November 6, 2017
By Kimberly Wolf RD, LDN, CDE, PAND Media Team Member
“How can we better reach our patients and make a meaningful difference in their quality of lives?” This was voiced from one of my Registered Dietitian colleagues at a monthly staff meeting. People suggested ideas in hopes for improvement. Ultimately, we realized that we needed to develop a meaningful skill that can be practiced with all patients. One such skill is Motivational Interviewing (MI). My colleagues and I were fortunate enough to attend a training course led by a MI instructor in order to learn & develop this skill.
“Motivational interviewing is a collaborative conversation to strengthen a person’s own motivation for and commitment to change.” It has been developed over several decades and is backed up with evidence for effectiveness. RDNs have been using this process to help improve clients’ outcomes in one’s health. Molly Kellogg LCSW, CEDRD and owner of a private practice in Philadelphia, has been using MI with her clients for years. She also teaches MI courses to other health professionals nationally. Ms. Kellogg shared, “Motivational interviewing can seem simple and one can learn the basic concepts fairly quickly. Becoming proficient is another thing all together. It takes repeated practice and feedback to attain true compliance.”
There are many steps to implementing MI. Here’s a few of the key techniques in MI. An in-depth course can help further ones knowledge in MI followed by continued honing of skills.
Before starting a client interaction, begin to develop a partnership with your patient. As the dietitian, you are guiding your client to voice change in his own words. There is a technique referred to as OARS that will help facilitate a dialogue with your client. OARS stands for asking open questions, affirming the patients efforts, reflecting statements back, and summarizing change talk.
There are two types of questions, open and closed. Closed-ended questions only yield a Yes or No response. Example: Do you exercise? An open ended question allows a conversation to form. Example: What would your life look like if you were successful in making these changes? This encourages a client to have an active discussion with you. You will typically gain a good deal of information which may help with the clients behavior changes.
Affirmations are important as they allow clients to be heard and appreciated. Choose to affirm a patient’s efforts rather than outcome to support changes. Example: Paul, you are creative in how to add in more fruits and vegetables daily.
Reflection is when an RDN mirrors back to the patient important statements that move toward change. Use this when you hear ambivalence or if a client is talking about change. Example: “You have a very busy schedule” or “it sounds like that was a challenge for you.” Reflection may help clients realize the truth that is within oneself.
Summarize: Gather the main themes from the patient and wrap it up as a statement. It shows the patient that you are listening and support their efforts. Example: I hear that you are concerned about your HgbA1c and how it affects your health. “You want to feel better. You have made some dietary changes. Your plan now is to pack your lunch daily to avoid ordering out with your coworkers. Did I get all of that?” By forming your clients’ change-talk into a summary, it allows them to hear their own words in an action format.
Resistance arises when a client is not ready to make a suggested change. As the RDN, we may expect our patients to implement a health goal, but that does not mean the patient is ready to do so. When this occurs, try promoting choice to the patient and acknowledge their resistance. Example: “Let’s back up. Tell me what is most important to you about your health.”
Evoking Change Talk vs Sustain talk: Dietitians can help clients come up with their own ways to change their behaviors. Evoking change talk is one of the goals in MI. You will be able to hear the positive language and interest in change. Example: “I could walk at lunch to get more steps in my day.” Sustain talk is the opposite when one is not interested in making behavior changes or focuses on the barriers. Example: “I have no time to cook and fast food is easier.”
How can you become more proficient in motivational interviewing as a dietetics professional? Sign up for a CEU workshop or read a MI article. There are several MI publications that are written by RDs and relate specifically to nutrition. These include:
Clifford, Dawn; Curtis, Laura Motivational Interviewing in Nutrition and Fitness. 1st ed. New York, NY: Guildford Press; 2016.
Kellogg, Molly Counseling Tips for Nutrition Therapists: Practice Workbook Series (Vol 1-3). Philadelphia, PA: Kg Press; 2006, 2009, 2014.
Try practicing MI techniques with colleagues and your clients and ask for feedback. You may find it helpful to record yourself using MI then listening back for self-critiquing. Improved confidence and skill come in time by continual learning and practicing motivational interviewing.
Note: original article posted on password protected website for dietitians: https://eatrightpa.org/members/newsletter/become-proficient-motivational-interviewing/