The world is full of suffering.
It is also full of overcoming it.
Helen Keller
The important thing in science is not so much
to obtain new facts as to discover
new ways of thinking about them.
Sir William Bragg
Sometimes we need to bring up an important topic that we believe the client may not want to discuss. Here is an extended format for these tough situations where you know or suspect that your client has no intention of making any changes and you feel you must try to make an impact. It was originally developed for clients engaging in harmful or dangerous behavior (e.g., drug use or smoking). Nutrition professionals will find this process useful with a client whose health is imminently impacted by diet. For example, a patient is readmitted for chronic heart failure and has been consuming a high sodium diet.
As with any effective counseling strategy, this format is embedded in an atmosphere of collaboration, assumption of client autonomy, wishing to hear the client’s perspective and compassion. The conversation is opened by the counselor asking permission to discuss the topic. “Your doctor has asked me to speak with you about how you are eating. May we do that for a few minutes?”
The acronym FRAMES is used to remember this model:
Feedback: Give feedback on the risks and negative consequences of the behavior. Seek the client’s reaction and listen. “This fluid accumulation that caused your doctor to bring you in here is due to salt in your food. Each time fluid builds up it causes damage to your heart. What is your response to this information?”
Responsibility: Emphasize that the individual is responsible for making the decision about behaviors. “It’s entirely your choice how you pick your foods. It’s my job to provide information to help you make these choices that affect your health.”
Advice: Give straightforward advice on modifying behavior. “This list of foods includes the ones that contain enough salt that fluid builds up.”
Menu of options: Give a menu of ideas the client may choose to pursue. This fosters the client’s involvement in decision-making. “Some of my other patients learn new ways to cook, or how to choose foods at the market, or how to get less salt when eating out. Tell me which of these approaches interest you?”
Empathy: Be empathic, respectful and nonjudgmental. “This condition is tough on you and I want to hear what this all means to you.”
Self-efficacy: Express optimism that the individual can modify her behavior if she chooses and that the desired result will follow. “I know it is possible to make simple changes that will allow you to stay out of the hospital.”