Hey there dietitians, let me ask you this: is motivational interviewing the missing tool in your nutrition toolbox? Here is a clue the answer is a definite yes:
Do you ever wonder why some clients seem to be ready to take clear and consistent actions while others wallow in doubt and lack confidence? Even if their backgrounds and circumstances are similar – and the nutrition counseling that you provide can be similar – your client’s persistence and readiness to change can be remarkably different.
Even though you are a nutrition expert, maybe you’re not asking the right questions or connecting with your client in an effective way. Motivational Interviewing can help!
Motivational Interviewing offers you the skills and strategies to gain access to your client’s inner thought processes and to better understand what makes them tick. Motivational interviewing also allows nutrition professionals just like you to change client meetings from something that can feel like pulling teeth into a meeting that feels purposeful and productive.
As dietitians, we are in this field because we want to motivate our clients to lead healthier lives and to feel empowered about their nutrition. But as we have learned from personal experience, just being excited about a strategy or knowing the possible negative outcomes is not enough to connect with clients and effect change.
In this article, learn what Motivational Interviewing is, the research supporting its use as well as hear from your peers who use motivational interviewing in their practice. You’ll have the knowledge to get started with motivational interviewing in your practice and see RD2RD tools that you can start using today.
Let’s dive in!
Disclosure: This article contains affiliate links. As an affiliate, RD2RD earns a commission on qualifying purchases at no cost to you.
What is motivational interviewing?
One of the most powerful tools in the dietitian’s toolbox is motivational interviewing (MI). The Motivational Interviewing (MI) technique is an effective and influential tool for behavior change. It can be used to improve nutrition counseling sessions by helping patients set goals and providing them with the skills to meet their needs. This technique can be used to spark behavior change, igniting your clients’ desire to make healthier food choices and improve their nutrition habits.
Motivational interviewing is a collaborative, solution-focused approach to helping your clients achieve their health goals. It’s based on the belief that everyone has his or her own reasons for doing what they do and change comes from within—the client needs to want to make changes before any real progress can be made towards behavior modification.
Motivational interviewing is an approach that emphasizes client self-determination and autonomy. The dietitian’s job is not to tell clients what they should do or force them into doing anything; rather, it’s about asking open-ended questions that help build rapport between the client and therapist while empowering the patient to take control of his or her own life.
“In general, I find that it is hard to go wrong when you are following the principles of motivational interviewing. My big don’t for motivational interviewing is don’t skip to the planning phase of the counseling session. As healthcare professionals, we see a problem, and we want to help fix it. This can result in us jumping straight into teaching new skills or helping our clients brainstorm ways to change, thereby missing the motivational part of motivational interviewing. Build up the reasons and confidence to change first, and then the plan will follow.”
Motivational interviewing uses different techniques than traditional nutrition counseling that you may have learned in school and practiced in the field, where you’re the educator and your client is the student.
Motivational interviewing is a client-centered approach that uses open-ended questions to understand what your clients’ goals are and how they feel about them. Motivational interviewing also encourages you to communicate with empathy, avoid arguments, and focus on the present moment in order to guide your clients towards their own answers.
Motivational Interviewing was developed in the 1980s in the psychology field and has since been used to affect health behavior change for clients with everything from mental health challenges, addiction, diabetes, and weight loss (1).
Benefits of motivational interviewing
Motivational interviewing has the strong potential to benefit both you and your client.
Motivational interviewing is more than just a technique; it’s an approach that focuses on the individual’s needs and goals. Motivating someone to make changes can be challenging, but you will find this method helpful when facing some common challenges in your practice, such as:
- Increased trust between you and your client
- Better adherence to behavior goals (2)
- Weight loss that lasts (3)
- Clients feeling more empowered and in control of their lives and their health
Are you ready to build your foundation of understanding about MI? Let’s first cover what the spirit of MI is.
The “spirit” of motivational interviewing
You may be wondering…what do you mean, the “spirit” of Motivational Interviewing. The spirit of MI has to do with how you approach your counseling session and where your mindset is as a nutrition professional (4).
There are four spirits of motivational interviewing. Let’s explain what each one is, individually.
Collaboration or Partnership
The first spirit of MI is Collaboration or Partnership.
Motivational interviewing is a collaborative process between the client and clinician. Motivating your clients will require an equal partnership or collaboration of efforts to help them achieve their goals.
