Read your clients and let them guide you.
Make it your goal to hunt for authentic examples of positive charac-
teristics within the client’s commentary. It all starts when you pick up the scent in a seemingly insignificant client statement. Ask open-ended questions to have the client elaborate more. Follow the trail of information until you find a strength you can acknowledge. Then present the affirmation as a statement: “It’s through your cooking that you are showing your family how much you love them. You are a caring person.” Below are some brief
scripts in which the practitioner seeks opportunities to use affirmations.
Here is an example of a 70-year old woman who struggles with mild
depression and motivation to exercise:
client: I was just so much better at this when I did it before.
pRactitioneR: Tell me about that time. [open-ended question]
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client: I could get up in the morning and exercise first thing.
pRactitioneR: You were able to make exercise a top priority. [reflec-
tion]
client: Well, I just knew it would make me feel better, and it really
did. My therapist used to beg me to exercise. I felt like it worked
better than my meds. I even slept better.
pRactitioneR: Exercising keeps your energy levels up and helps to sub-
due the depression, keeping you in a healthier place. [reflection]
client: I think that I can get up in the morning and walk around the
outdoor mall near my house. It’s not that big of a deal. I just need
to think about how good it’s going to make me feel.
pRactitioneR: You’re committed to making this a priority because
you know how much you’ll benefit from it. [affirmation]
client: Yes, it really points my whole day in a different direction. I
know it sounds small, but I just do so much better when I start the
day on the right foot.
In this dialogue, the client mentions how she was able to exercise in the past. Halfway through the dialogue, the practitioner switches the reflection into the present tense, implying that the benefits the client felt would be the same if she started exercising again. The client was then able to visualize herself getting up in the morning to go for a walk and she decided it was possible.
In the next example, a 45-year-old woman is trying to plan and pre-
pare regularly scheduled meals for herself.
pRactitioneR: How is your meal schedule going? [open-ended ques-
tion]
client: It’s going OK. I’ve been making an effort to have my lunch in
the break room at work instead of at my desk. That way I don’t
work and eat at the same time.
pRactitioneR: You made a point of getting away from your desk so
you’ll be more focused on eating. [reflection]
client: Yes, because if I sit at my desk and eat, before you know it my lunch is gone and I didn’t really taste any of it.
pRactitioneR: And it’s important to you to be more mindful of how
your body feels when you’re eating so you feel more satisfied.
[reflection]
client: It has been lately, at least. I can see that I’ve been eating so much and hardly tasting any of it. It’s like I’ve been eating in a fog.
pRactitioneR: You want to do what’s right for your body. [affirmation]
client: I really do. It just feels right.
Affirmations 115
Accepting
Committed
Flexible
Persevering
Stubborn
Active
Competent
Focused
Persistent
Thankful
Adaptable
Concerned
Forgiving
Positive
Thorough
Adventuresome
Confident
Forward-looking
Powerful
Thoughtful
Affectionate
Considerate
Free
Prayerful
Tough
Affirmative
Courageous
Happy
Quick
Trusting
Alert
Creative
Healthy
Reasonable
Trustworthy
Alive
Decisive
Hopeful
Receptive
Truthful
Ambitious
Dedicated
Imaginative
Relaxed
Understanding
Anchored
Determined
Ingenious
Reliable
Unique
Assertive
Die-hard
Intelligent
Resourceful
Unstoppable
Assured
Diligent
Knowledgeable
Responsible
Vigorous
Attentive
Doer
Loving
Sensible
Visionary
Bold
Eager
Mature
Skillful
Whole
Brave
Earnest
Open
Solid
Willing
Bright
Effective
Optimistic
Spiritual
Winning
Capable
Energetic
Orderly
Stable
Wise
Careful
Experienced
Organized
Steady
Worthy
Cheerful
Faithful
Patient
Straight
Zealous
Clever
Fearless
Perceptive
Strong
Zestful
FIgure 7.2. Characteristics of successful changers. From Miller (2004).
PIckIng the rIght AFFIrMAtIon
There are many ways to offer affirmations depending on which direction
you’d like to guide your client. Figure 7.2 offers a list of 100 characteristics of successful people. It can be used to help give you an idea of what you’re looking for in your clients.
Below are two scenarios, each with a list of affirming words that might be appropriate to the situation.
