I had the privilege of attending a webinar recently which included a presentation by Carol Dweck, Ph.D. who wrote the book Mindset. She spoke about the theory she has researched extensively at Stanford University as it applies to people trying to lose weight.
Basically there are two mindsets she describes: The fixed mindset and the growth mindset. People develop one or the other of these mindsets in different aspects of their lives (education, relationships, eating behaviors) and through different experiences and perspectives.
Those with the fixed mindset think, "this is just the way things were meant to be", as in "Being fat is just in my genes" or "I was just meant to be this weight" or "No matter what I do it's just not going to work". Sound familiar?
Those who are of the growth mindset, on the other hand, look for ways they can improve, appreciate challenges, and try to figure out what they can do next to get the results they prefer. "The last time I lost weight, this is what worked for me, so I would like to try that again" or "If I watch less television I'll have more time to exercise". They enjoy strategizing and achieving and accomplishing. If this sounds familiar, you must have clients who are great fun to work with!
We already know how important frame of mind is in weight loss success. This way of categorizing how people think and why clarifies more precisely where people are coming from and how they can adjust their thinking to improve their success at getting the weight off.
It helps me, as a weight loss coach, to see how I can direct my line of questioning to steer my clients towards a more positive outlook.
What helps people to move more towards the "growth" mindset is experiencing success from their actions and being acknowledged for their actions. People who are of the "fixed" mindset often grew up being told "you are so pretty" or "you are smart", giving credit to the way they were born and not credit to anything they tried doing (ie, you are just born smart or pretty and lucky you if you are).
Children who were complimented on their accomplishments in a way that acknowledged their effort ("great job on that test--you must have studied very hard") turned out to be more growth minded because they realized they could achieve something by working instead of just through fate.
It's important for our clients to realize they do have control over their weight. This is the first step to letting them move forward--realizing they can affect change. Helping people shift from a fixed to a growth mindset can be a great investment of time at the beginning of working with a client in order to best support them and help them change.
Read reviews on this book and consider purchasing a copy through Amazon by clicking on the image below.
Monday, October 26, 2009
Thursday, September 17, 2009
Hints on Motivational Interviewing from the Man Who Wrote The Book!
I had the extraordinary pleasure of attending a PESI webinar with Dr. Stephen Rollnick himself, co-author of the Motivational Interviewing book. It was a great experience. He is an excellent speaker with a delightful accent.
I have his book and, as I was mentioning to a colleague yesterday, hearing him speak was like getting to see the movie!
There were a few points he made during the hour that I would love to share with you. It gives a good basis for people who would like to practice motivational interviewing. Some of you are just being introduced to it, and others are using in now. Dr. Rollnick explained that many practitioners struggle to get it right as a practice, but just don't seem to "get" the heart of it. So here are some basics he stressed:
1. Motivational Interviewing is not a process that you strive to learn, but a way of being with your client.
You practice being non-judgemental and focus on eliciting reasons to change from your client. You resist the "righting reflex" as he calls it, and shift your way of thinking from "I know what is best for you" to "you tell me what's best for you and let me be your guide"
2. MI is about believing that your client has the solution. You are there to work through their ambivalence with them and draw them out of their uncertainty.
3. Confrontation does not result in a positive outcome. People cannot be forced into becoming ready to change. The more you push, the more they will naturally push back. Let them express where they are now and where they want to be. You are present to listen, and question (elicit), but not to tell them what they should be doing.
4. Dr. Rollnick defined what he calls the "MI heart": collaborative, person-centered, guiding, and eliciting and strengthening the motivation for change.
As healthcare professionals we want our clients to be successful. But they can only change when they are ready. We can help them to become ready and to realize when they are ready to take a step. We should not expect there to be good results when we try to force them to do what we assume is best for them.
Dr. Rollnick points out that using MI in our practice can result in a lower stress level for us in our job. We no longer feel responsible for coming up with all the answers. We can sit back, safe in the knowledge that our clients have the answers they need. We need only to help them find it.
