By Richard Kahn
I am inspired to share a fictional representation of a composite case example based on the type of client issues that I am presented with in a public health nutrition clinic that allows for limited time for interventions frequent one-off encounters. As a beginner, I am motivated to practice my newly acquired solution-focused skills that I am learning within the class. The clinic is a challenging, yet rewarding place to practice as the cases are often complex once the clients are given the opportunity to open up. I will call this client “Tina”. Tina is 29 years old pregnant client who was self-referred with rapid weight gain of 20 pounds in the past 2 months. She was already obese, reported limited family and social connections and said she likes to be independent. I had about 20 minutes with this client, of which at least 5 minutes was managing bureaucratic details.
We have been learning about “Hidden VIPS” in our class, and I asked her “ What did your physician say to you about your weight gain?” This could have been better phrased as what concerns did your physician offer you?” My goal was to bring up a potentially sensitive topic indirectly. Tina responded desultorily, “Nothing, except that I am gaining too much”. She also went on to say that her prior experiences with dieticians were a waste of time and gave her nothing of value.
I would have better to ask for “her good reason for the weight gain?” Instead, I asked, “What happened that led to the rapid weight gain?” This wording of this question permitted her to be the expert and indicated to her an non-assuming stance on my part. She opened up to me. She said two family members died during the past two months, including the death of a very close grandmother. These deaths required traveling domestically and outside the US to see participate in family mourning activities.
Traveling, she said, included eating on the run and frequent high calorie family meals as part of family rituals, and her emotional upset that led to overeating to cope with the grief. It would have been better practice to acknowledge how difficult these deaths must be “for her”, and ask her how she has been coping and managing. She told me that since she returned from the family events, that she had gotten herself “back on track.” As a new SF practitioner, I forgot to follow up in some ways and, as a dietitian certainly should have asked her how she had gotten back on track. On the other hand, I was able to focus on her solution and not her problem by saying, “Death disrupts life. The important thing is that you are back on track. She brought up that she had started an aerobic exercise program. I might have offered a compliment on her exercise plan. I kept my dietitians cap on and asked if her physician approved the plan instead. Words used to create local dialogue by using the words death, back on track and exercise.
As a nutritionist, I am required to provide nutrition education. I asked her permission if it would be ok for me to discuss some of this information with her. She agreed. I asked her what “she knows” about food labeling in relation to calories given her prior unsatisfying experience with dieticians. Offering an option let her decide if she wanted to learn as well providing an indirect compliment that assumed she already knew something about label reading. She then acknowledged she didn’t know much and would be glad to learn about it, The teaching went well and she further agreed to learn about dietary fiber in foods. Fiber increases satiety without calories. A yes set was created by asking permission.
The time available was ending and I invited her to choose between another nutrition session or a breastfeeding class for her next visit. She agreed to the class! I asked her how she rated our meeting on a scale from 1-10. She said a 6. I asked her what would make the session better, she smiled and said she learned something new. I took her words and smile as a higher rating. We parted with smiles and a handshake. Body language can be accepted as a positive response in SFBT. (More Than Miracles, p. 56)
Upon reflection, I can see many questions and responses that were helpful. In addition, I see that I will need more practice and study to become a competent SFBT practitioner. I will have to be more alert to opportunities to use SFBT techniques such as hidden VIPs such as the physician whose advice was originally disdained but remained a support in her exercise, explore current family relations, ‘good reasons’ for gaining weight, asking how she decided on a healthier diet and exercise, how she manages to include more health promoting actions while she is coping with her loss and validating her experience with you ‘for you’ statements. Given the available time and limited scope of my dietary work in the clinic, sticking with her solution of and use of a single scale and observation might be adequate.
One thing I have learned that, a beginner, using even a limited set of SFBT questions is a kinder approach to me as a learner than trying to be perfect short meetings in a rushed setting. I have more time in other types of professional encounters for fuller explorations. My best hopes for me need framing by time. I know from even a beginner’s experience that practice and study will pay off for the clients and myself.