What Does Asking Our Patients to "Do The Work"Even Mean?

I've been mulling this over for some time now wondering if I can articulate my concerns about asking our patients/clients to "do the work".

My main concern is that while whatever technique, theory, meal plan, therapeutic modality makes sense to us, we need to be mindful that this may be the first time the person sitting before us may have ever heard of it. Or, they have done the so called "work" a million times over and are still struggling. Then they may feel shame that they still can't meet our suggestions and recommendations.

My biggest concern is that it can so easily turn into victim blaming. By this I mean that our explanation as to why someone has not reached a goal, changed their behaviour, lost some weight left a domestic violence situation or is still struggling ,is because they just didn't or are not doing "the work". Especially in the weight management world where we now know that asking someone to just eat less and move more is rarely helpful.  I also see this in the area of complex domestic abuse when a common refrain is "why don't they just leave?"Or with women really struggling with menopause symptoms being asked to challenge their thoughts about it when some cant sleep , function , or are debilitated with hot flushes and distressed mood. 

Being aware of the backdrop of the person's life before we assign tasks or at least assess if the task we are assigning or recommending is doable for them is really important. 

Judging our patients is detrimental to the whole process. They will see through it and not feel safe to be able to disclose what is really going on in their lives.

I am in a very privileged position to be invited into people's lives as they work through many tough challenges.

Because a few things can be true at the same time, just because a patient wants to have help with changing their eating/ exercise lifestyle behaviours it doesn't necessarily translate into them being able to implement what we recommend or suggest to suit our arbitrary expectation of change. 

 It is not because they are unwilling, not because they are lazy, not because they don't think it's a good idea but because in the backdrop of their own lives it's just not that simple.

A couple of the biggest and hardest situations I hear quite frequently is  one  of deep grief and loss. Often multiple losses in a short space of time.When a person's world is upside down with grief, appetite, sleep, clear thinking can be broken and fragmented. They are caught with self-soothing eating or non-eating and despite their want to manage their weight it's just too hard to take on board strategies, eating plans, sleep hygiene literature or gym programs.

Or, for  the many people I see who  live with constant and chronic pain. Just getting to the shops can be difficult, let alone following a meal plan or going to the gym. These are just a few examples of the very complex personal lives people present with when they are asking for help with their weight. 

Our weight is not a separate entity to our life.

If we can suspend our judgment which can sound like "why don't they just do the work?" and really be there for them, the changes will come when they feel ready. Even teeny-weeny baby steps are significant.

I remember when I worked in a psychiatric clinic in the mood disorder ward, many patients couldn't face eating. They had complete loss of appetite and or taste and the medications were either making them gain weight or dulling their world to the point of not being able to face cooking or eating. Instead of pushing them to do what we thought was best for them it made more sense to work with them. So, if for example they couldn't face chewing we could find easy pre bought soups to re heat or frozen berries to suck on. Rather than impose what we thought they should do we could work with them to find nutritious but acceptable options until they felt stronger and ready to make some other changes.

Sometimes when a client's world is in chaos and upended the desire for control is strong and can manifest in wanting a structured plan and that is totally fine too.

Being cognisant of their world, their life, their needs, their obstacles and who they are is paramount if we want to be able to meet their needs and support them.

Not sigh and say, "well it's their fault, they just haven't done the work". That can sound like victim blaming and can be soul destroying.

Ginette Lenham ©December 2023