Tip #129 When Clients are Mandated

In some nutrition counseling settings, clients have not chosen to meet with you. They have been told to or even coerced.

There is no such thing as a problem
without a gift for you in its hands. 

Richard Bach

It is impossible for a man to learn
what he thinks he already knows.


For example, participants in WIC (The Special Supplemental Nutrition Program for Women, Infants and Children) must engage in nutrition counseling or education to receive food assistance. Patients may follow the doctor’s advice and make an appointment even though they have no intention to make food behavior changes. Teens are often brought in by their parents. Some may welcome the opportunity to learn more about nutrition and ask questions. Many do not. In Tip #107, you were offered suggestions for these situations. Here we look at additional concepts and stances.

Sometimes you know that you have a reluctant client. When you can’t tell if the client has chosen this appointment, feel this out at the beginning. For example:

  • “Tell me what caused you to call for this appointment.”
  • “What do you understand about what we will do here today?”
  • “Tell me your thoughts about coming in here.”
  • “How do you see this visit helping you?”

Proceeding to assessment and planning for change will be a waste of time if initial resistance to being there is not addressed. Simply acknowledging itgoes a long way (Tip #103). This might sound like:

  • “It was not your idea to talk with the nutritionist today.”
  • “I hear that you did not come in with any concerns about your nutrition.”
  • “You generally follow your doctor’s advice so you came in and yet you wonder what good it will do.”
  • “You feel your eating habits are fine.”

Find a way to affirm something (Tip #63).

  • “I appreciate you coming in today.”
  • “I see you are someone who follows your doctor’s recommendations.”
  • “You came to WIC because you want to do the best for you and your family.”

If the person seems cooperative and yet expresses confusion about why she is there, you could offer a list of things you often help people with. The list would be based on what you know about her and a guess about what might concern her. Offer choice, including just spending a few minutes discussing her health concerns generally.

Sometimes initial open questions do not elicit any concerns or desire to make any changes. You could respond to this by reflecting what you hear and asking permission to have a more general conversation for a few minutes. For example:

  • In a community health setting: “I hear you didn’t come in here with anything you wanted help with. Might we spend a few minutes just chatting about your family’s eating habits?”
  • With a teen who has insulin-dependent diabetes: “It was not your idea to come here and you’re feeling forced. You see everything as going just fine.
  • How about we just chat about where diabetes fits in your life?”
  • With a middle-age man with hypertension: “You don’t get why your doctor is making such a big deal about how you eat and your drinking. May we just talk for a bit instead about your health generally and how you are feeling these days?”

Proceed with open questions (Tip #108) such as:

  • “Tell me how meals go at your house.”
  • “So tell me about your best days and your not-so-good days.”

Asking for elaboration will bring out more of what is true for this person and may give the conversation a focus.

  • “Tell me more about that part.”
  • “Give me an example.”
  • “In what ways?”

You can choose to reflect potential areas of focus. If you hear several, you could summarize them and then ask to focus (Tip #116) on one concern.

  • “You find it a drag when your kids are so picky and sometimes you wonder if they are getting enough milk. If I was to help you with one of those today, which would it be?”
  • “You hate it when you mother nags you about testing your blood sugar and you mentioned how embarrassing it is when you are with your friends and your blood sugar goes low. Might we focus today on finding a way for one of these situations to go better?”
  • “You would rather not have to take all this blood pressure medication and your wife tells you that she doesn’t like how much you drink. If we were to explore some solutions to either of these, which would it be?”

If and when a focus is chosen, it may be tempting to jump into giving advice and suggestions. Continue in a collaborative stance by asking the client for suggestions about how to proceed or asking permission to provide advice (Tip #59).

  • “If you were to do one thing differently to make that go better, what might it be?”
  • “What are your thoughts about what you could do to make it less likely your mom will nag you?”
  • “I have some ideas for a few changes that would make the low blood sugar happen less. May I share them?”
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