Page 133 - Nutrition Counseling and Education Skills: A Guide for Professionals

has helped others. Then I would like to hear your response and thoughts.” One tries to find the client’s
strengths rather than just weaknesses and elicit motivation for change.

SELF-ASSESSMENT 1

Which of the following client statements represent “change talk?”

1. I guess you will tell me what to do.
2. I want to lose weight to feel better.
3. The doctor says my blood pressure is too high and to eat less salt.
4. I can start eating a small breakfast.

Elicit–Provide–Elicit
MI is described as having an “‘elicit–provide–elicit” framework.6,15 The counselor “elicits” or draws out what
the person needs or wants to know or do. One “provides” information in a neutral manner when the client has
given permission. One “elicits” what the client thinks about the provided information and what it means to
him or her by asking “What does this mean to you?” This emphasizes the client’s active involvement and may
enhance motivation for change.6 In this way, the counselor guides the client toward motivation to change by
asking open-ended questions and listening to the client. Once the client is motivated to change, behavioral or
cognitive counseling strategies discussed in other chapters may be useful.

Eliciting questions may include: “What would you like to know about . . .?” which tells the counselor what
is important or of concern to the client.13 A second approach: “What do you already know about . . .?” has the
advantage of saving time and avoids discussing what the person already knows. The counselor learns about the
client’s experience.

Change
What to change? The client may have mentioned more than one possibility or option for change. If so, one
guides the person in examining and determining which alternative to select as it is important for the client to
select the one where success is most likely. For example: “With your limited time, which of the two changes
do you want to start with?”

Why change? The counselor can expect that the client sees pros and cons of change. It is advisable to ask
the client to express both the pros and the cons. If the practitioner has an additional behavioral change goal in
mind, one may inquire whether the client would like to hear it. For example: “What do you see as the reasons
to change your food intake now as opposed to waiting until you finish the major project at work?” The
counselor may summarize the pros and cons in the client’s words to see whether this is the best change to try
first, but focus especially on the pros.

The concept of the “importance” of the change to the person and of the “confidence” in the ability to make
the change are important determinants of readiness to change.6,17 One may assess readiness for change by
asking two questions: How important is the change to you? And how successful do you think you will be
regarding the change? Box 6-3 provides a series of questions to use in assessing these two areas with clients.6

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