Monday, July 6, 2015

Motivational Interviewing Basics Part I

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:
Motivational Interviewing in Primary Care Reduces Obesity:

Have you heard of or utilized motivational interviewing in your practice? Share or comment below.