Rx: More exercise

Physicians should be prescribing exercise but they don’t (click here to read more). Many of them also do not know how to have conversations surrounding those behaviors that their patients should or should not be doing that “accounts for 50 percent of our overall health.”

This is MY specialty! I am trained to have these conversations and we can have the conversation over a walk in the park! Give me a call and we can take the first step toward overall health and well-being sooner rather than later! 404-895-1525 or email me at Denice@WalkAndTalkAtlanta.com.

 

What is your motivation?

All this talk about change: stages of change, processes of change, change talk…

How does a person step into and make lasting change? By tapping into what motivates them.

Remember I asked about the thing you had considered changing but had not yet done so. How long have you thought about it? Where are you in terms of stage of change? What kind of language do you use when you think and talk about this change? Are you still ambivalent, preparing, or have you moved into mobilization?

motivation

When I have conversations about behavior change with my clients, particularly related to health behaviors, there are lots of questions I ask them to help them think more about what their motivations to change are such as, “What would be the most important reason to make this change?”

Oftentimes other people asking us to make a change impose their agenda upon us. For example, a physician might tell us to eat healthier and get more exercise so we can lower our cholesterol and control our blood sugar. Those are legitimate reasons to do so and yet so many people do not follow through. Why? Because the doctor’s reasons for making the change do not align with our reasons. A discussion about changing behaviors related to health that might have more impact would be to get the person talking about their goals, values, and dreams related to life and health. My mom wants to live to be at least 100. I hope to one day have grandchildren and I want to be active and healthy so I can run around and play with them. Someone else may want to travel and see the world. Different people have different reasons for making the same change. Some examples of questions that might uncover these reasons are as follows:

• What things are you struggling to do currently but wishes you could do because you have not made the change?
• How would life be better five years down the road if you make this change?
• What will life look like in five years if you don’t make this change?
• What are the three best reasons to do this?

Another approach is to have the individual talk about past successes in making change and how to overcome any barriers to making the change right now.

• How have you made other changes in your life in the past?
• What things have you done in the past toward making this change and how were you successful?
• What things stand in the way of doing this and how might you overcome them?

In keeping in mind the stages of change, it is often necessary to consider preparation. Remember change is a process and some changes require much more preparation and take longer to make. I don’t just decide today that I want to lose 20 pounds and wake up tomorrow morning 20 pounds lighter! Lots of preparation takes place in the form of changes in diet, increases in physical activity, and even then progress is slow.

I learned a while back that even skilled hikers whom have prepared extensively to climb Mt. Everest still have quite the journey ahead of them once they arrive in Nepal at the foot of the mountain. They don’t arrive and immediately climb straight to the top. They spend weeks on the mountain often taking daily jaunts going back and forth but not really making any progress up. Why? To acclimate themselves to the altitude and harsh environment. Progress requires preparation and that may take many shapes and forms. Someone seeking to become healthier may need some time to acclimate to the changes. They may need a support system to guide them along the way.

• What kind of support system do you need in place to make this change? How can you make that happen?
• What would have to happen in order for you to do this?

Something else to consider is what one person is willing and able to do may be very different than what others are willing and able to do. I used to work for a primary care medical residency. Our medical residents, fresh out of medical school were eager to impart their knowledge to their patients and they were more than ready to let all their patients know about the importance of eating healthier and getting more exercise. Makes perfect sense! However, upon arrival to their new training assignment our residents were taken on a community “ride along” and what they discovered was that there were some very real challenges to this poor community regarding diet and exercise. The area was what was known as a food desert. There were limited grocery stores with fresh fruits and vegetables and these were not centrally located. Many of the community members did not have reliable transportation if they had transportation at all. They often relied on public transportation and that makes grocery shopping difficult. On the other hand, convenience stores, fast food, and liquor stores lined every corner and were within walking distance making unhealthy eating very convenient. As for exercise, much of the area lacked sidewalks for safe walking or bike riding, and many people feared walking in their neighborhoods because of crime. While there were some parks, even these were not always safe, nor were they located close to some of our patients’ neighborhoods. If these individuals were going to eat healthy and exercise it was going to require a lot of preparation and some creativity on their part to make it happen. Our residents learned it wasn’t enough to tell their patients, “You need to…” They came to understand there were some very real barriers to engaging in healthy habits.

