Ineffective Path:
COACH: During this conversation, Susan will refer to the MOVE! Program, a weight loss program originally designed for veterans. Consult the resources section for similar programs in your area.
SUSAN: Hi Kevin, it’s nice to see you again.
KEVIN: Good to see you too, Susan!
SUSAN: I had a look at your chart before you arrived. Your weight is around the same as your last visit. 256 pounds.
COACH: Referring to Kevin’s weight in the chart can be useful, though it is better to first check in with Kevin.
KEVIN: (sighs) Hoping it might’ve been a little lower. I guess I could be exercising more and eating better but I dunno. I’m just a little preoccupied right now.
SUSAN: Would you like to talk about losing weight today?
COACH: It’s good that you asked Kevin what he wants, though it’s better to do so with an open ended question, which cannot be answered with a simple “yes” or “no,” to encourage the patient to share their priorities.
KEVIN: Well, no, actually. I don’t really wanna talk about my weight. Not right now, at least.
SUSAN: You really need to make exercise and healthy eating a priority.
KEVIN: Yeah, yeah, tell me something I don’t know.
COACH: By trying to tell Kevin what his priorities should be, you missed opportunities to learn about his struggles and his desire to change. Instead, try to elicit priorities from him with an open ended question.
KEVIN: Like why I’m so tired all the time.
KEVIN: I’ve just been feeling worn out lately. Zonked, you know? Particularly when I get home from work. Hard to even concentrate on the whole weight thing right now. I might not have been perfect with the exercise and eating, but I didn’t miss one day of meds.
KEVIN’S THOUGHT: I know weight’s coming up sooner or later. If she’ll just listen to me about the tiredness first.
SUSAN: It’s great to hear that you’ve been taking your medication regularly, Kevin! I’m also hearing that you’d like to work on a plan to have more energy.
KEVIN: Yeah. Be nice to have a little more gas in the tank.
COACH: Good job! You affirmed Kevin’s efforts to take his medication regularly and acknowledged his concern about his lack of energy
SUSAN: You’re feeling tired now, but your previous weight plan could have helped with that.
KEVIN: Gee, thanks. Kick me while I’m down, why don’tcha?
COACH: Kevin clearly feels discouraged by being reminded that he didn’t stick to a weight plan. Staying positive, asking permission to share information, and listening for change talk can help show Kevin that you’re supporting him.
SUSAN: Weight management can help with the tiredness.
KEVIN: OK, how exactly?
SUSAN: The medication you take helps control your diabetes and blood pressure, and blood pressure medication can sometimes make you feel more tired. Or it could be your weight itself that’s contributing to the tiredness. Good news is, either way, if we work on a plan that helps you manage your weight, that could reduce your tiredness, and potentially reduce the amount of medicine you need to take.
KEVIN: Sounds promising. But what kind of plan, exactly?
SUSAN: We’d start by looking at your A1C levels and blood pressure. Then we could put our heads together and think of some other ways to manage those levels: besides just medication. How would you feel about that?
KEVIN: Doesn’t sound too bad, so far.
COACH: You did a good job of using the Elicit Provide Elicit technique! Because you first asked Kevin what he thought might be causing his tiredness, he was more open to hearing the information you provided.
COACH: Weight management is important, though it’s better to let the topic arise naturally from Kevin’s own experiences. When you lecture Kevin, he may become defensive.
COACH: Good! You assured Kevin that you did not intend to reprimand him. As a result, you recovered the conversation and gained an opportunity to share important information.
SUSAN: No problem, Kevin. According to your chart, your A1C level is 9.
KEVIN: OK. Whoa. Gotta digest that for a sec. Man, I was really hoping I made more of a dent there.
SUSAN: We really need to get those levels down, Kevin. They need to be closer to 7 for the good of your own health. Yeah, yeah.
COACH: Reprimanding Kevin led him to feel less willing to open up. Instead, consider exploring his understanding about A1C levels, which may provide opportunities to offer information and build motivation.
SUSAN: You’ve got some work to do to get to your stated goal of 7.
KEVIN: Man, was hoping I made more progress than that. And now I feel like a big fat failure.
COACH: Though this response reflects a desire to improve Kevin’s diabetes management, this response was experienced as judgmental and discouraging. Instead, consider exploring what Kevin understands about A1C levels and self management.
SUSAN: Don’t worry, there’s plenty of time to get those A1C levels lowered.
KEVIN: That’s easy for you to say! You don’t have to worry about.
COACH: Even though you intended to comfort Kevin, it is usually more effective to explore his understanding and motivation for participating in treatment and self management.