(If you are interested in purchasing a copy of Motivational Interviewing by Miller and Rollnick, you can do so by clicking on the image below)
I have his book and, as I was mentioning to a colleague yesterday, hearing him speak was like getting to see the movie!
There were a few points he made during the hour that I would love to share with you. It gives a good basis for people who would like to practice motivational interviewing. Some of you are just being introduced to it, and others are using in now. Dr. Rollnick explained that many practitioners struggle to get it right as a practice, but just don't seem to "get" the heart of it. So here are some basics he stressed:
1. Motivational Interviewing is not a process that you strive to learn, but a way of being with your client.
You practice being non-judgemental and focus on eliciting reasons to change from your client. You resist the "righting reflex" as he calls it, and shift your way of thinking from "I know what is best for you" to "you tell me what's best for you and let me be your guide"
2. MI is about believing that your client has the solution. You are there to work through their ambivalence with them and draw them out of their uncertainty.
3. Confrontation does not result in a positive outcome. People cannot be forced into becoming ready to change. The more you push, the more they will naturally push back. Let them express where they are now and where they want to be. You are present to listen, and question (elicit), but not to tell them what they should be doing.
4. Dr. Rollnick defined what he calls the "MI heart": collaborative, person-centered, guiding, and eliciting and strengthening the motivation for change.
As healthcare professionals we want our clients to be successful. But they can only change when they are ready. We can help them to become ready and to realize when they are ready to take a step. We should not expect there to be good results when we try to force them to do what we assume is best for them.
Dr. Rollnick points out that using MI in our practice can result in a lower stress level for us in our job. We no longer feel responsible for coming up with all the answers. We can sit back, safe in the knowledge that our clients have the answers they need. We need only to help them find it.
(If you are interested in purchasing a copy of Motivational Interviewing by Miller and Rollnick, you can do so by clicking on the image below)
Monday, August 17, 2009
Applying the Stages of Change to Weight Loss Clientele
Last week I wrote about the 5 stages of change. Today I will explain one way I use them with my clients. I have a handout I use during the first meeting as part of the initial assessment process. I discuss what the stages of change are and how they are a normal part of the process of change. We acknowledge that change may be difficult and that there are behaviors some people are very against even considering. For instance, in looking at behaviors that affect weight, a person may say they are "ready to start exercising, have been thinking about how to will make better restaurant choices, but will never, ever keep a food diary so don't even bring it up again!"
I have adapted my handout from one used in the Department of Defense HEALTH (Healthy Eating and Active Living in Tricare Households) weight loss program book. The changes are divided into a short list of behaviors that can be made to help weight loss occur. Instead of "I am ready to lose weight" there are specific behaviors listed down the left side of the chart. Here are some examples:
1) Keep a food diary, either on paper or online
2) Keep an exercise journal
3) Choose lower calorie foods more often
4) Choose reasonable portion sizes
5) Incorporate physical activity into daily life
Across the top of the chart there are statements correlating to the stages of change:
1) I'm not interested in doing this
2) I have thought about doing this
3) I have tried to do this on and off and intend to again very soon
4) I am doing this successfully, but for less than 6 months
5) I have been doing this successfully for at least 6 months
I have my client examine the chart, and fill in the appropriate box for each behavior with the correlating stage of change they are in with today's date.
For instance, the client in the above example may fill in today's date in the boxes to correlate, "I have been incorporating physical activity into my daily life but for less than 6 months; I have thought about making healthier choices in restaurants on and off; and I am not interested in keeping a food diary". Using the date instead of a checkmark allows us to come back in a month or two and see what has changed with their stages. It's another way to measure the success of their mindset and of our coaching sessions.
Often I have found a client to change their stage and not realize it. When we meet for the 6th time, for instance, they are telling me how they read the nutritional content of fast food choices before they go out to eat so they can choose the low calorie options, and they pack their lunch every day for work, when before they were always driving through the pick up window for a jumbo burger and extra large fries.
