I am often asked, “How do you keep a client motivated?” This is a key concern in health behavior counseling, especially when the change needed is long term, such as in weight management or diabetes. If our clients are to be successful with their health goals, the behavior changes need to be permanent.
Difficulties increase
the nearer we approach our goal.Goethe
Self-initiated learning, once begun,
develops its own momentum.Ray Hartjen
Real permanent change to eating habits is not easy. How can we best support this process of real change? Let’s review what our job is and isn’t with respect to motivation. It’s not our job to motivate the client. At times, our clients seem to ask us to keep them motivated.
Tempting as it may be, taking this approach eventually backfires. We will not always be there to provide external motivation. If the client relies on us, he will eventually revert to previous behaviors. Trying to provide motivation to our clients also has the disadvantage that we use our ideas for motivation, not the true internal reasons this person has to change and maintain the target behaviors.
So if it’s not effective in the long run when we try to do the motivating, what can we do? We can elicit what naturally moves this person toward change and then support and remind. Tips #20, Unpacking Meaning (available in Practice Workbook, Vol 1). and #60, Open Questioning, offer guidance on this process of eliciting what inspires a client to change.
Our job is not done when a client voices reasons to change. A client’s statements of desire, reasons, and need to change are change talk (Tip #95). We help cement these in place when we reflect them back to the client (Tip #6, available in Practice Workbook, Vol 1). We can reflect them again in a summary later in the session (Tip #72). Ask the client if jotting down the list for himself would be useful. Some clients find it valuable to discuss their reasons at each session or to say them to themselves every day.
How can we remember and make the most use of what clients have told us is their motivation to make changes? You may find it useful to have a system to keep track of a client’s change talk, such as notes in a specific place in your chart. When change is not happening, it may be tempting to simply look at the list and remind a client of his motivations. “But you said you wanted to be able to play with your kids.” This will likely bring up resistance. We can instead ask permission to circle back to explore what the client wants. First, use open questioning to elicit what is there. The client may have forgotten some reasons to change, so you can toss in items from your list. Stay open to the possibility that some motivations may have shifted over time. This reiteration can seem tedious to us. Real permanent change naturally happens in fits and starts and usually includes a lot of repetitive talk.
We naturally launch into education and problem-solving when we think a client is on board for change. This is an important part of our job (and for some of us, the most fun). We can easily miss the signs of slipping motivation until outright resistance pops up or the client doesn’t come back. Expecting to revisit reasons to change over and over makes the long-term process go more smoothly.
Here are some ideas for language that will elicit forgotten motivation:
“Can you help me remember what brought you in here the first time? What did you want?”
“When you first came in here, you told me what you hoped to gain by working with me. May we review what you wished for? … Tell me how things stand for you now.”
“I seem to remember you saying something about… What is true about that now?”
“Do you remember telling me that you wanted…? Tell me more about that.”