Monday, August 3, 2015

Motivational Interviewing Part II

This is part two in a series regarding Motivational Interviewing.  The goal of Motivational Interviewing (MI) is to increase client awareness and decrease ambivalence or resistance towards change.  For those in private practice, you may already be aware of how important your relationship is with a client.
Please note that a lot 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.

Case Western Reserve University’s Center for Evidenced-Based Practices (CEBP) is a resource for MI and focuses on practitioner’s changing their service approach and culture towards MI.  These benefits include positive outcomes and client engagement/ retention. 
The focus of this post builds on avoiding and dealing with client resistance.  This link focuses on OARS (open ended questions, affirmations, and reflections) and the other acronym DARN CAT (which will be the subject of part three). 

·         Open ended questions allow your client to reflect on why they’re seeing you or allows them to open up.
o   You may want to ask, “What food or part of your diet holds you back?” to a client that isn’t showing weight loss.
o   “What do you want to do next?” if a client seems ambivalent.
·         Affirmations show the client that you care and take notice.
o   “I’m glad you shared your struggles with the meal plan we developed, what changes are doable for your schedule right now?”
·         Reflections can repeat what a client says or reflect feelings to help put them in perspective. 
o   Client statement: “That box of candy I keep in my desk helps me deal with my boss when she’s in a bad mood.”
o   Simple reflection: “You eat to cope with work stress.”
·         Summary Statements link themes and client comments together.
o   “You have expressed concern with work and have a demanding boss, these are stressful situations.”

These are basic steps to reframe a client’s situation, it combined environmental stressors that contribute to a habit that we may seem as unhealthy but the client may seem as a coping mechanism.  OARs questions and MI is challenging to implement initially but having a few open ended questions to sprinkle into a session with a client is a first step to improving your practice. 
What challenges have you seen on a daily or weekly basis?  Have you used Motivational Interviewing?  What struggles do you have with implementing it?