I will ask them, "Do you realize how much your behavior has changed? Do you remember driving through and picking up fast food almost every day before last month?" and they may shrug it off. It's a tremendous help to their progress for them to see what a huge change they have made and for me to acknowledge how far they have come with this change. That is how I find using a date in the appropriate box helps: So they can return to the chart occasionally and have a visual of moving ahead. I have them place today's date now in the next box if they have advanced to the next stage of change.
This can also help them see how it's possible to repeat the forward movement with another habit; so I ask them, "which of these behaviors would you like to address next?"
In coaching, the weight loss expert does not decide what the next change in behavior will be: we ask the client to choose one to work on next. We may address one the client is not interested in to find out why, and to help them see what might lead them to become interested.
One woman said, she was not interested in keeping a food diary, period. I asked her what her objection was to doing this. She explained it would make her uncomfortable to have to confront how much she actually ate. When I explained this was the very purpose of keeping a food diary--to realistically see what her intake was on a daily basis--she agreed to try it. She ended up finding it extremely helpful in making further changes to reduce high calorie foods and went on to lose weight successfully.
Let us know what you do with the stages of change to assess, reassess, and motivate your clients.
I have adapted my handout from one used in the Department of Defense HEALTH (Healthy Eating and Active Living in Tricare Households) weight loss program book. The changes are divided into a short list of behaviors that can be made to help weight loss occur. Instead of "I am ready to lose weight" there are specific behaviors listed down the left side of the chart. Here are some examples:
1) Keep a food diary, either on paper or online
2) Keep an exercise journal
3) Choose lower calorie foods more often
4) Choose reasonable portion sizes
5) Incorporate physical activity into daily life
Across the top of the chart there are statements correlating to the stages of change:
1) I'm not interested in doing this
2) I have thought about doing this
3) I have tried to do this on and off and intend to again very soon
4) I am doing this successfully, but for less than 6 months
5) I have been doing this successfully for at least 6 months
I have my client examine the chart, and fill in the appropriate box for each behavior with the correlating stage of change they are in with today's date.
For instance, the client in the above example may fill in today's date in the boxes to correlate, "I have been incorporating physical activity into my daily life but for less than 6 months; I have thought about making healthier choices in restaurants on and off; and I am not interested in keeping a food diary". Using the date instead of a checkmark allows us to come back in a month or two and see what has changed with their stages. It's another way to measure the success of their mindset and of our coaching sessions.
Often I have found a client to change their stage and not realize it. When we meet for the 6th time, for instance, they are telling me how they read the nutritional content of fast food choices before they go out to eat so they can choose the low calorie options, and they pack their lunch every day for work, when before they were always driving through the pick up window for a jumbo burger and extra large fries.
I will ask them, "Do you realize how much your behavior has changed? Do you remember driving through and picking up fast food almost every day before last month?" and they may shrug it off. It's a tremendous help to their progress for them to see what a huge change they have made and for me to acknowledge how far they have come with this change. That is how I find using a date in the appropriate box helps: So they can return to the chart occasionally and have a visual of moving ahead. I have them place today's date now in the next box if they have advanced to the next stage of change.
This can also help them see how it's possible to repeat the forward movement with another habit; so I ask them, "which of these behaviors would you like to address next?"
In coaching, the weight loss expert does not decide what the next change in behavior will be: we ask the client to choose one to work on next. We may address one the client is not interested in to find out why, and to help them see what might lead them to become interested.
One woman said, she was not interested in keeping a food diary, period. I asked her what her objection was to doing this. She explained it would make her uncomfortable to have to confront how much she actually ate. When I explained this was the very purpose of keeping a food diary--to realistically see what her intake was on a daily basis--she agreed to try it. She ended up finding it extremely helpful in making further changes to reduce high calorie foods and went on to lose weight successfully.
