlikely to open up a useful collaboration.
What to do:
- Elicit values and goals with open questions. “What concerns you most about your diabetes?” “Tell me how you want your food to support your health.” (See Tip #29 for more examples.)
- Reflect and summarize what you hear of values and goals and what you see that seems to be a contradiction. Use “and” instead of “but” (Tip #55). “It’s important to you to follow what your doctor says and you want to do all you can to manage your blood sugar through how you eat. You kept track of your carb portions for a few weeks last summer and are not sure how many carb servings you have at each meal recently.”
- Follow up your summary with a key question (Tips #72 and #60). “What do you see yourself doing this week to gain more control over your blood sugar?”
This process of effectively being with people when they consider making changes (or don’t) takes practice and skill. Before gaining this level of competence, it feels like hard work. With time, it becomes smoother and easier on you. In the meantime, take care of yourself (Tips #36, #55 and #57). Perhaps when clients continue to attend sessions and don’t change, it will help to remind yourself that your job does not include making people change, only facilitating change when clients are ready. When you resist the temptation to confront or force change, they get ready sooner and it’s easier on you.