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The Ladder Method: why using psychology is crucial to client success

What we do as nutritional practitioners is even more complex than developing individualized dietary interventions and therapeutic protocols. There’s a psychology behind what we do when we work with clients and it centers around attitude and behaviour change. 

The Art of Behavior Change

Changing ingrained behaviours, attitudes and beliefs is an extremely delicate and complicated process. It requires an understanding of how beliefs, attitudes and behaviours are interrelated. These relationships form both our sense of self and world-view, and are one of the reasons why changing habits and behaviours can be so difficult — our behaviours are tightly tied to our beliefs and sense of who we are. 

As humans, we generally want our world to make sense. We have an internal drive to keep our actions and beliefs consistent. It therefore makes sense that when we act in a way that contradicts what we believe or value, we experience distress and unease. This state of mental distress is called Cognitive Dissonance.

Cognitive Dissonance 

Cognitive Dissonance is a term used to describe the mental discomfort experienced when either our behaviours and beliefs do not align,or when we hold two contradicting beliefs. This psychological theory is based on three basic assumptions:  

  1. Humans are sensitive to inconsistencies between beliefs and behaviours. 

  2. When these inconsistencies are recognized, dissonance is experienced which motivates us to resolve that conflict.

  3. Dissonance will be resolved in one of three ways:  I) Change the belief  II) Change the behaviour  III) Change the perception of the behaviour

Let’ s look at an example…..

As a nutritionist, you likely value your health. You probably make a conscious effort to choose nutritious whole foods, avoid processed foods, added sugar, and get quality sleep. Unfortunately you may spend a lot of your day sitting at a desk or in your office with clients, or you may go through periods where you neglect your exercise routine. Chances are, you feel guilty because you know how important it is to be physically active. This guilt and emotional discomfort is cognitive dissonance. To resolve this dissonance you have the following options: 

  1. Change Your Belief: You COULD decide that it really isn’t that important to be physically active. 

  2. Change The Behaviour: Upon recognizing this dissonance and the resulting guilt, you could vow to begin an exercise routine and implement small ways to be more active throughout your day. 

  3. Change The Perception of The Behaviour: Finally, you could rationalize. You could tell yourself that it’s okay that you aren’t exercising because you’re taking care of your health in other ways.

According to psychologists, most of us would chose door # 3.

Rationalizing, the Human Solution 

If we’re looking at negative health habits and behaviours, it may seem logical to assume that  recognizing the disparity between what you know or believe and engaging in that harmful action would lead to the motivation to resolve that dissonance by changing the behaviour. Unfortunately, humans have a pervasive tendency to rationalize. 

Cognitive dissonance becomes problematic when it leads us to resolve dissonance by rationalizing, explaining away a harmful behaviour and avoiding or discrediting new information- whether consciously or subconsciously. Since our actions are driven by habitual behaviors rather than belief systems, when resolving a dissonance by rationalizing we see a decrease in client compliance. 

The tendency to rationalize occurs because cognitive dissonance impacts our beliefs, attitudes, behaviours, thoughts and decisions. This internal state of unease can cause us to feel anxiety, guilt and even shame. It can influence how we feel about or view ourselves and lead to negative self-esteem or low self-worth. As a result, you may see the following negative reactions in clients when attempting to facilitate positive behaviour change: 

  1. They may try to justify or rationalize a decision, behaviour or action they’ve made that contradicts the behaviour change they need to make. 

  2. They may feel ashamed about some of their negative health behaviours or habits and attempt to hide/omit these habits during sessions. 

  3. They may adopt new beliefs or ideas to help justify or explain away the conflict between their behaviour and beliefs and may blame others or external factors.

  4. They may only seek information that confirms their existing beliefs, or devalue/discredit information or interventions you suggest which contradict their current behaviours or attitudes. 

  5. They may even “give up” and say they just can’t do it and decide to discontinue sessions.

  6. They may not see results due to a false sense of adhering to a protocol 

It is important to note that all clients will experience dissonance to varying degrees. This will depend on their tolerance for inconsistencies, how personal or ingrained the belief or behaviour is, or the size of the disparity between the behaviour and belief. 

It is therefore crucial to approach each client where they are at that point in their journey.

To  realize that not only will each client have specific dietary needs, they will also have specific environmental differences such as: genetics, lifestyle, upbringing, support systems, culture etc.. These non-dietary factors need to be addressed in order for protocols and dietary interventions to not only work, but stick. 

The Ladder Method 

Structuring protocols that facilitate long-term behavior change and results like a step ladder is a strategy that helps to bridge the gap between where a client is and where they want to go.

Each rung on the ladder is the next step towards the top. Interventions and protocols are tools to guide your clients baby step by baby step towards their goals. You need to break changes down into small, achievable steps, that minimize the disparity between their current behaviours and goals you are setting together.

For example, if you’re starting with a client who’s been eating the standard american diet, you can’t simply provide them with a perfect, whole food diet strategy cutting out all the processed and refined foods they are used to. This cultivates feelings of dissonance and is like asking the client to jump off the floor to the top of the step ladder.

By breaking things down into small, achievable steps you minimize the dissonance experienced, empower and motivate clients as they recognize the progress made with each small change. 

When we work with our clients, we want to create a motivating and empowering relationship that gently guides them towards their health goals. This means not only appropriately matching a client to right dietary intervention or protocol, but also understanding what the client is capable of and what their current beliefs and attitudes are.

By using tiny habits that build upon each other and move our clients towards their health needs and goals we ensure changes are not too drastic and still align with their current self-image and beliefs. By doing this clients are more likely to stick with each change because it doesn’t feel too uncomfortable or impossible. Furthermore, we give clients the time to get accustomed to and comfortable with each change before moving on to the next step. This creates feelings of accomplishment, empowerment and ensures lasting change....and before you know it, they are standing tall and proud at the top of the ladder.

Katie Hogg is a soon to be graduate from the Institute of Holistic Nutrition (IHN), Toronto. She holds a Bachelor of Arts from the University of Western Ontario with a major in Psychology. Her own personal struggle with chronic, undiagnosed health issues lead her to pursue her education in Holistic Nutrition after experiencing first hand the profound benefits that changes in diet, lifestyle and supplementation had on her health. This experience led her to develop a profound passion for learning, researching and sharing up-to-date information to nutrition and health based questions. Aside from her passion for all things food, health and nutrition, Katie spends her time painting, reading and hiking with her dog. 

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