Coach: When you use a directive instead of an empathetic tone in a sensitive conversation, it can make the client feel judged and misunderstood. This is an example of a really poor response to Samantha. To move forward, let’s go back in time and have the Health Coach pick something else, that won’t be as upsetting to this mom.
Health Coach: Why are you thinking about switching to formula?
Samantha: You know, with the pumping and being away all day, it would just be easier if my mom could give her a bottle and not worry about where it came from.
Health Coach: It would be easier.
Samantha: I mean, it's going to happen anyway, right? I already feel my supply dropping. You read about this all the time, women go back to work and their milk dries up. (a little sad) It's just something I've got to accept.
Health Coach: You don't like pumping.
Samantha: I feel like a dairy cow hooked up to that thing.
Health Coach: It's uncomfortable for you.
Samantha: It's more than uncomfortable, it doesn't work. I mean, it takes so long just to get a lousy three ounces.
Coach: By reflecting what the mom doesn't like about breastfeeding ("You don't like pumping"), the Health Coach encouraged her to respond with more of the same ("It doesn't work"). To encourage her to keep breastfeeding, he should ask questions or reflect her change talk, any reluctance she is showing about deciding to stop.
Health Coach: Breastfeeding provides so many benefits to Zoe.
Samantha: Yeah, well, she's had four months of it. That's better than most kids, right?
Health Coach: Babies who stop nursing at four months have four times the risk of pneumonia over babies who nurse past six months. And every month you nurse lowers Zoe's risk of obesity in adulthood.
Samantha: (tight, clipped) Right.
Pic 9: The screen changes to a close-up of Dr. Schwartz.
Dr. Schwartz: The Health Coach used a direct tone again, let’s just pretend this didn’t happen. The Health Coach should put this mom’s agenda at the center instead of his agenda.
Pic 10: The screen returns to the exam room with the male health coach and Samantha.
Samantha’s thought: Give me a break. I'm doing the best I can.
Coach: This mom seems to be under a lot of stress. Emphasizing the negatives of her decision only made her feel guilty and frustrated. It didn't help her plan a better way to handle pumping at work.
Health Coach: Tell me about your pumping experience. What's that been like for you?
Samantha: Man, I work at a magazine, so my boss knows the laws and they give me my breaks and stuff. But we've got tight deadlines and there's just never a good time to do it.
Health Coach: It's hard to find the time.
Samantha: And then when I do, all I can think is "Are they talking about me? Can people hear the pump through the walls?" It gets me so stressed I can't even relax enough for my milk to let down unless I watch videos of Zoe crying. And then I just miss her so much.
Coach: By asking an open-ended question about her experience, the Health Coach got this mom to open up. But he should be careful not to dwell on the negative and instead look for change talk that might encourage her to continue breastfeeding.
Coach: The health coach is entering the evoke stage of the conversation. His goal is to evoke this mother’s reasons to change her decision to switch to formula.
Health Coach: Your workplace isn't supportive of you breastfeeding?
Samantha: (grudgingly) No, they are. But you feel like your co-workers are judgmental?
Samantha: I don't know. Maybe it's all in my head.
Coach: Reflections should be statements, not questions. When you use a question to reflect clients' feelings, they may think you're asking them to justify what they just said. In this case, the mom started second-guessing herself.
Health Coach: It sounds like you want to talk to your office about getting better support at work.
Samantha: No. No, I think what I need is not to have to pump at work. Is there a way to do that?
Samantha’s thought: If I could nurse without pumping, I'd do it in a heartbeat.
Coach: The Health Coach used an action reflection to frame a barrier as a potential action step. Even though the mom disagreed with his exact plan, notice how it helped her come up with her own solution. You can think of reflections as hypotheses, sometimes you can learn just as much from a wrong hypothesis as a right one!
Coach: The health coach is now in the plan stage of the conversation. His goal is to collaborate with this mom on a plan to address her trouble with pumping so she can continue to breastfeed.
Health Coach: Could you work at home sometimes? That might be a more relaxed atmosphere to pump in.
Samantha: If my boss would let me do that, I'd have done it already.
Coach: When the Health Coach makes his own suggestion, it puts the mom in the position of judging his ideas rather than coming up with solutions of her own.