Heather: Right now he drinks two root beers a day. Could we, could we get it down to one? Do you think that would be okay, Ethan?

Ethan: I guess.

Health Coach: Ethan, would it help if you got to decide when you got the root beer? Like after school or with dinner?

Ethan: Yeah, that would be better. I guess just one will be okay if I get to pick when to drink it.

Heather: Great. I'm with you, Ethan. I think one a day will be a good start.

Ethan’s Thought: Okay, maybe this isn't the worst day of my life. I mean, I'm not getting any shots.

Health Coach: When you think about ways that you can help Ethan be as healthy as possible, you feel allowing him to choose when to have just one root beer each day is a good first step.

Heather: I think so. I just want him to be healthy and happy. If he wants this, then I'm on board. What do you think, Ethan?

Ethan: Yeah, I, I could try it.

Health Coach: What might make it hard to stick to your plan?

Ethan: I really like root beer!

Heather: Yes, you do like your root beer. My husband might put up a little bit of a fight, but I’ll talk to him. This seems possible. Letting him have just one root beer a day shouldn’t be that hard. Right, Ethan?

Ethan: I guess I could try.

Health Coach: Alright, so it sounds like both of you are feeling pretty confident about your ability to try this out.

Coach: It's a good idea to ask about barriers to change. If you can help clients problem-solve, that increases the chances that they'll stick to a change plan.

Health Coach: Well, it sounds like you have a plan moving forward. Do you mind if I call you in a couple weeks to see how it's going?

Heather: Okay, sure.

Health Coach: And, Ethan, I want to know how you're doing, too.

Ethan: Okay.

Heather: Talk to you in a couple weeks!

Pic 3: The screen fades to black before transitioning to a close-up of Dr. Schwartz.

Dr. Schwartz: Using motivational interviewing can be pretty difficult at first, but I think the health coach gave it a very good effort. Now let’s look at her dashboard, which will analyze her choices and offer some suggestions for how best to use MI in your practice.

Client Motivation: Overall, the health coach did a great job using MI techniques to put Ethan’s and his mother’s concerns at the center of their conversation. Because they felt listened to and understood, they were willing to commit to a change toward a healthier lifestyle.

Feedback on Technique

• Setting the Agenda
  • The health coach started the conversation on a good note, asking permission to discuss Ethan’s weight and using client-centered questions.
  • When it came time to decide which of Ethan’s habits to focus on, the health coach let them decide where to start making changes. This is an effective approach because families often already know where it would be best to start.
• Using Open-Ended Questions
  • The health coach made great use of open-ended questions. By asking for input from the mom at every step of the conversation, she made Heather feel valued and included. It could also help to involve Ethan in the discussion.
• Respectfully Sharing Information
  • The Health Coach made great use of the Elicit-Provide-Elicit technique to provide this family information respectfully. And she avoided many temptations to use directive language that could have alienated Ethan or his mom.
• Using Reflections
  • The Health Coach made a good effort to use reflections to help Ethan and his mother feel listened to and motivated to make changes. Reflections are powerful tools and she could use them even more frequently than she did in this conversation.
  • A good way to set up for a reflection is to ask an open-ended question like “How do you feel about Ethan’s weight?” or “What do you like and not like about soda?” Then you can reflect any change talk the question elicits.

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