KEVIN: I mean, in general I’m okay with the fact that a paragon of health I’m not. ’Course I can’t be too out of shape, gotta be able to keep up with work and all. Never thought I’d spend the rest of my life in construction after I came back from overseas. But it’s managed to pay our bills for thirty odd years, so far.
COACH: Kevin shared some information that could lead him to positive change. Explore this topic to build his motivation!
SUSAN: It’s difficult to be the sole financial contributor.
KEVIN: Yeah, I mean it can be tough sometimes. But doesn’t matter how hard it gets, I gotta be able to take care of my family.
COACH: Though your reflection missed an opportunity to reflect what Kevin said about his health, it gave him an opportunity to respond and reflect on his motivation.
SUSAN: If you kept up the exercise, you’d be in good enough shape for your job.
KEVIN: I understand that. But I didn’t keep up the exercise. Which is why I’m now worrying about it.
COACH: Even though you connected job performance with weight management, you implied that Kevin might be at fault for his present condition. As a result, Kevin feels discouraged. Next time, use a reflection to give Kevin the opportunity to explore his own desires, abilities, reasons, and need for change.
KEVIN: These days my job’s got me managing more and building less, but there’s still enough work involved that it ain’t a walk in the park. If the boss swings by and there aren’t enough guys on the project, I gotta show I can carry my own. My family relies on it.
KEVIN: Man, I really thought I would have made more progress on my weight by now. I did try to lose a few pounds, before I was feeling so tired. Guess it wasn’t enough. But the thought of doing more? It’s just so overwhelming!
SUSAN: Come on, you can do it! A couple visits to the gym will help you shed some pounds.
KEVIN: Um, have you seen me? I’m a big guy. It is DEFINITELY not easy for a person of my size to lose weight.
KEVIN’S THOUGHT: Man, I might have weight issues, but she needs to see someone about her vision.
COACH: Telling Kevin that losing weight is easy led him to feel like you were downplaying his struggles.
SUSAN: You should try the MOVE! program.
KEVIN: Hmm, I think I’ve heard of that. I’m not sure I’m ready to talk about a “program” yet.
COACH: Kevin is not yet ready to talk about the MOVE! program. Instead of making a suggestion, it would be more effective to explore his perspective and/or respond to him in a way that makes him feel listened to and respected. Hit UNDO to go back and try a different approach.
SUSAN: Everyone can lose weight, no matter their size.
KEVIN: Yeah, right. I’ve heard that before. Look,
COACH: Though you are trying to be encouraging, this kind of encouragement can discount Kevin’s feelings and experience.
KEVIN: I tried a little exercise, eating a little better. It was going okay to begin with. Then I just kinda ran outta steam. Really thought it’d be easier to keep up with.
KEVIN’S THOUGHT: And I thought it would’ve made more of an impact, too!
SUSAN: Kevin, when you run out of steam, just have those health benefits in mind and keep trying.
KEVIN: Try harder? I don’t think you realize how hard this already is!
SUSAN: I do get it Kevin. It is hard! I am just saying it is useful to think about all the benefits of losing weight when you hit roadblocks.
KEVIN: That’s easy to say, but doesn’t help me with the roadblocks!
COACH: Your encouragement came off as dismissive of Kevin’s efforts and challenges. Instead, explore what strategies worked for him in the past.
SUSAN: Kevin, I can provide info on some weight management programs that could help you.
KEVIN: Eh, that’s all right Ms. Bell, I don’t think I really need more info. It’s really just time that’s my biggest concern right now.
COACH: Before sharing information about programs, it’s better to give Kevin the opportunity to talk about his past experience with weight management options.
SUSAN: Kevin, I really think you should hear what I have to say about these weight loss programs.
KEVIN: And I’m telling you I don’t have the time.
COACH: Until Kevin has his concerns about time acknowledged, he is uninterested in hearing about weight loss programs.
KEVIN: Problem is,
KEVIN: My evening hours are kinda sacred. When else am I gonna watch my games and keep up with my teams? I can’t sacrifice that!
SUSAN: I can tell you a few ways you can manage your time better.
KEVIN: Yeah, okay. You’re the expert. I guess.
COACH: Careful. Instead of offering advice, consider engaging and collaborating with Kevin by exploring his ideas for freeing up time.
SUSAN: Now let’s talk about how important making a change is to you to overcome these challenges.
KEVIN: Really? Okay.
COACH: Though exploring importance is a great way to explore motivation, it would be better to reflect and summarize what you have learned so far before moving on. A summary can show Kevin you’ve heard his concerns. Remember, you always can ’Undo’ a selection to see how Kevin responds to a different choice.
KEVIN: Time to make a change, I guess.
COACH: Let’s pause here to look at how effective your choices were in eliciting motivations from Kevin. Then you will have a chance to conclude the conversation by discussing his barriers to change and collaborating on a plan.