FIT can be tailored to one brief session or a course of therapy over several weeks. Not all elements need be covered in a single session.

In the spirit of motivational interviewing, all but the briefest sessions should begin by establishing rapport and negotiating the session’s agenda. When delivering FIT remotely by phone or internet, check that the client is somewhere where they feel comfortable, relaxed, private, and free from distractions.

Key skills for the practitioner are listening actively and with empathy, accepting that the client alone has the answers to their problem. It is important to help the client resolve ambivalence about behaviour change by reflecting back to them the emotional content of what they are saying. The purpose of the FIT interview is to elicit the client’s solutions to their problem and to train them to use functional imagery to support their motivation to achieve those solutions.

There is more information about motivational interviewing here and about communication skills here.

Negotiating the agenda

Negotiating the session’s agenda informs the client of what the practitioner has planned for the session. This process allows the client to give their permission to discuss sensitive topics about why they came to see the practitioner. However, it is up to the client to agree or disagree with this agenda. In this instance, the spirit of autonomy and partnership are encompassed as it is crucial to negotiate the agenda in a collaborative manner. If the client feels that they are not ready to discuss a specific issue, the spirit of autonomy takes forefront.

The following extract exemplifies how the negotiating agenda conversation may progress.

Interviewer: I looking forward to hearing about your experiences but before we start I would it be ok if I tell you what I have planned for the session? [asking permission]

Client: Yes, that’s ok.

Interviewer: Good. For our session today, we could start out by briefly talking about why you are here and I will ask you to complete a questionnaire, if that’s ok. Then we will talk a bit more about why you are here and we will explore what imagery is and how it can be helpful. Does that all sound okay to you? Is there anything else you would like to put on the agenda to talk about today?” [collaborating on agenda setting]

Client: Yes that sounds good. I’m happy with that.

Interviewer: I would also like to let you know that you are free to stop this session and if there is anything that makes you feel uncomfortable in today’s session, please let me know. It is your choice what we talk about [reinforcing autonomy]. How does that all sound to you?

Client: I’m happy with that.

Establishing rapport

Even in a very brief session where there is no scope for negotiating an agenda, it is important to begin with open questions that allow the client to talk about what matters most to them. Doing so provides a collaborative context for the interview and acknowledges that the client, not the interviewer, is the expert in their problem and potential solutions. Asking the client why they are seeking help is a good start as it demonstrates a willingness to listen and to try and understand their concerns.

Below are two scenarios, the first using a conventional ‘doctor-patient’ approach and the second taking a client-centred approach. Note that while the second approach might seem less direct, it elicits more information, reveals what the client knows already and what is motivating them, and gets to the point of what help they want more quickly.

Doctor-patient approach

Doctor: Looking at my notes, I see you’ve come to talk about losing weight.

Patient: Yes, that’s right

Doctor: Do you feel you eat healthily?

Patient: Yes

Doctor: Do you take much exercise?

Patient: Not really. I’m not sure what I could do.

Client-centred approach

Interviewer: Can you tell me why you have come here today? [open question]

Client: Last time we met, you said that I was at risk of developing diabetes and that has been worrying me. I’d like to try and lose some weight.

Interviewer: You’d feel happier if you could lose weight [reflecting back their concerns]. What have you been thinking about doing? [open question]

Client: Well, I’ve started eating more healthily but I really need some advice on exercising.