I’ve written many Tips on giving advice. As nutrition counselors that is an important part of our job. To summarize:
Motivational Interviewing offers us this format for most effectively couching our education:
- Elicit what the client already knows and/or needs from you.
- Provide the information in a neutral manner.
- Elicit the client’s response to the information.
Don’t give your advice before you are called upon.
Desiderius Erasmus
There can be no knowledge without emotion. We may be aware of a
truth, yet until we have felt its force, it is not ours. To the
cognition of the brain must be added the experience of the soul.
Arnold Bennett
There is more detail on these steps in Tip #59 in the Practice Workbook, Vol. 3.
The reason to use this careful process in giving advice is that our clients are apt to react in a negative way when we simply give the advice or information when we feel it’s necessary. We have all heard “Yes, but…” or gotten arguments to not take the advice. When the education is couched in this respectful way, reactiveness is less likely.
This Tip adds a few more ideas for making it most likely your wonderful advice will be taken.
We can be alert for clues that our client is open to education or suggestions. Here are four situations that come up often in nutrition counseling. Each of them offers us an invitation:
- Asking for validation: “I noticed that I get hungry in the afternoon when I stick to the portions you suggest for lunch. Is this normal?” or “I’m not sure I’m doing this intuitive eating thing right because most days it’s so easy.”
- Asking for your permission: “Can I eat cake on my granddaughter’s birthday?” “What will happen if I don’t follow this diet perfectly?”
- Misinformation: “I heard that the Paleo diet is the best one for everyone because it’s what our ancestors ate.”
- Adding essential information: For example, when the client has worked hard and has successfully learned about carbohydrate portions and you know that the timing of meals has not been addressed.
In each of these cases you can first reflect what you are hearing and then go into the first “elicit.” For example: “It’s important to you to eat well for your health and you want to enjoy your granddaughter’s birthday. Let’s see, what would be most useful from me about this?” (complex reflection and beginning elicit)
There is another situation where adding a reflection before the first elicit is effective. When you are hearing a lot of sustain talk (reasons to not change) or feelings that sound not supportive of change, it is useful to reflect that feeling first.
Example:
Client: “I don’t know about all this. I know I need to do something about my diet, but it’s so hard with my work schedule. They keep changing it up on me.”
Counselor: What thoughts do you have about ways you can adjust this meal plan for a night shift? (elicit)
Now, read this again with two sentences added. Notice how much more likely it would be for the client to react negatively above when the counselor goes right to the advice format.
Client: “I don’t know about all this. I know I need to do something about my diet, but it’s so hard with my work schedule. They keep changing it up on me.”
Counselor: “I hear that you want to eat well for your health and you get discouraged with the inconsistency of your shifts. You are aware that to make this work we will need to find solutions that fit your various schedules. (feeling reflection) What thoughts do you have about ways you can adjust this meal plan for a night shift?” (elicit)
When we provide education and the client is clearly with us, we need to do only a bit of this. With clients who struggle or who are reluctant in any way, we are more effective when we pay attention to invitations for education and when we break it down and insert reflections.