Motivational interviewing is a powerful tool to support clients in being active leaders of their own health and wellness journey.
While asking your clients questions, not only are you learning more about them, you are creating a safe space where they can think about past experiences and current health behaviors.
One of the most powerful and effective results of motivational interviewing is the power it has to help clients overcome doubt. Doubt is a common experience among people who have a desire to adopt a new health behavior or modify an existing one but are aware of personal and environmental challenges that may come in the way of doing so.
In this article, we give you six question prompts that can be used to engage your client in a discussion that will help them to overcome self-doubt.
What Is Motivational Interviewing?
Motivational interviewing is a technique where you build a safe space for clients to tell you about their experiences, opinions, knowledge, and desires. In the process, not only does the coach become more aware of the unique experiences and challenges of their clients, the clients are given space to more concretely express their priorities and goals and connect to deep motivating factors behind current behaviors and desired ones.
In motivational interviewing, you ask your client open questions about what their current health behaviors are; why they have built those behaviors; if, how, and why they have thought about changing them; and multiple other topics. When you don’t hold judgment as they answer, they feel validated and heard, and this builds a sense of trust in the coach-client relationship.
When appropriate, you can ask clients if they would like to hear about the information you have before offering it freely. When coaches ask for permission and encourage reflection, it can greatly impact the openness of clients to hear information that may be useful to them.
You can learn more about motivational interviewing, including the fundamental principles and core skills, here.
The Role of Doubt in Some Health Behavior Change Frameworks
Health behavior change frameworks are extremely useful for helping to understand how people adopt and sustain healthy behaviors that are conducive to wellbeing. They are also useful for helping us to think about factors that impede people in moving from one stage of behavior change to another that gets them closer to adopting a new health practice sustainably.
Keep in mind that, just like choice is only one factor that influences health behaviors, self-doubt is just one type of doubt that may impede individuals from making health behavior changes after recognizing a desire to do so. Other types of doubt may include a lack of confidence in a healthcare provider and/or whether environmental factors will allow the individual to make health behavior changes.
The Role of Doubt in the Transtheoretical Model of Behavior Change
The transtheoretical model was developed by Prochaska and DiClemente with the goal of summarizing the unifying factors of several behavior change theories. The transtheoretical stages of change model, which is pictured below and described in detail in the complete blog about health behavior change theories, is summarized in five main stages:
The movement of an individual along the five stages is considered progress toward desired change. At any stage, an individual can relapse to a previous stage.
Why might a person relapse or not progress to the next stage of health behavior change? There are several reasons, including:
- A lack of social support
- A lack of access to healthcare services
- Changes in priorities
- Changes in health goals
- Change in health status
- Changes in or an underestimation of the power of social, environmental, and psychological determinants of health
Self-doubt is considered one of the psychological or cognitive determinants of health. Health coaches have an important role in understanding and supporting clients in modifying their mindset that may be impeding their progress from one stage to another.
The Role of Doubt in the Health Belief Model of Behavior Change
The Health Belief Model is one of the most widely used health behavior change frameworks. It is also one of the oldest in Western society, which is why it has abundant studies that support its use.
The Health Belief Model focuses on the psychological determinants of health behavior change. The psychological determinants include:
- Perceived susceptibility to developing a health condition
- Perceived severity of the health condition
- Perceived benefits of taking action to prevent or reduce the risk of the current condition
- Perceived barriers to taking action
- Cues to action or events that occur that motivate a person to do something differently
- Self-efficacy or the confidence in a person’s ability to take action
The psychological determinants are interconnected, and they are informed by trauma. Below is the diagram that explains how the different psychological factors come into play with each other according to the Health Belief Model.
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Self-efficacy is the opposite of self-doubt. So, when health coaches want to help clients overcome self-doubt, what they should be aiming to do is improve the clients’ sense of self-efficacy.
Characteristics of Self-Doubt
Beata Souders, a candidate for a doctorate in psychology, identifies several characteristics that people with self-doubt or a lack of self-efficacy may have.
- Avoiding accepting challenges in fear of failing
- Believing that they are incapable of change or of performing complicated tasks
- Focusing on adversities and past failures as character traits or personal shortcomings
- A lack of sense of commitment
6 Motivational Interviewing Question Prompts to Help Clients Overcome Self-Doubt
Note: Remember to follow the principles of motivational interviewing when using these question prompts in your practice.
Can you tell me about a time where you made a change you wanted to make in your life?
