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Family Meals Focus

The Ellyn Satter Institute Newsletter

Control vs trust in nutrition education

by Ellyn Satter, Registered Dietitian and Family Therapist

You don’t have to “get” your client to make changes with her food selection or food regulation. Instead of being so controlling, introduce her to the possibilities, and trust her to act on it – or not. Follow a division of responsibility in doing nutrition education: Give the information in the clearest and most neutral fashion you possibly can. Then trust your client to determine whether or not that information is useful to her in her life circumstances.   

Educators feel pressured to produce nutritional change

Unfortunately, health care and nutrition policy are fundamentally paternalistic and authoritarian. Particularly in mandated programs where children and parents are identified as being at nutritional or psychosocial risk, the pressure is on the educator to bring about change. Essentially, the stance is “do what I say.” This is control model: The expectation is that others be told what to do and they do it. The client complies – or not. If not, both educator and client “fail.” To get compliance, the educator motivates, exhorts, teaches in often creative and entertaining detail, and uses any number of approaches. The control model posture is thus fundamentally paternalistic and disempowering for the client. The educator presumes to know more than clients do about their lives and what is appropriate for them.

Counselors offer help, but don’t try to control outcome

Clients approached with trust and respect are more likely to collaborate in working toward productive change than those who are approached in a paternalistic fashion.

On the other hand, doing nutrition education in an authoritative fashion establishes a whole different dynamic. The educators posture is one of trust and respect for the client, of saying “let’s see if we can figure this out together.” The client is offered a choice about whether or not to collaborate and about which course of action to take – if any. Facilitated nutrition education is counselling using a trust model approach. When nutrition education is offered, it is from the perspective of needs expressed by the client and offered as a possibility, not as a should or ought. Clients approached in this fashion have the opportunity to feel respected, empowered, and affirmed.

Trust and respect is empowering

Paradoxically, clients approached with trust and respect are more likely to collaborate in working toward productive change than those who are approached in a paternalistic fashion. Like children, adults do and dare more when they are given choice. For the client treated respectfully, change is intrinsically motivated, supported by relationship with the educator. To empower clients, health educators have to really mean clients are entitled to make their own choices. If the educator fakes being respectful as a form of manipulating, clients will detect that and the interaction will be unproductive.


 How issues play out in a control approach versus the trust model

Issue

CONTROL

TRUST

What is the priority?

Formula; diet; nutrition lesson

Person

What is the purpose of education?

Adherence; compliance to the formula

Introduce the possibilities, look together for courses of action

What is the basis for change?

Conforming to expectations.

Relationship. Choice based on increased  awareness of self, options

What energizes change?

Fear & avoidance, shoulds & oughts from self, others

Self respect. Pleasure and mastery, adventure and optimism

What is the role of the health educator?

Nutritional director; motivator

Consumer and patient advocate and resource person

Who puts in energy, investment?

Educator

Client

Who takes responsibility?

Educator

Client

 

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