Nutritional Counseling isn’t easy. It can seem like a tug of war or you feel
like someone’s mother “eat your vegetables” on repeat. One challenging aspect is knowing exactly
what the client needs (perhaps a daily Frappucino habit is not helping their
blood sugar control or weight issues) but the client not perceiving that as the
problem.
Please note that a significant amount of this information
comes from chemical dependency and substance abuse counselors and researchers
but can be effectively applied to many areas of practice. These are examples and considerations for
dietetic practitioners meant to help with any challenging clients you
face.
The following definition and bullet points come from Case Western Reserve’s
Center for Evidenced-Based Practices (CEBP).
Motivational
Interviewing (MI) is an evidence-based treatment that addresses ambivalence to
change.
•Discover their own interest in considering and/or making a
change in their life (e.g., diet, exercise, managing symptoms of physical or
mental illness, reducing and eliminating the use of alcohol, tobacco, and other
drugs)
•Express in their own words their desire for change (i.e.,
"change-talk")
•Examine their ambivalence about the change
•Plan for and begin the process of change
•Elicit and strengthen change-talk
•Enhance their confidence in taking action and noticing that
even small, incremental changes are important
•Strengthen their commitment to change
MI is challenging but successful for counseling based
practitioners. On the practitioner side,
it can be a challenging to focus on listening to the client versus constantly
“fixing the problem.” This post will focus on the core principles of MI (as
adapted from Case Western):
·
Expressing empathy
·
Rolling with the client’s resistance to change
·
Developing discrepancy
·
Supporting self-efficacy
Going back to the Frapuccino example, from a client centered
approach, one needs to look at the real reason why they’re going daily. The client can say they have no time to make
breakfast, they may want a treat, or this might just be a habit. Once they’ve identified the barrier they may
want to change it or they might want to “fix” another area of their diet for
example (maybe this client is more willing to cut out a bi-weekly happy hour or
quit snacking after work). Another goal
of the practitioner may be to support the client in self-efficacy as in an “I
can do this” mentality. Changing
diet/lifestyle is challenging for anyone but adding compassion and support to
allow the client to “sort this out” allows for the client to find solutions to
their own problems and develop a better relationship with their practitioner.
Extra Credit Reading
Training Dietitians in Motivational Interviewing: A Pilot
Study of the Effects on Dietitian and Patient Behaviour: http://www.mitrip.org/ojs/index.php/mitrip/article/view/55
Motivational Interviewing in Primary Care Reduces Obesity: http://www.medscape.com/viewarticle/842242
Have you heard of or utilized motivational interviewing in
your practice? Share or comment below.
