Family Counseling: Childhood Nutrition

Pic 3: The screen fades to one that reads “Next Appointment: Six Weeks Later” before returning to the exam room.

Adrian: I couldn’t stop thinking about what you’d said, with the sugar and the snack food. So, I started watching what Maya really eats when we’re out at Elena’s games, and it’s ridiculous. She’s eating, like, three snacks a night, and so am I.

Health Coach: Adrian, it sounds like you're ready for the whole family to get a little healthier.

Adrian: Yeah. I think I am. So, what can we do?

Coach: This is a positive reframe that turns changing Maya's snacking habits from a chore into a benefit for the entire family.

Health Coach: If it helps, you can think of a snack as a kind of mini-meal. That way you can plan for it, instead of just reacting once she says she's hungry. Anything with some protein and fiber will go a long way toward satisfying her hunger.

Adrian: Well, I'm at work all day, so whatever I bring has to hold up well. Maybe, uh, nuts and a banana?

Maya: Oook oook, I'm a monkey! Monkeys like bananas.

Health Coach: (laughs) And will this monkey help Daddy pack up a snack in the morning?

(Maya nods)

Health Coach: Maya, your Daddy and I are talking about how to give you good food that fills up your tummy and keeps you healthy. What kinds of fruits and vegetables do you like?

Maya: Fruit, fruit roll-ups?

Adrian: You like apples, sweetie, and blueberries.

Maya: I like how they squish!

Health Coach: (laughs) Maybe you can help Daddy or Mommy pick out some fruit to bring for a snack. What do you think?

Maya: Okay!

Coach: It's smart to involve Maya in planning her snacks. Kids (like adults) are much more likely to embrace changes if they feel like they have some control over them.

Health Coach: You're making some great changes here, Adrian. I think you and Maya will both see some real results.

Adrian: Thanks. I, (sigh) I didn’t realize how much of a problem Maya’s snacking really was. I’m glad we’re fixing it.

Maya: I’m hungry.

Adrian: Let’s go to the supermarket! You can help me pick out some blueberries, apples, all that stuff.

Pic 4: The exam room fades away and the screen transitions to a close-up of Dr. Schwartz.

Dr. Schwartz: In this conversation, the dad offered significant sustain talk and was not interested in considering lifestyle changes. In your practice, how might the MI skills you have learned help you respond to sustain talk? Now let’s look at a dashboard, which will analyze the health coach’s choices and offer some suggestions for how to best use MI.

Pic 5: The screen changes to a screen that contains information about different aspects and ratings of the conversation. Under “Overall Performance,” there’s an image of a blue circle under the words “Change Talk” which has the text “100 points out of 100” on it. Each technique under “Feedback on Technique” contains a scale of 0 to 10.

Overall Performance:

Overall, the health coach did a great job. By using motivational interviewing techniques, she helped this dad recognize that he wants to change Maya’s snacking habits, which helped him commit to making a change.

Feedback on Technique

Affirming His Perspective: Rated ten out of ten.

The health coach did a nice job using affirmations to build a strong rapport. Clients are more likely to listen to you and open up when you affirm their strengths and autonomy.

Reflecting Change Talk: Rated ten out of ten.

The health coach used reflections to help this dad explore his ambivalence about change. By using double-sided reflections to acknowledge his sustain talk, while reflecting his reasons for change last, she encouraged him to keep exploring his own reasons for change.

Reframing Sustain Talk: Rated ten out of ten.

The health coach used reframing to help the dad look at some of his concerns as strengths and solutions, instead of insurmountable obstacles.

Setting an Agenda: Rated ten out of ten.

Finally, the health coach did a great job avoiding a directive tone! When you use these techniques with actual clients, try to examine your own words with the same discretion the health coach used here. When you avoid telling clients what to do and instead let them guide the conversation, they are far more likely to follow through with change.