Page 127 - Nutrition Counseling and Education Skills: A Guide for Professionals

client talks. The purpose is to have the client continue to explore the problem. Reflective listening is a skill
which requires practice.7

CASE ANALYSIS 2

Using reflective listening, how would you comment on Robin’s story?

Empower Your Client
Since clients are the ones who have to do the changing, they need to actively engage in the discussion of their
healthcare. Some clients may have tried to change in the past and failed. Yet they have personal resources and
solutions and can change if they decide to do so. Focusing on past successes rather than failures may increase
self-efficacy, the belief that one is capable. The counselor can help clients explore how best to make changes
to benefit their health. If the client asks, mentioning another client’s successes may offer suggestions (See Box
6-1).

Microskills of Motivational Interviewing

Many counseling approaches also use the same interviewing skills that build rapport, explore concerns, and
convey empathy.5 The MI microskills are expressed by the acronym OARS: (1) Open-ended questions; (2)
Affirming; (3) Reflecting; and (4) Summarizing. These help the client explore and resolve ambivalence and
any barriers to behavior change.7,9,10 Training may be needed in developing these skills.

Asking Open-Ended Questions
Open-ended questions are the communication tools to move the conversation along and evoke responses.
They are the information gathering backbone of the session in which the counselor discovers what is
important to the client. Questions should set a nonjudgmental, collaborative tone that can evoke talk about
change. It is helpful to focus first on the person’s life, thoughts, and situation before focusing on the problem
area and especially to reduce resistance, evoke change talk, and build motivation for change. Later, one can
focus on the problem area to develop and implement a plan for change and examine the importance and
commitment of the client.7,8,11

EXAMPLE “What concerns do you have about your health?
“What differences do you think you can try?”
“What will you do first?”
“When will you be able to . . .”

In general, MI counselors answer with one or two reflections for every client answer to a question to be sure
they understand. For example: “What brings you here today?” “So you’re here because of your diabetes,” a
statement, not a question.

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