Scenario 1
Tyler is a 55-year-old electrician who has just been diagnosed with
celiac disease, a condition requiring a strict gluten-free diet. He has spent his entire life eating wheat, barley, and rye, the three main food sources of gluten. He is now being asked to restrict gluten entirely. He has returned for his first follow-up appointment and has eliminated
gluten for an entire week. It wasn’t easy, but he feels successful. The following characteristics may be appropriate for Tyler.
Adaptable Effective
Capable Flexible
Committed Focused
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MASTERING THE MICROSKILLS: OARS
Competent Imaginative
Confident Knowledgeable
Creative Persistent
Dedicated Resourceful
Determined Thorough
Diligent Tough
It’s easy to affirm clients when they are successful. It’s harder to do so when they are struggling. Consider affirmations that might be used
with the client in Scenario 2.
Scenario 2
Becky is a 45-year-old mother of three who has end-stage renal failure
after a traumatic car accident damaged her only functioning kidney.
She has just started dialysis and needs to restrict her intake of fluids, potassium, phosphorus, and
sodium. She also needs to increase her
protein intake, a nutrient she previously had to limit. Possible affirmations for Becky include the following:
Brave Courageous
Capable Hopeful
Careful Organized
Committed Persevering
Competent Strong
Concerned Tough
Which affirmation the practitioner chooses depends on what he or
she wants the client to talk about more. When affirming a client, there is no right or wrong answer. There are many ways to affirm clients, and any affirmation is better than no affirmation. Each affirmation will take the client on a specific path. As mentioned before, you are likely to get more of what you affirm or reflect. If you reflect sustain talk, the client is certain to dwell on how her previous attempt failed. If you highlight the client’s strengths or commitment, then you are likely going to hear more change
talk.
test yourself
Below are client statements followed by three possible affirmations. As you read the client statement, think of possible qualities to affirm before looking at the three affirmations provided.
• Client statement: “It’s not that I don’t want to eat healthy. I’ve done it before. I used to go to the store and get all the right foods, but
Affirmations 117
then they started going bad in the fridge and I couldn’t stand all that waste.”
• Affirmation 1: “You want to eat healthy.”
• Affirmation 2: “You already know what kind of foods to buy.”
• Affirmation 3: “Not being wasteful is important to you.”
• Client statement: “I just felt so much better when I was working out in my garden. It’s not even that I was exercising all that hard. I was
just always doing something.”
• Affirmation 1: “You have a green thumb.”
• Affirmation 2: “It’s not about exercise to you, it’s about cultivating something.”
• Affirmation 3: “You notice that it’s easy for you to incorporate physical activity when you do the things you enjoy.”
• Client statement: “That’s why gastric bypass is right for me. I can do it. I know I can, I just need help. These past few months have
shown me what I’m capable of. I’ve never eaten better in my life, but
the weight just won’t budge.”
• Affirmation 1: “You are committed to getting your body as healthy as possible before this surgery.”
• Affirmation 2: “You have proven to yourself how strong you are.”
• Affirmation 3: “You are capable of amazing things. Nothing is going to stand in your way.”
• Client statement: “It’s hard to see how much strength I’ve lost over the years. I can still do most things though; I just don’t recover the
way I used to. Every year, I take my girls and their families on a ski
trip. Lately, I see myself starting to slow down. You know, though,
it’s not a race. I just enjoy being out there on that mountain with my
whole family and I feel good.”
• Affirmation 1: “You enjoy being active with your family.”
• Affirmation 2: “Being there for your family is important to you and you’re able to shift your focus to what’s important.”
• Affirmation 3: “You just cruise down the mountain enjoying the big picture. You feel peace in where you are in your life.”
• Client statement: “My biggest problem is soda. I drink about two a day now and I think I’m addicted to it. I was drinking more than
that and I cut it back already. I just need that caffeine in the after-
noon to stay alert at work.”
• Affirmation 1: “You were already successful with making a change in how much soda you drink.”
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• Affirmation 2: “You know yourself well and where you’d like to focus your attention.”
• Affirmation 3: “Your career is important to you and you want to finish strong each day.”
selF-AFFIrMAtIons
Although affirmations help clients to internalize and develop positive self-talk, the best type of affirmation is the one the client generates. The use of strengths-based open-ended questions can help you to uncover self-affirmations that become even more powerful in the behavior change process.
pRactitioneR: Tell me about some things you do to take care of your
son’s health. [strengths-based question]
client: I do always make a point of putting together his lunch. I just
worry that he’ll be tired in his afternoon classes if he doesn’t have
a healthy lunch.
pRactitioneR: You’re looking out for him. [reflection]
client: I just love him and want him to have a long, healthy life. [self-affirmation]
In this example the practitioner asks the client to come up with some-
thing she does for her son’s health. By asking the client to come up with positive behaviors, the client is more likely to internalize it, letting it spread to other areas of her life.