When your clients walk into a health coaching session with you, they may assume that you will only be talking about progress updates toward their health goals. When a person is experiencing self-doubt in their ability to make health behavior changes, they might have trouble remembering that they are capable of change.
Shifting the focus from health behaviors, which may be a subject of contention, to positive experiences in the past, may not only lighten the mood but also creates an opportunity for your clients to reflect on situations where they were able to overcome adversity.
Some follow-up questions you might want to ask include:
- What do you think made that situation different from other moments where you faced adversity?
- Can you recall another situation where you wanted to make a change and did it?
- Can you recall a situation where a change was unexpected, but you enjoyed the outcome?
What personal strengths do you have that would help you achieve your health goals?
It is possible that your client may respond that they don’t have any of the skills they need to achieve their health goals. In this case, you might want to migrate away from speaking about health goals for a few minutes since they might feel particularly vulnerable or doubtful at that moment. Instead, you can ask them to think about a professional goal or personal goal they have achieved in the past. If they are having trouble thinking of anything, you can provide some examples, such as graduating from high school or college, getting a certificate, landing a job, buying a house, or getting taxes in order.
Then, ask them to identify personal strengths they have that allowed them to achieve that goal. If they are still having trouble vocalizing their strengths, you can ask permission to share what you perceive are your client’s strengths based on the information they shared with you. Some adjectives you may want to consider using, when applicable, include:
You can ask if they agree with those descriptors and explain how their past actions reveal those traits. Next, you can explore whether those characteristics can be applied to achieving their health goals and even visualize what it would look like if they did so.
What encourages and inspires you?
You can focus this question on their health goals but not necessarily. If you choose to apply it to your client’s health goals, it will help to highlight perceived benefits and cues to action of the Health Belief Model.
At first, for some clients, it can be helpful to speak more generally about what encourages and inspires them and explore those elements. Then, you can ask them if they feel those people, feelings, or elements they mentioned are relevant in their health behaviors and health goals.
You might also want to ask about whether they are interested in modifying their health goals so that they lean on what encourages and inspires them more clearly.
What can you gain by making a change?
This question helps clients reflect on the perceived benefits of changing their health behavior. One of the advantages of this question is that clients often see the benefits as only coming about once the final goal is reached. Where relevant, you can offer information about how incremental changes can offer benefits.
For example, if your client wants to meet the minimum physical activity guidelines (30 minutes of moderate exercise a day, five days a week) as part of a strategy to lower their high blood pressure, you can inform them, with their permission, that even a few minutes of movement during the day is beneficial to their heart health.
Not only do these conversations offer a safe space to discuss progress and setbacks, but they also help clients to set aside an all-or-nothing mentality and be proud and forgiving of themselves.
Who could offer you support in making this change?
The role of social support in overcoming self-doubt is often overlooked. Humans are naturally social beings that thrive in tight-knit groups. Social support may include family members but not necessarily. They may be friends, colleagues, or people from support groups.
Your client may even specifically look to you as someone whose support they are seeking in order to make a health change. If that is the case, or if your client is struggling to identify people who they can count on, offer your full support and ask them what they would like that to look like.
Remember, however, to reinforce your professional boundaries so you don’t experience burnout.
What can we work on together to make you feel the progress I have noticed?
Before asking this question, ask your client if they feel okay with you making an observation about their progress.
With their permission, lead with a concrete observation or example of the progress you’ve perceived and recall traits related to self-efficacy.
Here is an example of how you might want to use this question:
Since we first started meeting, I’ve noticed that you have [make a positive observation about their progress]. This shows great [mention traits or characteristics]. How can we work together to modify your goals and help you appreciate the progress I have noticed?
The purpose of this question is to reevaluate the coaching plan or your client’s health goals. You might find they felt that the goals they had originally set with you were unrealistic, so opening the door to revising those goals to allow them to feel like they are more attainable can represent a significant relief to them in the short run and greater self-efficacy to achieve health behavior goals and sustain positive health behaviors in the long run.
Self-doubt is a common issue when people desire to make a change in any aspect of their lives. When it comes to health behaviors, the health coach is the primary expert in how to support clients in overcoming self-doubt and other cognitive barriers to positive health behavior change.
Motivational interviewing techniques are one way to explore the different components that influence health beliefs that influence how individuals are making progress toward health behavior change. When the question prompts in this article are integrated into a larger coaching strategy, your clients can begin to feel more self-efficacious while also understanding that the health coaching space is a safe space.
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