Adrian: Look, I don't want her to go hungry. But, yeah, I'd rather it was my meatloaf and mashed potatoes and not some bag of chips.
Health Coach: You're not happy with the kinds of foods she eats, like bags of chips.
Adrian: I mean, not if it ruins her appetite for dinner, but. (sigh) We’re on the go all the time after school. Her sister Elena’s got soccer practice twice a week, games on Thursday, plus ice skating, and Maya does music on Mondays. I don’t even start cooking until 6:30 most days. Without a snack or two, she’d be a total mess.
Coach: The health coach gave a good double-sided reflection, reflecting the sustain talk first (she needs a snack) and the change talk last (you also want her to eat dinner). That prompted more change talk from the dad, which gives the health coach common ground to work toward a change in Maya's eating habits.
Health Coach: (warm and empathetic) You're so tuned in to Maya, and so good at responding to her needs, that it can be hard not to jump into action if she says she's hungry. It feels like that's your job.
Adrian: Well, yeah.
Health Coach: You immediately want to give her something, whatever's available.
Adrian: (hesitant) I guess that's, that's not as necessary any more, now that she's better. It's just hard. I don't want to ignore her if she really is hungry.
Coach: The health coach did a good job. By reframing the dad's sustain talk, she uncovered that he's been overly attentive to her needs since her pneumonia. But the phrase "if she's really hungry" gives a glimmer of change talk. Does he really believe Maya is hungry every time she asks for a snack?
Health Coach: Maya, what were you feeling when you asked for that granola bar just now?
Maya: Uh.
Health Coach: Were you hungry? Did your tummy feel rumbly and empty? Or were you getting bored listening to me and Daddy talk?
Maya: You're so boring.
Adrian: Okay, yeah, I, I see what you’re saying, and maybe sometimes we do give her snacks to keep her quiet. But not most of the time, I swear, I’m not kidding when I said she gets out of control. She is a disaster.
Coach: Involving Maya in the conversation at a level she can understand lays the groundwork for her to cooperate with the plan the health coach and her dad come up with. As she gets older, she can start to learn the difference between boredom and actual hunger.
Health Coach: You've noticed that when and what Maya eats is closely connected to how she feels and behaves.
Adrian: (considering) Yeah, yeah, I guess it is. I mean, it certainly made a difference at breakfast.
Maya: (pouting) Daddy won't give me Marshmallow Crunch.
Health Coach: (to Maya) Daddy's a smart guy! He changed what you eat at breakfast because he knows that cereal with marshmallows won't help your body feel good.
Adrian: Yeah, I, we used to let the girls have whatever cereal they wanted, but then they, like, couldn't make it to lunch. So we took away the marshmallows and added an egg. I started getting a lot fewer phone calls from daycare. But I can't do that with every meal. I don't want to be one of those parents who are obsessed with controlling what their kids eat.
Adrian’s thought: I swore I would never obsess over what my girls eat, the way my parents did.
Coach: Here, the health coach reframed a negative thought (that Maya has meltdowns if she doesn't snack) into one which gives the dad a sense of control (if Maya's mood is connected to what she eats, then he can change the food he offers, like he did at breakfast). She did a good job empowering him to make a change.
Health Coach: It sounds like it's important to you for Maya to be involved in choosing her food.
Adrian: Yeah, it is. I want her to learn to make healthy choices for herself. But a four-year-old isn't going to choose an apple when she knows she can have a cookie.
Health Coach: You're trying to offer healthy choices. But Maya still knows there are cookies and chips around.
Adrian: We'd have to have nothing in the whole house but fruits and vegetables for that to be what she picks.
Coach: Reframing can help turn a client's sustain talk ("I don't want to be controlling about food"), into an affirmation of their strengths and a way to approach change ("It's important that Maya choose her own food").
Health Coach: (A few seconds of silence)
Adrian: Okay, yeah, it would be easier if we didn't have any junk food in the house. But, I don't know. That's a lot to ask.
Health Coach: It would be a big change.
Adrian: I don’t know. I mean, won’t she just grow into eating better? I don’t want to become the Food Police.
Coach: Sometimes a strategic silence is exactly what it takes to help the family come to a realization on their own.
Health Coach: There's nothing wrong with waiting until the right time to make a change. It's also great that you are open to the idea that Maya might change her eating habits on her own.
Adrian: I just don't want it to become the thing we're always fighting about. I lived that as a kid, and I don’t want to go there again.
Health Coach: This is all completely your decision. Maya's lucky to have a dad who takes such good care of her.
Adrian: Thanks for saying that, and (sigh) it's true, I just don't think this is the time to start changing how we eat. You know, we just got over her being sick, now let's enjoy the normal for a little bit.
Health Coach: Okay. How do you feel about checking back in a month or two and we can see Maya's growth again and make sure we're on track?
Adrian: Uh, yeah sure. We could do that.
Coach: This was good. Don't be afraid to end a visit without a clear goal in mind. It's often better to give clients time to mull over changes, rather than suggesting a plan they have no intention of following. Remember that change takes place at home, not in your office.
Health Coach: Great, you can make an appointment on the way out.