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Clinical Tips: Help Your Clients Build Healthy Habits – and Actually Maintain Them

Help Your Clients Build Healthy Habits – and Actually Maintain Them

“I need to lose weight/get fit/eat better/be healthier”

“I really need to look after myself better”

Many clients will say these things but then struggle to put these changes into action. (Many of us, as therapists, can struggle with this too.) As therapists, an important part of our role is to help our clients live better lives, and this often includes supporting them to improve their health. Being fitter, stronger, and having better nutrition will support them to achieve other goals and live a valued life, and it will also improve their mood. So, whether it’s a New Year’s resolution or a desire for positive change at any other time of the year, helping your client to put these changes into action in a lasting, sustainable way is something valuable you can offer.

Unfortunately, change is HARD. If you have ever had a gym membership but not gone regularly or had an intention to walk early in the morning but hit snooze on your alarm, you will know that building healthy habits can be an experience of repeated failure. You can’t just rely on your initial motivation, because when you really need it, motivation tends to disappear.

Weight goals are particularly tricky to achieve because there are hundreds of variables that lead to someone’s final weight on the scales. Most of us assume that simply eating less and exercising more should be enough to lose weight but there is also family history, genetics, body type, race/ethnicity, age, sex, eating and physical habits, access to healthy foods, socio-economic advantage/disadvantage, where you live, the work you do and how you do it, how active you are across the day, family habits, culture, relationship stresses, sleep and more… and these will determine whether you can sustain any weight loss.

Fortunately, there are several ways you can help your clients (and yourself) put healthy habits into action. Most of us learn that using ‘S.M.A.R.T. goals’ is a sound method as it includes many of the essential elements of effective goals. Originally developed by George T. Doran (1981) as a way of setting organisation and management objectives, the mnemonic S.M.A.R.T. has evolved over time, particularly when applied to individuals. There are many slight variations, but the one that fits best with a psychological approach is probably: Specific, Measurable, Achievable, Relevant, and Time-bounded.

Using S.M.A.R.T. is a good foundation for goal setting, but there are several ways you can make these goals more likely to be achieved. Let’s look at how as a therapist you can support long-term, sustainable change across each of the elements of a S.M.A.R.T goal.

Specific => Choose Just One Small Thing to Change

The first step in setting any goal is clarifying what the client really wants to achieve, starting with simple questions like “what do you mean by getting fit/being healthy?” Once you’ve done this, help your client make the goal SMALLER. I am not saying their dream must be small – by all means, dream big – just that they will do better taking small steps towards this. At all times, but particularly in a pandemic, it’s important to focus on the small things you can control. By making their goals easier to achieve, they are more like to get off to a good start and build a foundation for future growth.

Make sure goals are positively framed. This is not the same as “having a positive intention” or “being positive”. Instead, ensure the goal is something your client can work toward. Try not to set a goal to move away from something unwanted, because this does not tell them what to do – just what not to do.

Ideally, goals should focus on changing one specific behaviour only. For example, your client might work on increasing the frequency of days that they make themselves lunch rather than buying a burger and chips. Or they could increase the number of days they take a snack in the car to help prevent themselves from getting a donut at the service station. Over time these tiny changes add up.

Relevant => Link to Broader Values

To find motivation, your client’s goals need to be aligned with their own values. They should not reflect other peoples’ values or the ideals imposed upon them by society (particularly one obsessed with dieting, thinness, and fat phobia). ‘Health’ often isn’t considered to be a value; it is something that helps you live your values. Help the client to choose small, positive healthy actions that are aligned with their broader values – and support them to take these steps consistently. To achieve this, you might need to reframe the goal. “Losing weight” might become making more nutritious eating choices during the day to support their energy levels and mood, and this, in turn, might help your client be a more patient and playful mum. Now, this would be something worth working towards.

Make sure the goals aren’t yours either. When it comes to dieting and exercise, many people have strong views about what works. Make sure you do not promote any one diet, weight loss, or exercise approach, even if you have found it works for you. What works is different for everyone. If just being told what to do was going to work, your client would have achieved success already through the myriad of diet and exercise options out there. What they need is help in achieving lasting behavioural change.