Sometimes affirmations made by the practitioner produce a domino
effect resulting in a client self-affirmation. Here is an example of a 65-year-old woman who had an elevated fasting glucose lab.
client: All my sisters have diabetes and my mother too.
pRactitioneR: And it worries you that you’re next. [reflection]
client: Yes, I’m scared that if I don’t change what I’m doing now, that I’m going to get it too.
pRactitioneR: You see that there are some things you can do that
might reduce your chances of developing diabetes. [reflection]
client: I do. I think I need to quit drinking soda, for one. I go through a 12-pack a week. I think that’s where I need to start.
pRactitioneR: Once you see your goal, you don’t back down. [affir-
mation]
client: Yes, I’m a goal-driven person. I’ve always been that way. [self-affirmation]
Affirmations 119
pRactitioneR: What’s another time that you made a goal and went
for it? [open-ended question]
In the previous dialogue, the client starts to voice change talk. The
practitioner follows with an affirmation to help solidify her commitment.
The client then makes a powerful strengths-based statement about herself.
The practitioner can strategically use that statement as a springboard to elicit more positive statements. It can also be used in future dialogues to help further cement her commitment to change.
There’s never a bad time or place for an affirmation. Always be on
the lookout for a characteristic or attribute to affirm. Including affirmations in the mix with open-ended questions, reflections and summaries will increase your client’s confidence in behavior change.
chAPter 8
Reflections
I don’t know what it is about listening. I just know when I’m
heard, it feels damned good.
—caRl RogeRS
It feels good to be validated. Clients feel heard and understood when the practitioner takes the time to reflect or paraphrase what they are saying.
With reflective listening, the most widely used microskill in MI, the practitioner reflects what the client is thinking and feeling and expresses this understanding back to the client. A general guideline is to provide two reflections or more for every open-ended question. Reflective listening statements do more than just demonstrate that the practitioner is listening; they are intentionally and strategically placed to emphasize the client’s ambivalence, strengths, and desire to change. This chapter introduces this important microskill within MI that becomes the foundation for an environment where clients can feel supported in their efforts toward change.
BeneFIts oF reF
lectIons
Consistent and liberal use of reflections makes the client feel validated and understood, ultimately building trust within the counseling relationship.
Rephrasing what the client says dem-
Consistent and liberal use of
onstrates empathy and a general curi-
reflections makes the client feel
osity and desire to fully understand
validated and understood, which
the client’s perspective. Reflections
ultimately builds trust within the
also help to coax the client to elabo-
rate on certain thoughts and feelings.
counseling relationship.
In hearing his own thoughts and
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Reflections 121
feelings laid out in a direct and organized way, the client may even experience an “ah-ha” moment. A client might say, “Gosh, I never realized I felt that way.”
ForMIng reFlectIons
In reflective listening, also known as active listening, the practitioner interprets what the person means and relays this meaning back to the client. Reflections are statements, not questions; therefore voice inflection decreases at the end of the statement. Reflections open with statements such as:
“So you feel. . . . ”
“You’re wondering if. . . . ”
“It seems as though. . . . ”
“You are. . . . ”
Reflections are concise. In general, attempt to make the reflection no
longer than the client’s original statement. Forming accurate reflections requires you to listen intently not only to what the person says, but also to what the person means to say. People don’t always say what they mean, so at times, you will be taking a guess at what you think they mean.
client: This just came out of nowhere. I don’t have diabetes.
pRactitioneR: You don’t see yourself as a person who can have this
kind of disease.
client: I’ve been through Vietnam.
pRactitioneR: You thought that your fighting was over.
Tone of voice is the difference between expressing empathy or sarcasm.
If you genuinely place yourself in a
curious frame of mind, you may find Strive to be a clear pool of water, your voice naturally adopts an empa-reflecting the image of what
thetic cadence. Strive to be a clear people intend to be.
pool of water, reflecting the image of
what people intend to be.
when to reFlect
Motivational Interviewing in Nutrition and Fitness Page 16