Page 124 - Nutrition Counseling and Education Skills: A Guide for Professionals

Chances are that clients already know that eating healthier and exercising more promote positive health,
but they are enjoying the status quo (a sedentary lifestyle, lack of exercise, and eating the wrong foods) and
think of reasons not to change. Once people become unstuck from the conflicting motivations of whether or
not to change that immobilize them, they can move toward a decision and a commitment to take action. MI
helps to resolve the ambivalence and move them toward change.

MI is recognized as an effective approach in Diabetes Self-Management Education.13 It may be especially
useful along with other evidence-based methods when ambivalence or lack of motivation is the main obstacle
to behavior change. These would be people in the precontemplation and contemplation Stages of Change
discussed in Chapter 5. The approach can be integrated into Prochaska’s Stages of Change Model in which
people move from being unaware or unwilling to do anything about a health problem, called precontemplation,
to considering the possibility of change or contemplation.5 In later stages, people prepare to make a change, or
determine to finally take action.

CASE ANALYSIS 1

What would you say to Robin to initiate the conversation?

MI seeks to overcome ambivalence and evoke the client’s own motivation for change. It promotes the
client’s readiness to change or to try various courses of action. The client elaborates and the counselor uses
reflective listening to mirror back what the client has said. Rollnick and colleagues consider MI a form of
guiding rather than giving advice and directing. They suggest that all consultations be based on a guiding style
even if full MI is not done.6

In a nonthreatening atmosphere, the nutrition and dietetics counselor may explore with clients their
ambivalence and have them, not the counselor, voice the reasons for making a change. This approach is also
useful in follow-up visits with clients.

Spirit of Motivational Interviewing

As in client-centered therapy, the counselor’s style or approach is a central factor in MI. The motivational
approach draws on empathic, client-centered counseling that guides rather than directs and does not offer
advice. MI has a special character or spirit represented by specific counselor behaviors. The guiding
philosophy is not unique to MI and the elements may be found in other approaches. The three components
are: (1) partnership, (2) evocation, and (3) honoring client autonomy.7

Partnership
MI is a partnership. The relationship is not one in which a passive client is given advice and information by
the counselor. It is not something done to a person. MI is done “for” and “with” a person as an active
collaboration, recognizing that the client is the expert on his or her environment and life situation although
the counselor has specific expertise.

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