Finally, when someone agrees it is time to make a change and they have expressed willingness to do so, rather than jump to outlining sour own plan for them one of the very best questions to ask is , “So what, then, is your first step?” Remember, whose idea is the best idea? The person making the change! So if they’re going to make the change, ask them how they plan to do it! You might be surprised. It might not be how you would approach it, but if it works for them, let them run with it. And they will find out soon enough whether it’s going to work. And if not, it’s not failure, it’s just a lesson learned about what not to do!

These questions are just scratching the surface of how a change conversation might occur with me in a client session. In fact, we would explore some of these questions in much greater depth over time depending on how serious the issue is. Sometimes, particularly depending on the stage of change the individual is in, the conversation might be short and sweet. The person may have just needed to speak the decision out loud and have someone hold him/her accountable. And sometimes people need to uncover the underlying issues that prevent them from moving forward and these can be varied and complex.

The goal of change conversations is to uncover the discrepancy between where someone wants to be versus where they are now and highlight that discrepancy. Back to my running example: On the one hand, I say I want to run faster, run stronger, and fit back into my size six skirts, yet on the other hand I don’t run as often as I should. Why do I not do what I say I want to do? I know what has worked for me in the past and that is a good support system, running partners, and/or some type of competition or accountability. I am currently lacking those things. In order for me to step into that change I would need to figure out how to incorporate those things where I am now in life.

So before being critical of yourself or others for not moving forward in a change, take a moment to step back and consider that different people have different reasons for making changes, even similar changes. Also, different people have different motivations, different goals, dreams, and values. Real change has to tap into what is most important to the individual and aligns with what that person feels he/she is willing and able to do.

Are you thinking about a change you would like to make? Would you like for me to facilitate that conversation? Schedule your walk-and-talk session with me today. You can reach me at 404-895-1525 or Denice@WalkAndTalkAtlanta.com. I also have office appointments or online sessions (for Georgia residents).

Conversation about change

“My friend says she wants to change so and so, and I told her what she ought to do but she just doesn’t do it. I don’t know what her problem is.”

Sound familiar? Hopefully by now I have described that the process of change is a little complex. Previously I described the stages of change. Today I’m going to describe the processes that underlie a conversation about change.

We all have those conversations with others about changes either they say they wish to make or we feel like they should consider and vice versa. These conversations are sometimes fruitful and other times not. What’s up with that?

Miller & Rollnick (2013) have studied the change process extensively, particularly some of the components that go into a successful conversation about change, and have determined four fundamental processes beginning with engaging.

Slide1

Engaging is the process of building rapport and trust. Having a conversation about something difficult in your life is easier with someone you trust and feel has your best interest at heart. Suppose a perfect stranger came up to me on the street and said, “Your butt is too big. You really should exercise more.” There’s truth in those statements. A whole lot of truth! However, I might turn around and tell that person, “I don’t know you from Adam. Who the heck are you to tell me what I need to do???” There is absolutely no engagement there.

Sometimes we go to others for help, such as a physician, therapist, or even a friend or family member. Even in those times when we are actively seeking counsel there is still a need to ensure a measure of trust and respect before diving into the issue at hand.

Building upon the engagement process the next stage is focus. What behavior are we talking about? For example, I want to be as healthy as possible but there are several contributing factors to my health: What I eat, how much I exercise, my sleep habits, my level of stress, etc. I could talk about any and all of these things but I might also end up talking in circles or getting off on a tangent. Conversations about behavior change need to have a clear focus and this focus should be determined by the person seeking to make the change for reasons we’ll discuss later.

So, now that we’ve established rapport/trust, and the topic has been chosen, now what? Now it is time to get down to the nitty gritty and evoke the individual’s OWN reasons and means for change…his/her own goals and desires. Why is this important? Think about it. If I’m thinking about making a change, whose ideas about making this change are the best? MINE! If you are thinking about making a change, whose ideas about making that change are the best? YOURS! The conversation needs to be tailored to the individual. It needs to reflect what is important to you, your abilities, and your challenges, as well as how you feel you can best go about making those changes. More about this later.

