As nutrition professionals we are trained to assess our clients’ nutritional status and determine the best treatment for the nutrition problems we find. This means focusing on what’s wrong. We understandably use our corrective lens. This is appropriate and useful in our role on the medical team.
When we move into an outpatient setting in a clinic or private practice, the medical model is not enough. In these settings we encounter people with their complex experiences, beliefs and desires about health and food. In order for them (and us) to reach our goals, behavior change needs to happen. We, of course, want to change the client’s behavior. When we act on this wanting to change someone’s behavior, it is called the righting reflex. Wanting to change someone’s behavior is normal. How we proceed will affect whether change happens.
It’s not giving that’s bad,
but forcing one to receive.
– Alejandro Jordorowsky
Between stimulus and response there is a space.
In that space is our power to choose our response.
In our response lies our growth and our freedom.
– Viktor E. Frankl
When it comes to behavior change, we are called on to counsel our clients, not treat them. Many of you have noticed that in your most successful nutrition counseling sessions you actually use very little of your extensive nutrition knowledge. The success is often determined by your skill as a counselor, not how much you know. So ideally we add on to our nutrition profession what is essentially a whole other profession (counseling) for which others train for in graduate programs and internships.
This is not news to most of you. In these Tips and my training programs, I attempt to fill in these gaps in our training. Here I focus on a few things you can do to work with your righting reflex so it doesn’t get in the way of effective practice.
In Motivational Interviewing we take time to focus on the person’s perspective first. This is the engagement process. (More on engagement in Tip #115) We set aside our perspective and attend to what is true for our client, asking open-ended questions and reflecting what we hear. This means coming alongside a person who has strengths, knowledge and desires. We get on that person’s page as thoroughly as we can. This sets up the subtle shift from fixing the person to helping her.
Another way to make this shift is to attend to how one provides advice. This includes giving advice only with permission and offering it with the assumption of client-autonomy. Tips #59 (in Vol. 3) and #147 contain more detail about autonomy-supportive advising.
I often hear from colleagues that much as they want to avoid the righting reflex and to stay in a helping stance they keep slipping back into trying to change their clients. They tell me of noticing giving advice without permission or making a suggestion when the client has not asked for it. They also suspect that in many sessions they are completely unaware of how much the righting reflex is in charge. In nutrition counseling, we ask ourselves to override our core professional training and natural instinct. No wonder it is so hard!
A reframe that may be useful:
An important step is to acknowledge that the righting reflex is present; it is normal and serves a very important function. It is the part of you that quickly picks out the salient information you hear from the client and learn from the medical record. It also pulls from memory the advice and suggestions that you know to be most applicable here. For those of us in practice for years, this feels intuitive and happens smoothly and easily. Take a moment to think of how useful it is and to appreciate this part of you.
Your righting reflex is only one of your many parts. It has strengths and skills. It also has limitations. It is not good at putting you in the client’s shoes and does not care much about helping the client make his own choices. This part of you naturally wants to proceed with pointing out to the person what he should do. Allowing this part to be in the lead as you counsel is counterproductive and will evoke client resistance.
You do have other parts that are skilled at sitting back and evoking from the client what matters to him and staying open and curious. You could ask your righting reflex (or whatever you choose to call it) to stay in the passenger’s seat and advise you as you engage with and counsel the client. Asking it to step aside (but not go too far because you still need its knowledge) allows you to focus on the person in front of you. You may even be able to locate where your righting reflex resides in your body. Mine seems to be in the muscles that cause me to lean forward. When it’s time to counsel, smile at that part to show your appreciation and gently ask it to step aside and remain in an adviser role. If you locate where your curious, compassionate part resides in your body, this may help you lead from that part more often.