Let us know what you do with the stages of change to assess, reassess, and motivate your clients.
Wednesday, August 12, 2009
Assessing Readiness to Change
The Five Stages of Change were recognized and outlined in the 1980's by Prochaska and DeClemente to help people stop smoking. In the years since that time, these changes have proven to be useful in helping clients change a variety of behaviors--from drug abuse to alcoholism--and can be helpful in assessing your own clients' readiness to change eating behaviors in order to lose weight.
Here is a brief definition of the stages:
1. PRECONTEMPLATION: The client does not recognize their behavior as a problem
2. CONTEMPLATION: The client is considering the possibility of changing behavior and at the same time rejecting the idea of change
3. PREPARATION: The client is leaning toward change, seriously considering no longer engaging in present behavior
4. ACTION: The client is taking steps to no longer engage in the behavior
5. MAINTENANCE: The client is identifying and using strategies to prevent relapse and addressing other areas of life
6. This stage has been added more recently and signifies the person now has the new habits ingrained in their daily life. In the first five stages we often see relapses and the client can move back and forth easily from one stage to the other. In this last stage there is rarely a backward move.
How can these be used in your practice?
First identifying where the client is currently gives you a great starting place for the conversation. If the client is ready to start limiting their intake of high-fat foods, they may benefit from information on label-reading, or ideas on how to cook using less fat. However, if the client is in stage one or two, they will not be receptive to ideas about eating a lower fat diet. What first needs to be addressed may be the fact that they are overweight and it is harmful to their health. Perhaps they need to know that they will still be able to eat some of the foods they like before they say, "Okay, I'll give it a try".
Finding out where your client is in the readiness to change spectrum will help you realize what they need right now, and this will make you a very attractive professional to them, increasing the chances they come back for another visit.
Another way the stages of change can be helpful is to be able to show the client where they are right now and why. It may be helpful for some people to see that they are in a stage of ambivalence and that, indeed, there are reasons they do enjoy engaging in their current behavior. Just reflecting to them that you hear them say 'eating is an enjoyable activity' and confirming that this is true of most humans will help them see that you are not judging them or making them wrong. This keeps them from becoming defensive, allows them to relax and hear what you have to say, and encourages them because you understand where they are coming from.
And thirdly, the best use of the stages of change is to help your client move ahead to the next one! Later this week I'll show you how I use the stages of change when I start working with clients for weight loss. It's not just one change they are going to make, so I'll show you how I break it down to make it much less intimidating.
Here is a brief definition of the stages:
1. PRECONTEMPLATION: The client does not recognize their behavior as a problem
2. CONTEMPLATION: The client is considering the possibility of changing behavior and at the same time rejecting the idea of change
3. PREPARATION: The client is leaning toward change, seriously considering no longer engaging in present behavior
4. ACTION: The client is taking steps to no longer engage in the behavior
5. MAINTENANCE: The client is identifying and using strategies to prevent relapse and addressing other areas of life
6. This stage has been added more recently and signifies the person now has the new habits ingrained in their daily life. In the first five stages we often see relapses and the client can move back and forth easily from one stage to the other. In this last stage there is rarely a backward move.
How can these be used in your practice?
First identifying where the client is currently gives you a great starting place for the conversation. If the client is ready to start limiting their intake of high-fat foods, they may benefit from information on label-reading, or ideas on how to cook using less fat. However, if the client is in stage one or two, they will not be receptive to ideas about eating a lower fat diet. What first needs to be addressed may be the fact that they are overweight and it is harmful to their health. Perhaps they need to know that they will still be able to eat some of the foods they like before they say, "Okay, I'll give it a try".
Finding out where your client is in the readiness to change spectrum will help you realize what they need right now, and this will make you a very attractive professional to them, increasing the chances they come back for another visit.