The final process in change conversation is planning. Think back to the beginning of this post. People often jump ahead to a change plan and can’t understand why others don’t respond positively. Perhaps because they don’t feel you have their best interest in mind (no engaging), the plan doesn’t reflect their preferred direction (wrong focus), and it doesn’t take into consideration their individuals goals and means (no personal evocation). For example, I might offer a product or service that legitimately addresses a health need I think you have, but have I taken the time to find out 1) whether this is the need you really are hoping to address first, 2) whether you are willing or able to spend money on my product or service or 3) whether you really are ready to step into the action phase of change? Pushing for action prematurely and without considering the other’s intrinsic reasons for change can shut down the conversation immediately.

To recap, the four processes are engaging, focusing, evoking, and planning. These stages build upon each other and each one must be established before moving onto the other. These stages are also recursive in that at any given point in a conversation we may need to step back down and revisit a previous stage before moving on. For instance, during the evoking phase when asking about reasons for change the conversation might get off topic. In this case there might be a need to refocus. If we move ahead too prematurely to making a plan and the other person is not ready and begins to shut down we may need to step all the way back to the engaging stage to re-establish trust and rapport.

I hope you’re beginning to see that conversations about change can be sensitive and difficult. Very few people want to be told what to do without some say in the matter, even those asking for help. My next post will cover more about tapping into intrinsic motivation. Stay tuned for DARN-CATs.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.

Your brain on a walk

Remember the commercial of an egg and a frying pan? This is your brain. This is your brain on drugs.

New academic research supports evidence that a walk in nearby nature, such as a park, reduces some of the stress than can lead to depression. City dwellers have a higher likelihood of developing depression and walking around in crowded areas with heavy traffic can increase this likelihood.

Why not combine the best therapeutic effects of nature, exercise, and talk therapy to create some peace of mind?

Call or email today to schedule your walk-and-talk therapy session. 404-895-1525 or Denice@WalkAndTalkAtlanta.com

Exploring new territory

It’s no secret I like to explore the outdoors. Perhaps the only thing better than having a park as my “backyard” in the midst of the big city would be living in the mountains with plenty of hiking trails to explore. Ideally I could have both.

Today, however, my better half and I went out for a walk and took a detour. I knew about the detour but didn’t want to take it on by myself. And rightly so, it was not an area that I would have been comfortable exploring by myself certain times of day or certain times of the week. But today the alternate route was calling my name and it was full of surprises and new perspectives.

I had read about the eastside extension of the Atlanta BeltLine and while I’ve put in many a mile on the paved eastside section I had not yet ventured onto the extension. I had checked out the route on various maps and had an idea where it would go and where we might come out; however, viewing the route on a map versus experiencing it in the flesh was a very different experience!

First, there were plenty of surprises along the way. Things I wasn’t expecting such as the two artistic treasures pictured. I could have easily walked past the mask without even noticing it had I not looked up from the path we were walking at just the right moment.

underpass mask

We also had a general idea where we were based on our knowledge of the path from the maps but the path didn’t come out exactly where we expected and we were “lost” for a brief period of time. If it weren’t for landmarks with which we were familiar and a keen eye for an exit we could still be out there wandering the trail.

And now, you guessed it–I’m about to make some more therapy analogies. Therapy is exploring your life from a different angle. It is taking some time out to walk through circumstances with a slightly different perspective–to travel down a slightly different path for a period of time. The therapist and the client have an idea of where the therapy session might go, but often there are surprises along the way which are revealing, enlightening, and can sometimes bring new perspective.

It is also important to pay attention to the landmarks along the way. It isn’t always helpful to continue down the same trail for too long. Sometimes there is no benefit. Sometimes it is easy to get lost and not make real progress. Sometimes time restraints permit further exploration. And sometimes the subject matter is too amazing–or too difficult–to digest all at once and must be revisited again at another time.

The thing to remember, however, is that it can be refreshing and exhilarating to travel down a previously unknown path with a trusted individual.

If you would be interested in exploring some new territory in your life and would like someone to walk alongside you, give me a call at 404-895-1525 or email me at Denice@WalkAndTalkAtlanta.com. I am totally up for the adventure!