Pic 12: The screen again changes to a close-up of Dr. Schwartz.
Dr. Schwartz: This response also used a directive tone. Let’s go back in time and have the health coach try a different response that reflects this family’s desire for change, affirms their autonomy, or reframes their difficulties in a way that helps them solve them.
Pic 13: The screen returns to Maya, Adrian, and the health coach.
Coach: Emotional eating is an important topic to share with parents. But the health coach should try to let the topic arise naturally from the family's own concerns and observations. When you're the one to bring it up, the family may become defensive.
Health Coach: What kind of granola bar is that, Maya?
Maya: Chocolate chip!
Adrian: It’s the only kind she likes. (small laugh) But they’re organic. No trans fats.
Coach: While it can be effective to talk to Maya and her dad directly about the snack she's eating right now, the health coach should be careful because families sometimes take offense if they feel pressured to defend their actions.
Health Coach: You feel like Maya really needs a snack after school. It keeps her happy.
Adrian: Yeah. I can't have her having a tantrum while I'm driving Elena to soccer practice. Or screaming in the stands while we're trying to watch.
Health Coach: It's important that Maya behave well at Elena's events.
Adrian: Yeah, so, you know, I offer her a treat if she'll sit quietly while her sister plays. Otherwise I'd never get to watch Elena.
Coach: By reflecting the dad's sustain talk, the health coach encouraged more sustain talk. Instead, she should try reflecting change talk or reframe his approach in a way that invites him to re-examine his thought process.
Health Coach: You want to give Maya snacks when she's hungry, and you sometimes find yourself using snacks as a reward.
Adrian: I've never met a parent who's above a little bribery.
Health Coach: All parents use food as rewards.
Adrian: All the ones I know.
Health Coach: (pushing just a little) And you haven't seen any problems with it.
Adrian: (conceding) I mean, you do get the thing where they start asking for bigger and bigger rewards, but you just have to know where to set limits.
Coach: By using a double-sided reflection to acknowledge that the dad is feeding Maya both when she's hungry and to reward behavior, the health coach is helping him realize that this could be a problem. She should continue to reflect the trouble he's having with the status quo to encourage him to think about change.
Health Coach: I'm wondering whether you've heard the term emotional eating? Can you tell me what you think that means?
Adrian: Um, I don't know, it's like eating junk food to make yourself feel better when you're sad?
Health Coach: Right. We use that term for any kind of eating that isn't based on hunger. Whether we're eating because we're sad, or bored, or giving our kids a treat as a reward for being good. What do you think about that?
Adrian: I guess it's a bad habit.
Health Coach: It can be a problem when it teaches us to ignore our body's signals of hunger and fullness and to eat for reasons related to what we feel.
Adrian: It's not like it goes any better to tell your kids that they can't eat. They're still learning not to listen to their bodies. You're just punishing them for liking things that taste good.
Coach: By using a question to see what the dad knew about emotional eating rather than just providing the information herself, the health coach kept him engaged in the conversation. He's still offering sustain talk, but if you listen closely, his reasons are getting less superficial and therefore probably closer to the emotional issues that are keeping him from considering change.
Health Coach: I think a good goal is to plan to replace at least one of Maya's daily snacks with a fruit or vegetable.
Adrian: Um, I'm not gonna put my four-year-old on a diet.
Health Coach: A fruit or vegetable will have nutrients Maya needs and fiber to make her feel full.
Adrian: Look, I'm not gonna start my kid down that road, okay, the dieting and the self-loathing and eating disorders. I'm not making her miserable just because you think she isn't thin enough. She's beautiful just the way she is.
Maya: Daddy says we should be beautiful inside.
Adrian’s thought: We decide what’s best for our family. Not you.
Coach: This dad isn't ready to decide on a plan yet. With motivational interviewing, the specific plan of how and when to change comes from the client or parent, not the nurse. Think of it as getting a field ready so you can plant seeds. Pushing for a plan before families are ready doesn't let those seeds grow.
Health Coach: I'm not talking about what Maya looks like. Of course, she's a beautiful little girl. I'm just talking about the best ways to keep her healthy.
Adrian: And why is that always about being thin? Why is it never about being concerned that telling a four-year-old to worry about her weight is setting her up for some eating disorder? Look, I see girls in my school, eight, nine years old, always trying to diet and look sexy, and it just breaks my heart. I'm not starting Maya down that road.
Coach: The health coach got defensive here, trying to respond to what felt like an unfair accusation, rather than trying to understand why this dad was upset. The focus should always be on what the family is feeling, not you.
Health Coach: You're a good parent, and to you, good parents aren't controlling about food. It bothers you when people do that.
Adrian: It doesn't work. I mean, my parents hated what I ate. They called me a pig, they took my desserts away, they made me run laps to try to get in shape. All you learn is how good it feels to eat junk food the minute they're not around.
Health Coach: That didn't help you make healthy eating choices.
Adrian: It just made me miserable. And fatter than if they'd left me alone.
Maya: It's okay, Daddy.
Maya’s thought: Why is Daddy upset? Am I getting sick again?
Coach: The health coach is finding out why this dad is resisting change. Often, when families offer significant sustain talk, there is an unvoiced emotional reason that's driving them. Until they confront their feelings about the issue, they are unlikely to resolve their ambivalence.
Health Coach: You don't want to become your parents.
Adrian: Yes! Exactly.
Health Coach: (gentle) This is important to you. Maybe important enough to be influencing some of your decisions.
Adrian: Yeah. Every time I tell her, "Don't eat that," "You've had enough," or "That's not good for you," it's like I hear my dad's voice all over again.
Health Coach: That makes it hard to set healthy limits.
Adrian: Yeah, it does.