Values are also useful because you can link any small gains to a bigger life purpose. Take time to explore the potentially bigger implications of their small changes and generalise the learning from one gain to other areas of their life, asking “if you can do this, what else can you do?” I always find this creative, expansive conversation incredibly inspiring.

Achievable => Allow for Missteps and Imperfection

Goals need to be imperfect so you can mess up without failing. We make things harder for ourselves by setting ‘perfect, forever goals’ (Kemp, 2021). These goals are too big, too challenging and demand exceptionless performance to be achieved. (“Are you really going to walk EVERY day, and NEVER eat dessert?”) With these goals, we fail as soon as we slip up. Miss one walk and you’ve failed. Check out the resource guide Effective Goal Setting for Perfectionists for more information on perfectionistic goal setting and how to overcome it.

Instead, help your client focus on building just one healthy habit over time. Be specific about the change and don’t attempt to change too much at once. In fact, if you are trying to change two things, that is one too many. (Can I say this often enough?) Your client might start by swapping just one snack to something more nutritious or eating more regularly across the day.

Measurable => Track and Make the Most of Successes

Once you have set a small goal, keeping track of progress is crucial but be careful what you measure, and how. Make sure to keep track of successes over time, not failures. My clients track things like how many days they remember to take their lunch, or how many days they go for a walk.

Keeping a physical record such as a chart or calendar (or if you prefer, an app) really helps. I find that the people who are most successful keep records of their successes in a very visible way. Like ‘adult star charts’, visible records enhance personal accountability and motivation when the achievements begin to stack up. Those who rely on their memory tend to be much less successful in achieving their goals. Remember that forgetting is a huge barrier to change, and something you can address specifically, by having your client take notes, set reminders, or use their calendar.

Make sure to check your client’s progress in every session, as your clients will benefit from these conversations in many ways. This gentle and kind accountability will them stay on track. Your clients don’t need to feel guilty if they haven’t done as much as they wanted but avoiding a little embarrassment can be motivating in small doses.

Time Bounded => Focus on Incremental Improvement

I know traditionally goals must be ‘time-bounded’, but the length of time for health-related goals may not be clearly defined because what is important is incremental improvement. Always celebrate persistence. Many people have low confidence that they can make a change, so make the initial goal simply “let’s see how many you can do”. Whatever they achieve can become their baseline and you can build from there.

Make sure to celebrate any small successes, and as you review progress, make sure to look back to see how far your client has come. This when you can extract the learning, asking them “what worked?” and “what will you do more of?” If there has been little progress since your last session, check that they still want to pursue this goal and troubleshoot what went wrong, asking “what got in the way” and “what will help you next time?” At some point your client’s progress will go backward – so normalise this and provide encouragement at this time. By providing oodles of support, accountability, and encouragement, you can help your clients achieve healthy changes, in their timeframes, and therefore improve their lives in lasting ways.

One Final Thought…

Building healthy habits is difficult and possible. For extra guidance, there are plenty of resources online designed to help people achieve their goals but choose carefully as many promote quick fixes. Start by checking out my resource on Effective Goal Setting for Perfectionists which delves into goal setting in more detail. An excellent resource is Dayna Lee-Baggley’s book Healthy Habits Suck: How to Get Off the Couch and Live a Healthy Life… Even If You Don’t Want To. This is an engaging and practical guide to making positive changes in your life. You can also listen to Dayna on the Psychologists Off the Clock podcast, or sign up for her high-quality, self-paced learning program.


References

Doran, G. T. (1981). There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review, 70(11): 35–36.

Kemp, J. (2021). The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills. Oakland: New Harbinger Publications.

Lee-Baggley, D. (2019). Healthy Habits Suck: How to Get off the Couch and Live a Healthy Life… Even if You Don’t Want To. Oakland: New Harbinger Publications.


About Jennifer Kemp MPsych(Clinical)

Jennifer is a Clinical Psychologist who works with clients who are struggling with perfectionism and the mental health problems perfectionism facilitates and maintains. Jennifer is the author of The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills. She integrates Acceptance and Commitment Therapy (ACT), behavior analysis, exposure, and Compassion-Focused Therapy approaches in her therapeutic and consultation work. Jennifer presents internationally on the topic of perfectionism and is available for public speaking, conferences, and workshops.