Should I take on this client?

Written by Dr Mendoza

Is it ethically correct to work with a client who wants to lose weight but psychologically they are not ready? This raises several interesting points. First, how do you know if they are ready to lose weight? I mean surely if they have come to you as a trainer and are willing to pay you for this service then they must be ready to lose weight. There is no ethical dilemma if you do not know any different. If you have read this far (and read on) and you have any idea about behaviour change then there is already an ethical dilemma.

My research has shown that clients will employ a personal trainer even if from a psychological perspective they are not ready to lose weight. This is not an uncommon occurrence as we see it every New Year. People decide to lose weight or get fit or give up smoking and/or drinking. Most of these New Year’s resolutions last a few weeks and then the old lifestyle habits slowly creep back in. What is happening here is a mis-match between the individuals unconscious beliefs and their conscious desires. If your desire to lose weight is at a ten when you start out with a PT but your beliefs about whether you can achieve that are a five your desire will always ultimately sink back to a five (level of belief). This is because the brain doesn’t like this mis-match and as the beliefs are more entrenched than the desire they win the struggle.

I said the beliefs are held at the unconscious level and this is what psychometric testing is trying to measure. The psychometric tests I used in my research can measure a number of aspects of the trans-theoretical model (TTM). The TTM was hypothesised by Prochaska and DiClemente and they proposed that people go through set stages on their way to making a behaviour change. Under-pinning the stages of change model are a number of other psychological constructs; and these go to make up the TTM. These include decisional balance and self-efficacy theory. These two models are particularly relevant in this example as you can think of self-efficacy as self-belief or self-confidence to some degree. This is turn is linked to decisional balance which proposes that we take a balance sheet approach when making decisions by weighing up the pros and cons of doing or not doing something. As these can both be measured we can get a feel for what someone’s true beliefs are. Thus, we now know whether their beliefs truly match their desires. If they don’t match up sufficiently then you now have a problem.

Why is understanding this relevant? If you could tell whether a client was really ready to change it is going to be far more beneficial to your business. There is a better chance they will lose the weight and a happy customer is a great advert for what you do (help clients lose weight and get fit). If they do not achieve their goal (perhaps because psychologically they were not ready to change) then they will blame you. It’s human nature to want to apportion blame somewhere else and not have to take responsibility for the outcome. The problem with this is that they will say to whoever will listen that you weren’t very good, and it never looked like working (or words to that effect). You are not there to put your side of the case and so word gets out that you are not that good at your job. This type of negative publicity can really harm any PT/gym business.

To some degree what they are saying is accurate because if you had taken the time to assess their psychological readiness you would not have taken them on as a client. You can see evidence of this quite regularly on social media in PT groups. Trainers asking what to do about clients who don’t show up or cancel sessions. Maybe they are not making the progress they expected. Basically, they are slowly relapsing and will ultimately drop out of the programme and cancel their PT sessions or gym membership. The other strength of regular psychometric testing is that you can predict that the relapse is occurring and intervene before the client drops-out of the programme.

The other ethical dilemma that this raises, especially if you work in a medical setting (NHS), is what do you do if you assess a client as not being ready to change; in other words, you shouldn’t take them on. Until a few years ago I really didn’t have the answer but then I found motivational interviewing (MI) in amongst several psychological journals. MI is designed very much with the ambivalent client in mind. You can think of ambivalence as the pros and cons of making a change being about equal. They won’t have a very strong belief that they can achieve a change either, so their self-efficacy won’t be that strong. By working with the clients in an MI consistent manner you can increase their level of self-efficacy and shift their decisional balance in favour of change. This means you can effectively move a client who is not quite ready to change to a point where they are psychologically in the right place.

I believe all personal trainers and coaches that work in the weight loss arena should possess these skills. Failure to learn these skills means that you can never really say you are working in an ethical manner because without a psychological assessment you would never know.