Page 123 - Nutrition Counseling and Education Skills: A Guide for Professionals

the counselor is listening and trying to understand. One should not repeat every phrase as it can have a parrot-
like effect. Active listening, reflecting, and paraphrasing are useful. It is important to understand the client
and the client’s world and determine what the client thinks is important.

If the counselor has these characteristics and attitudes and is able to communicate them to the client, then a
relationship develops that is experienced by the client as safe, secure, free from threat, and supportive. The
counselor is perceived as dependable, trustworthy, and consistent.

This outcome requires being a good listener, having intuition, providing feedback on both data and
feelings, and providing inspiration.6 It is the type of relationship that supports behavioral change, whether one
is working with clients or with staff.

In a client-centered approach, practitioners ask questions and listen carefully to understand the person’s
viewpoint within the context of their daily lives. It involves supporting the person’s ability to self-manage his
or her own medical problem or condition emphasizing problem solving, goal setting, and increasing self-
efficacy.

Motivational Interviewing

William Miller first described Motivational Interviewing (MI) in 1983 after treating problem drinkers. MI
has been described as “Carl Rogers in new clothes” since some of the techniques are rooted in Rogers’
approaches.5 MI has been defined as a “directive, client-centered counseling style for eliciting behavior change
by helping clients to explore and resolve ambivalence.”6 It is a person-centered method of guiding to evoke
and strengthen a person’s motivation and commitment to change.7

MI was originally developed from work with addictive behaviors, but the intervention has been used also in
a variety of healthcare behaviors.5 After three decades of research and clinical trials, results have been
published for a variety of health problems including diabetes, heart disease, dietary change, and exercise.
Studies have shown its effectiveness in weight loss, reducing blood pressure, reducing blood cholesterol, and
other medical problems.8,9 MI is being practiced with a range of cultural groups, and books about MI have
been translated into at least 22 languages.7 Two recent books have applied MI to diabetes care and to MI in
nutrition and fitness.10,11

Ambivalence

Ambivalence about change is normal and people experience it regularly.10 Ambivalence is the existence of
mutually conflicting feelings about thoughts or ideas, such as “I’d like to lose weight, but I enjoy eating.”9 MI
is a counseling style for addressing the ambivalence about change.7 It has person-centered elements, such as
empathy, an egalitarian relationship with a guiding style, and person-centered techniques, such as key
questions, reflective listening, shared decision-making, and eliciting change talk.12

People may have mixed feelings and an inability to select between two or more actions. There are reasons to
change a behavior as well as reasons not to. MI is different in using a collaborative, person-centered
communication style and in providing a method and process of moving people toward behavior change and
incorporating goals for change. The approach is designed to help people build a commitment and reach a
decision to change. The counselor elicits the clients’ own motivations for making a change in the interest of
their health.

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