was successfully added to your cart.

Do you ever find yourself in a situation where you are zooming out rather than zooming in?  Your mind disengages. You stop listening.  Of course, it happens to all of us.  There are many causes of disengagement, several include information overload or looking too far ahead and we can’t see the connection.  

In my spin class last week, I found myself doing just that, zooming out rather than zooming in to what the instructor was telling us.  No, it wasn’t because it was too early in the morning, (well, it was at 6:00 a.m.) rather, it was too much “what will happen in the next 30 minutes” that my mind could not hold it all in.  What I needed right then was a focus.  What do I need to know now, in the next three minutes?  Do I need to spin faster or add more gear to my bike?

In most trainings I conduct, I often hear, “I was on the phone with her for an hour, the patient kept talking and talking.”  The other challenge I often hear is “where do we start, we have so many issues that need to be addressed.” That is often the case when we are working with individuals with multiple chronic health and life issues.  It is the patient dealing with diabetes, hypertension, and depression.  It is the parent who is juggling a new baby, a toddler going to preschool, a job, laundry, meal planning and all that comes with managing a family and life.  The quick response is where do they want to start?  What is most important to them?  What are they ready for?  Where is their focus?

Dr. Miller and Dr. Rollnick, in motivational interviewing (MI), have identified Focusing as one of the Four Processes (Motivational Interviewing, Miller & Rollnick, 3rd Edition, 2013).  Focusing in MI is an ongoing process of seeking and maintaining direction in the conversation. Our ability as practitioners to work together on setting the focus is key. We can direct the conversation with the patient both in terms of overall, global focus, as well as specific topics, and action steps.

This can involve a 30,000 foot view (see the whole picture of a condition) and a pinpoint focus on what is most important to you right now to discuss.   Dr’s Miller and Rollnick call this structuring in agenda mapping.  Structuring is where we step back from the conversation for a moment to talk about its direction.  

“Would you mind if we consider some topics that we could discuss.”

“Let’s step back and consider what’s most important to focus on.”

“I’ve started making a list and would like to hear from you what is on your mind.”

After we have agreement on the agenda, one of the next steps in Zooming In.  To move from hypothetical, big picture, to the practical, next step.   Zooming In can also involve tuning in to the here and now.  We have the big picture, now what is our immediate next step?

This made me ponder as to how we often give too much information and look too far ahead that the patient/client disengages and losses their ability to focus with information overload.   What we know is after structuring the conversation together with the individual, guiding them to look at the “right now,” the “one small step you can take today,” has validity and value.

Once a shared Focus for the conversation has been established with our patient/client, be reminded of the value of the focus so our conversations have direction and we can zoom in together.

Transform conversations.  Transform healthcare.

Dr. Becky Lang


Leave a Reply

“Dr. Lang’s training provided me with a better understanding of the motivational interviewing process. The skills I learned from her training have helped me feel more engaged and thoughtful when listening and talking with those around me. Dr. Lang is energetic, knowledgeable, passionate and provides a great learning environment.”

Nancy AdrianseBSDH, Oral Health Manager, Iowa Primary Care Association

“The training I received in Becky’s motivational interviewing class was invaluable. It laid a wonderful foundation for me to effectively empower my patients to develop and implement positive changes for their health. Becky created such a nurturing, nonthreatening environment that allowed me to freely learn and practice. This is certainly a class I can recommend to anyone wanting to learn to assist others with behavior changes.”

Robin GeorgeRN, Motivational Interviewing training participant

“At the YMCA, we have worked with Dr. Becky Lang for over a decade now to help us shift and shape our culture. As an organization committed to strengthening our community, the coaching and training skills that Dr. Lang has provided have helped us immensely. With her education and guidance she has helped us establish a culture that focuses on building meaningful relationships with our members, focusing on their needs, and coaching them towards success in their pursuit of a healthy lifestyle. Dr. Lang has trained all levels of our staff from our front line Wellness Coaches to our Executive Directors and Leadership Teams. Her on-going support has allowed the coaching-culture to come alive in our organization.”

Kim Stewart Kim Stewart Director of Operations, YMCA of Greater Des Moines

“The training Becky provided has been one of the most rewarding nursing experience I have had in 30 years. The style of interviewing and teaching patients is rewarding and positive. Her techniques drive the sessions to be more personal and patient-centered. Through Becky’s teaching, I was comfortable to practice and get familiar with the motivational interviewing process. Becky is an exceptional trainer and I recommend her training to all health coaches and educators.”

Sandy LovelessRN, Motivational Interviewing training participant

“The motivational interviewing techniques Becky teaches allow patients to set goals and work toward changes that are important to them. Patients feel in control of their own health and allow me to be in a more supportive roll. Becky has a positive and uplifting spirit that makes her classes extremely enjoyable.”

Tyra CarltonRN, Motivational Interviewing training participant

“Rebecca Lang was a respected colleague who diligently served as a teacher and mentor to hundreds of students over her long career at Grand View University. I had the distinct pleasure to work with Becky and regularly witness her vocation to Wellness education. She motivates those around her by a strong and genuine commitment to a lifestyle which promotes health and well-being.”

Katharina TumpekPhD, Professor and former Chair, Dept. of Health Promotions, Grand View University

“It has been a pleasure to work with Becky Lang over the last 25 years. Within a variety of contexts in the wellness arena, I have witnessed Dr. Lang’s mastery as a wellness educator, a health coach, a professor, and, most recently, as a health coaching trainer. I could go on at length about Dr. Lang’s passion, enthusiasm, high energy, wisdom, and deep knowledge in health promotion and behavior change. One of the attributes that impresses me most, though, is her ability to create a relaxed, fun, interactive, and content-rich training environment. Her refreshingly supportive, inviting, and empathic style of training and coaching allows learners to take risks, experiment, try on new skills, and participate authentically in role play exercises without feeling awkward and intimidated. Through Dr. Lang’s coaching and training, people learn–often more than they imagined.”

Jill NorrisRN, MPH, PCMH-CCE, Director, Care Management, University of Iowa Health Alliance