How often have you heard, “He’s a control freak” or “I don’t have a choice”? These are common statements that show how important control and choice are in our lives. We humans do like control. When we have a degree of control over our environment, we are safer and we are more apt to get our needs met. So, of course, we prefer this. We naturally dig in our heels and resist when we sense that our control is being taken away or when we have few, if any, choices. Looked at this way, resistant behaviors can be seen as survival reactions.
The greatest good you can do for another
is not just to share your riches,
but to reveal to him his own.
Benjamin Disraeli
Freedom is not worth having
if it does not include the
freedom to make mistakes.
Mahatma Gandhi
Unfortunately, in the context of counseling for health behavior change, resistance usually means resistance to adopting beneficial new behaviors. (For more on resistance, see Tip #9, Vol 1.) How can we use this understanding of human nature to best help our clients?
One vital technique to minimize resistance is to encourage personal choice and control. Here are examples of ways to empower our patients:
At each visit, offer choices as often as possible. These may be relatively insignificant: which chair to sit in, which goal to work on first, or how soon to come for a return visit. This sets the tone for a collaborative relationship.
Ask permission before offering advice. It takes only a few seconds to say, “I have some ideas about which foods will work best in that situation. Would you like to hear those now?”
When patients want to pursue a behavior you do not believe will work or you even disapprove of, you could pause before giving your opinion. Begin with: “That is one of your choices” or “You could do that.” It is indeed the patient’s choice. No one is going to lock him up to keep him from doing it. Acknowledging this choice will likely make him more open to listening to your input. And then remember to ask permission before providing your opinion.
When a patient comes back and has not made a change you expected, be willing to look at what happened without judgment: “Oh, that’s interesting! I wonder how that came about. Would you be willing to explore that?”
Take care with your language. “You should…” or “You have to…” or “You need to…” will usually elicit resistance. None of us likes being told what to do. When you have a professional opinion, offer it as an “I” statement. For example, “I have found that most patients on this medication feel better when they eat protein at each meal” instead of “You have to eat protein at each meal.” (See Tip #39 for more on Imperatives.)
Your patient’s behaviors are indeed much more in his control than yours. Acknowledge this to the patient and get back to what you can do to help him reach his goals. Find ways to leave the patient with the choice and control while you stay in a consultant role.
Choice in educational settings:
One of the most effective ways to teach is by example. If you teach future health professionals, offer choice when you can and incorporate choice language in all interactions. When you offer choice around negotiable things, it is easier to set clear limits around non-negotiable ones.
Examples of things to offer choice around:
- When to schedule a necessary makeup class.
- What topic to study in more depth for a report.
- What topics to cover when you can’t cover everything.
- Which room to meet in or how to set up the room.
Notice your language. For example, instead of “You have to start your final project this week,” try this: “Students who begin their final project at this point in the semester learn more, have more fun and usually get a better grade. The choice is yours.” If you teach counseling skills, point out this language when you use it and ask the students to notice its effect on them.
Choice Language
Sit wherever you would like. Is the temperature OK in here? I can adjust it.
I have some recipes using beans. Would you like them?
What kind of feedback on your food records would be most useful to you?
Would you like to ask me questions first or hear what I have to say about the diet first?
I have several kinds of handouts on sodium. Which look most useful to you?
We offer educational groups here and individual counseling. Which do you prefer or do you want both?
I know you have just had some bad news today. Would you like to begin to discuss the diet for this condition now or schedule an appointment for another day?
Do you want these menus to give you several options or do you prefer just one choice?
It usually takes at least three visits to get the information you need to follow this diet. Would you like to come weekly or to spread out the visits more?
We only have 10 minutes left. We can either go over how to handle low blood sugar or begin to talk about how to eat out. Which is more important for you to take home today?
So you are thinking about doing the Atkins diet. I have an opinion and some experiences to share from other clients who have done it. What would you like from me?
Case Study
A dietitian I will call Kaylin decided to do an experiment after attending my training workshop. She would make only one change in her counseling process and wait to see what happened. She decided to focus on offering choice to her clients. A month later, she reported on her experiment. She said she had included choice about little things such as where to sit and bigger things such as which handouts to use and what topics to cover. The first client she did this with was a long-term client. Halfway through the session, she asked Kaylin if she had attended a conference recently. Kaylin was surprised and admitted that she had. The client just said that she could tell something was different and whatever it was Kaylin should keep doing it because she liked it. This was the only client who remarked on a change, but Kaylin could sense from her side of the process that it was going better. She seemed to develop rapport more quickly and she got less resistance. She enjoyed the more collaborative spirit.
Kaylin also noticed that a small percentage of clients did not respond well to choice. They seemed confused and asked her to just tell them what to do. She made a note of these clients so she could adjust her process with them. I congratulated her for such careful observation and suggested she continue to experiment. I pointed out that these clients might not feel ready to handle choice in their food plan but might still value choice in how the sessions were conducted.