Another way the stages of change can be helpful is to be able to show the client where they are right now and why. It may be helpful for some people to see that they are in a stage of ambivalence and that, indeed, there are reasons they do enjoy engaging in their current behavior. Just reflecting to them that you hear them say 'eating is an enjoyable activity' and confirming that this is true of most humans will help them see that you are not judging them or making them wrong. This keeps them from becoming defensive, allows them to relax and hear what you have to say, and encourages them because you understand where they are coming from.
And thirdly, the best use of the stages of change is to help your client move ahead to the next one! Later this week I'll show you how I use the stages of change when I start working with clients for weight loss. It's not just one change they are going to make, so I'll show you how I break it down to make it much less intimidating.
Thursday, August 6, 2009
It's Your Job--Not Your Responsibility
Your job is to help people lose weight. How successful your clients are may be how you gauge how successful you are as a weight loss professional It may even affect how good you feel about yourself or even your very self esteem. If your clients come back and haven't lost weight, if they get frustrated, if they lack motivation, if they plain just don't come back ... what does that do to how you feel about yourself?
Well, I have some amazing news that you are going to love (once you can accept it).
IT'S NOT YOUR FAULT IF YOUR CLIENT IS NOT SUCCESSFUL.
Because it's not YOUR responsibility.
Let's face it, we are the experts and we are here to provide information, encouragement, perspective, and acknowledgement. These can all help the person who is ready to make the changes in their diet and lifestyle to start melting off the pounds. But we can't do it for them. We don't shop for them or cook for them (although many of my clients have told me this is exactly what they need: "If only you could come to my house and cook all my meals for me!"). And we certainly can't eat for them.
We are there to provide them with the tools they need to start and continue on their journey to weight loss. If you are providing them with
- tools
- accurate information
- encouragement
- perspective
- acknowledgement
- a sparse amount of 'advising'
Then you are doing your job. You should be proud, you should sleep well at night, you should rest assured knowing you are a competent and caring professional. This is where the line is, and it cannot be crossed.
We do what we can, and we can do no more. Taking action lies with the client alone. Once you accept this fact it is amazing how much lighter the weight will be that some of us carry around. It will even affect how you converse with your clients, because there will not be that 'guilt' communicated through our voice that it's our fault too. It's not! There will be a subtle message sent that "I am giving you the tools and I expect you to use them: take the responsibility and accountability and come back and show me how well you've done with it". You may even find that you inspire people more when you give them this responsibility.
And that you stop suffering the guilt when you realize that it is not yours to take with you.
Please leave your comments and share with us: Do you believe this (yet?) and what has it done for you and your clients to carry the knowledge that it's on them.
Well, I have some amazing news that you are going to love (once you can accept it).
IT'S NOT YOUR FAULT IF YOUR CLIENT IS NOT SUCCESSFUL.
Because it's not YOUR responsibility.
Let's face it, we are the experts and we are here to provide information, encouragement, perspective, and acknowledgement. These can all help the person who is ready to make the changes in their diet and lifestyle to start melting off the pounds. But we can't do it for them. We don't shop for them or cook for them (although many of my clients have told me this is exactly what they need: "If only you could come to my house and cook all my meals for me!"). And we certainly can't eat for them.
We are there to provide them with the tools they need to start and continue on their journey to weight loss. If you are providing them with
- tools
- accurate information
- encouragement
- perspective
- acknowledgement
- a sparse amount of 'advising'
Then you are doing your job. You should be proud, you should sleep well at night, you should rest assured knowing you are a competent and caring professional. This is where the line is, and it cannot be crossed.
We do what we can, and we can do no more. Taking action lies with the client alone. Once you accept this fact it is amazing how much lighter the weight will be that some of us carry around. It will even affect how you converse with your clients, because there will not be that 'guilt' communicated through our voice that it's our fault too. It's not! There will be a subtle message sent that "I am giving you the tools and I expect you to use them: take the responsibility and accountability and come back and show me how well you've done with it". You may even find that you inspire people more when you give them this responsibility.