Rather than approaching your client as though you’re the expert in your patient’s life and there to provide education that they take in passively, collaboration says that while you’re the nutrition expert, your client is the expert in their own life. Together, you’ll create a plan that feels realistic and motivating for your client to make behavior changes.
Don’t you just love it when your boss is, well, super bossy to you? Probably not! And the truth is: your clients don’t like to feel bossed around, either.
The second spirit of MI is Evocation. Motivational Interviewing is about evoking change, not imposing it. Motivational Interviewing will help you elicit change from your clients by allowing them to explore their own motivations and decisions related to changing behavior.
The third spirit of MI is acceptance. This is about confirming your client’s own perspective of their life, their goals, and their ability to get there.
Acceptance in MI refers to the process of accepting the client where they are at in their readiness to change. Motivational interviewing seeks out opportunities for acceptance when you find them and encourages your clients through empathy, understanding, and validation.
The fourth spirit of MI is Compassion. Compassion refers to your ability as a dietitian to hold your client’s hand through the journey of change. Motivational interviewing allows you to feel compassion for the struggles that they are facing and validate their feelings while at the same time encouraging them forward towards goals.
Now that we’ve covered the four spirits of motivational interviewing, our next step as dietitians is to learn the four principles. After that: we’ll begin learning how to put these tools into practice, so keep reading!
The four principles
To better understand motivational interviewing and how to best use this tool as a dietitian, the next thing to understand are the four principles of Motivational Interviewing (5).
The first principle is to Express Empathy. Empathy refers to your ability as a dietitian to understand where the client is coming from. You need to let them know that you hear what they are saying and acknowledge their thoughts, feelings, and behaviors without judgment.
Approach each session free of preconceived notions or judgment.
Empathy helps you and your client to feel that your work together is collaborative and that you’re a trustworthy practitioner to work with.
Expressing empathy might sound like this:
“That sounds really challenging.”
“You’re stuck in a tricky situation here and I see why you feel…”
Just like you want your clients to be actively listening to you, your clients want the same from you. Expressing empathy shows your clients that you’re engaged and listening.
The next step is to Develop Discrepancy.
Motivational interviewing emphasizes the future and what is possible. Discrepancy helps shift your client forward by focusing on their goals instead of dwelling on where they are stuck now.
Discrepancy helps your client to be able to see the impact of their current behaviors and the benefits of behavior change.
Developing discrepancy might sounds like:
“What are some of the good things about [insert current behavior]? And, on the flipside, what are some of the less good things about [insert current behavior]? What are some of the potential benefits of [future behavior]?”
It is normal and expected for change to feel scary and hard. Rolling with resistance is our next step and covers how to support your nutrition clients through their fears and concerns.
Roll with Resistance
What doesn’t work in MI? Coming across as aggressive or attacking behaviors that are not working for your client. This puts them in defensive mode.
Instead, Roll with Resistance. This means acknowledging their feelings and thoughts without judging them, which allows your client the room they need to make their own decisions. Resistance means that the change is feeling overwhelming, scary, or impossible; the client may or may not be able to explain why they feel this way.
Rolling with resistance might sound like:
“It sounds like you didn’t like that suggestion.”
“You seem to feel hopeless about…”
“On the one hand you want ____, but on the other hand, you don’t think you can ___.”
The fourth and final principle of motivational interviewing is Support Self-Efficacy. This is about supporting your client’s abilities and skills to make the changes they want.
Motivational interviewing helps clients find their own answers for change by making them part of the experience, instead of telling or pushing them into it. Remember: while you are the nutrition expert, your client is the expert of their own life.
“Motivational interviewing is a wonderful tool to have in my toolkit as a nutrition professional. However, it isn’t a skill that can be developed overnight. My biggest tip to mastering motivational interviewing is to practice, even if it is in everyday conversations. Try taking a typical question that you might ask someone and turn it into an open-ended question.
Supporting self-efficacy might sound like this:
“I’m glad to see that even though last week you felt like you encountered some setbacks, you have developed a good plan of action for this week.”
“It sounds like you are still struggling with these changes. What seems to be getting in the way?”
Now that we know what the spirits of MI are, as well as the guiding principles, it is time to begin taking action and using these new tools in your practice. This next section shows us how.
Practice motivational interviewing with nutrition clients with OARS
Ready to put motivational interviewing into your nutrition practice? There are four main sections to implementing Motivational Interviewing; they use OARS as the acronym: this stands for “Open-Ended Questions,” “Affirmations,” “Reflections,” and “Summaries.”
Best way to understand what your client is thinking? Get them to talk.
