Today we explore how to work with a client who is not engaged in following evidence-based or scientific guidelines, including preventive tests, and is not seeking out reputable sources on the Web and beyond. Instead, s/he hunts down information and recommendations from non-reputable sources, while not listening to your well-informed advice.
It goes without saying that those reading this article honor and respect the scientific method, are skeptical of recommendations that lack a scientific foundation, and stay within the bounds of evidence- based guidelines that are worthy of publication in a peer-reviewed journal or textbook. The construct of evidence-based medicine has been around for about 20 years and is a relatively new, but essential paradigm in exercise program design and implementation. We are taught to refrain from making recommendations that are not firmly rooted in well-designed research studies, the more the better.
However, our clients may not be like us. They may not trust or respect science-based recommendations. Perhaps they think of themselves as right-brain types who didn’t enjoy science courses in their education, and value intuition and creativity more than the scientific method. Maybe they are frustrated with the limitations of the scientific method, which generates recommendations based upon aver- ages and bell curves that don’t seem relevant to their personal circumstances. They may be more interested in what complementary and alternative practitioners have to say because these practitioners treat people who have been failed by conventional medicine.
Some are justifiably concerned about how medical guidelines change dramatically over time. Lively debates have emerged recently among scientists and in the media about the pros/cons of mammograms, PSA tests for prostate cancer, and the value of annual physicals. Not long ago high carb/low fat diets were the universal recommendation for heart health; this is no longer valid as the evidence for low carb/moderate healthful fat diets is now compelling. The landmark June 2012 JAMA paper on weight loss maintenance by Ludwig et al., has overturned the science- based wisdom that a “calorie is a calorie” when it comes to energy expenditure.2 It turns out that high carb diets lead to an average of 300 fewer calories expended daily than low carb diets, a critical issue for weight loss maintenance. No wonder our clients may have become cynical about evidence-based guidelines. So how do we bridge the gap between our science-based wisdom and guidelines and our clients who don’t trust our science-based guidelines and resist our recommendations?
1. APPRECIATE WITHOUT JUDGMENT The only way a helping professional can defuse resistance is to get fully onto your clients’ side of the fence. Get down from your expert pedestal and honor your clients’ biological drive for autonomy, to choose their own path. Inquire openly and without even the tiniest whiff of judgment or expectation about how they make decisions on what to do to protect and improve their personal health. What is their approach to investigating options, whose advice do they trust most, how do they weigh up their options and decide? What do they think about evidence-based medical guidelines? Perhaps they will share painful stories about how they or close others have experienced difficulties with recommendations of reputable health care providers. Validate and show respect for their perspectives with authentic sincerity, however uncomfortable that might be.
2. COACH DON’T PREACH Once your clients trust that you appreciate and respect their viewpoints, bringing down the walls of resistance, you have created an opening to facilitate their finding a new and improved decision-making process. Move into a collaborative coaching conversation where you encourage clients to generate new ideas on how best to make health decisions, and get permission to offer your ideas and wisdom. While it’s tough for our expert minds to give up control of having the right answers, it is human nature for your clients to value what they discover more than what has been imposed. Allowing your clients to discover a better path for themselves will, in fact, dramatically increase your impact and your clients’ success. And the bonus is that they will be more likely to be interested in your best advice.
Originally published in ACSM Certified News Coaching Column