Ineffective Path:
COACH: Let’s get back to your conversation with Gregory. You’ve been able to discuss his motivations, now use the skills you’ve learned to discuss his barriers to change and collaborate on a plan.
CLARKE: I think you’re doing a great job, pal.
GREGORY: Huh. Well, thanks, “pal”. I, what is it you’re trying to say, exactly?
COACH: This effort to affirm is vague and the use of “pal” felt overly familiar. Affirmations are more effective when they specify specific behaviors or efforts.
CLARKE: Yeah, sorry, that wasn’t what I meant. Let me rephrase.
CLARKE: Gregory, I have to say, I’m proud of what you’ve accomplished already.
GREGORY: You’re proud?
COACH: This effort to affirm is vague and the use of “I’m proud” felt patronizing. Affirmations are more effective when they specify specific behaviors or efforts.
CLARKE: I was just trying to point out the steps you’ve already taken. The meds, quitting smoking, you know.
GREGORY: Right. Well, I think I’m ready to talk about a plan for what to do next, if that’s okay with you.
CLARKE: Oh, okay. Sounds good.
CLARKE: So, in terms of ways to continue improving your cardiovascular health, what are your thoughts?
GREGORY: Well, at first I thought the rehab program would be okay. I liked the sense of community.
CLARKE: You should give our cardiac rehab program one more try. It’s a great resource to help people like you.
GREGORY: Erm, sure, why not?
CLARKE: Great! Glad to hear it.
GREGORY: (sigh) Maybe it’ll be easier if I keep in mind what’s important to me.
COACH: Giving your unsolicited opinion didn’t leave space for Gregory to consider options and partner on a plan. Instead, consider exploring what didn’t work for him and what might help him follow through.
CLARKE: Like, being able to be active with your family.
GREGORY: I do wish I could have the energy to play with my grandkids. I, I’d like them to be able to keep thinking of me the same as I was before, as much as possible.
COACH: Great! You accurately identified and reflected what Gregory said is important to him, which evoked change talk about follow through and self care.
GREGORY: At the same time, I doubt it’ll make a difference.
GREGORY: I’m just not sure the program is for me.
CLARKE: That’s okay. You can keep considering the rehab program, and we can think about trying something else.
CLARKE: I think you should eat healthier meals. That will make a big difference.
COACH: Advising Gregory to do something he previously expressed reluctance to do is likely to elicit arguments against changing. Instead, consider asking Gregory what he wants to do to stay healthier. Remember, undoing is an option.
GREGORY: Uh, let me think. Kinda caught me off guard.
GREGORY: No. I like what I eat. I’d rather get a little more exercise.
CLARKE: Eating healthy would have a huge impact. I don’t want to. Okay? (sigh) I could see myself getting out, going for walks with my wife.
CLARKE: Okay, we should make that goal a little more clear.
GREGORY: (sigh) fine.
GREGORY: Uh, I could go with my wife when she goes for a walk every morning before breakfast, and every night after dinner.
GREGORY’S THOUGHT: I know what I like. I’m not just going to do what you want me to do.
CLARKE: I want to make sure your plan isn’t too vague.
COACH: Gregory felt you were criticizing his plan when you called it “vague,” and he got defensive. Instead, ask targeted questions to help him flesh out his plan.
GREGORY: Okay, wait, what are you saying?
CLARKE: I was wondering, can we get your plan to be a little more specific?
COACH: To help Gregory increase the specificity of his plan, you can ask open ended questions which would help him identify more specific ways to achieve his goals.
GREGORY: Enough, okay? I can figure out the specifics for myself.
CLARKE: I think it’s imp, stop. Just stop it. Man, I just, I got it.
CLARKE: Okay, no problem.
CLARKE: Do you think that goal is realistic?
GREGORY: Maybe.
COACH: Asking a closed ended question does not foster as much reflection or collaboration as an open ended question, such as “How realistic is your goal?”
CLARKE: I think we’re done for today. Could you take me through the plan we talked about?
GREGORY: Okay, sure. I’m going to,
GREGORY: Go for a walk with my wife at least 4 times a week, starting this weekend,
GREGORY: I’m going to stay smoke free, and continue my medications,
GREGORY: And maybe I’ll think about giving the cardiac rehab program another try.
CLARKE: That all sounds good. I’ll set up a time to call you and check in over the next couple weeks, if that’s okay with you.
GREGORY: Yup.
CLARKE: All right, thanks so much for talking, Gregory. When would be a good time around two weeks from now for me to call you and check in on how your goal is going?
GREGORY: Maybe two weeks from tomorrow, after four.
CLARKE: That sounds good. Thanks again for coming in today.
GREGORY: Sure thing.
COACH: Gregory left his appointment with a plan to go on some more walks with his wife, and to think about going back to the cardiac rehab program.
COACH: Gregory didn’t feel encouraged by this conversation though he initially tried to follow through on his plan. At his next appointment, he didn’t have any new cardiovascular symptoms and was still smoke free. However, he hadn’t followed through with rehab and didn’t meet his goal for exercise.
COACH: Now you can take a look at your performance dashboard, which will go into more detail about your choices throughout the conversation with Gregory.