And that you stop suffering the guilt when you realize that it is not yours to take with you.
Please leave your comments and share with us: Do you believe this (yet?) and what has it done for you and your clients to carry the knowledge that it's on them.
Tuesday, August 4, 2009
There's A New Study That Shows ...
I just attended an online webinar sponsored by the Preventive Cardiovascular Nurses Association (PCNA) on Translating Epidemiology into Sound Public Health Advice, and I wanted to share the great information presented by Dr. Douglas Weed, former chief, Office of Preventive Oncology at the National Cancer Institute.
There are many times we hear about a new study that has people running to buy blueberries, trash all their diet soda, burn their stashes of artificial sweetener, or start hoarding dark chocolate. Many times, the results of the study were published in a newspaper or became viral through email and it seems everyone has heard the new "evidence" and are all running to make a change. This seminar warned about being too quick to make a change, based on any singular study.
Dr. Weed spoke very knowledgeably and intelligently throughout the seminar, and especially during the question-and-answer session at the end. He gave an example of a study that linked drinking alcoholic beverages to being diagnosed with various types of cancer in women and led us through the hour showing the evidence published, and then the quotes published in newspapers and magazines. It was amazing: even the head scientist conducting the study started to make statements, quoting results that were not in line with the study's outcome!
Conclusions were made like "drinking any amount of alcohol has shown an increase in the incidence of cancer in women", when the study actually showed some cancer incidences decreased; furthermore it was explainedthat the reason "all cancer risk" appeared elevated was because the risk of some specific cancers were elevated. The Washington Post took some of the study results and wrote an article that started: For years, many women have been buoyed by the news about one of life's guilty pleasures: That nightly glass of wine may not only take the edge off a day but also improve their health. Now it turns out that sipping pinot noir might not be such a good idea after all. And they go on to include quotes from the author of the study such as "no level of alcohol intake can be considered safe" (neglecting the health benefits of alcohol that have been shown in numerous studies), and that "if you are regularly drinking even one drink per day you are increasing your risk of cancer" (neglecting to mention several types of cancer that were shown to be reduced in this study in groups of women who consumed alcohol).
Dr. Weed cautioned health professionals that "just because a study is published [even in a reputable journal such as The New England Journal of Medicine] does not give a reason to encourage people to change their behavior [based on that article alone]".
We need to read a study and ask ourselves these questions: "Does the study give us new information?"; "Is there evidence of a new causal relationship?"; "Does this give us cause to change public policy or make new recommendations to the public or even warn the public about something?"
No causation claims should be made based on one study, but instead the study should be examined for causation: Is there a strong and consistent association between the food or drink and the outcome? Is there biological plausibility? What do other studies on the same topic have to say?
Before health professionals start making recommendations we need to wait for the consensus from the scientific community and not start running wild with the information from a newspaper or magazine headline...Newspaper quotes are often worded to mean something far different that what the study actually showed.
Dr. Weed recommended some good resources for what we can rely on to make suggestions to our clients: Look to review papers and current textbook chapters for peer-reviewed conclusions. There, the research has already been gathered and assessed. A new journal article alone does not give sufficient evidence to start encouraging changes in our clients' lifestyle habits.
About YOU
If you are a caring and helping individual who works in the field of helping people lose weight, this blog is written for you.We want to help people, we've been trained on the best methods to lose weight, the healthiest ways to lose weight and the science of weight loss, and we work hard to translate all this information and deliver it to our clients.
But ... it just doesn't always work.
Our clients don't drop the pounds quickly.
Sometimes they don't follow through with the actions intended.
Some of them don't come back to their next appointment.
So we are frustrated.
Following are entries by me about things I've learned, read, and experienced with weight loss clients--and hopefully guest posts by others who are willing to share their lessons as well.
My hope is that we can all learn something new every day from each other, and try new approaches and tips in our own practices, with our own clients, and make a difference in someone's weight loss success today.
Subscribe to:
Posts (Atom)