“I have found MI has been such a great tool to help me to stop doing all the talking so that I can learn more about my client’s experience. My favorite question: “can you tell me more about that?”
The best questions for motivational interviewing are open-ended questions.
Open-ended questions need more than a yes or no answer and require more thought to answer. This is in contrast to close-ended questions which are passive and can be answered without much thought, such as, “how old are you” and “what medications do you take?” Open-ended questions engage your client’s brain and encourage them to think before speaking.
“What you would like to do for your health in the next week or two?”
“I’m wondering what you’d like to change about your morning routine.”
“What else can you share about that?”
“Let’s talk about…”
“How can you implement that this week?”
“How did that/does that affect you?”
Get your clients to share constructive information and build rapport with the right questions. As they speak, use affirmations.
Affirmations are statements that let the client know you’re listening to what they say and understand their feelings even if you don’t agree with those thoughts or feelings. The point of an affirmation is not to solve their problems. When you affirm your clients, it helps them feel heard and understood.
“Thank you for coming in today.”
“That was a useful step that you took.”
“I would find that difficult, too.”
Reflections are important as well, and they’re a bit different from affirmations.
Reflecting is simply repeating back what the client was just saying in their own words while adding a little bit of your perspective.
For example, your client says “I’m always hungry.” You say “So it seems like no matter how much you eat, you’re always hungry.”
Reflections show your client that you’re listening and actively participating in the conversation and are able to collaborate. It also ensures that you have an accurate take on the information that has been discussed in the session before.
“Change is hard. Often clients considering change grapple with what they have to give up in order to get the thing that they want. For example, if a client expresses resistance to taking a morning walk – it does the process well to ask them: “why do you want to walk like this in the first place?”
Even if you know the answer already, ask “why.” The answer to this question is a signpost telling the client stuck in resistance where to go next!
Summarizing the client’s words will either reaffirm their commitment to generating a next step or, the client will realize the new behavior in question is not one that they really want to pursue after all! Both outcomes are useful, as the client feels motivated to find and follow through on a behavior that improves their lives.”
Reflections are also an opportunity to assess your client’s readiness for change, based on how they’re describing their own circumstances. This is known as change talk.
A client who says “I have started an exercise program, and things are going well” believes in their own ability to change and sustain these new habits more than someone who says “I’m enjoying the exercising program right now, but I know I will go back to my old ways once the cold weather comes.”
Summaries are also an important part of using motivational interviewing to collaborate and make more progress with your clients. Summaries are brief, concise statements that summarize what the client has said without adding too many of your own personal opinions.
The client states “I eat when I’m stressed.” You say “So you are eating to deal with stress?” Hitting on this statement is a great way to start off an exploration into their motivation for changing.
Examples of motivational interviewing conversations
What makes learning a new topic simpler? Examples! In this section, Amy Helms – a dually licensed registered dietitian and therapist – has offered several examples of motivational interviewing conversations.
Conversation 1: Exploring Resistance
Client: “I have a good week but then I mess it up. I feel like this is pointless.”
Dietitian: “I hear you say that you are frustrated, and I also hear that you are experiencing some wins. What wins did you experience this week?”
Rationale: The word “but” negates the client’s preceding words. We can see the client may be stuck. By acknowledging the contrasting statements and splitting them with the use of “and” we create room to shift from resistance toward acknowledging ambivalence. Secondly, this shifts the tune of the session. Lastly, we are using an open-ended question.
Conversation 2: Affirming and evoking change talk
Client: “Well, I really wanted to binge on Thursday. I went down to the study room like we talked about until the urge passed. I felt really good about it. Then everything went downhill over the weekend.”
Dietitian: “It sounds like you were proud of accomplishing a goal we set, and you had a couple challenging days. Let’s look at what happened on both days to see what we can learn from them.”
Rationale: Motivational Interviewing assumes that failing to address barriers to success can lead to treatment failure. When we pursue a greater understanding of barriers with curiosity and not assumptions, we enhance the therapeutic alliance and enable the client to build a greater understanding of themselves and the problem.
Conversation 3: Keeping the client engaged
Client: “I had an exam on Thursday. I was motivated to study. Everyone was going out on Friday night. I did not go out. It’s just hard sometimes.”
Dietitian: “It sounds like it is more challenging when you are alone. It makes sense that you would cope in the way that has served you over the years. We may need to explore different skills to use over the weekend. You said you felt good about resisting the urge on Thursday. What do you think can help you over the weekend when you do not have assignments?”
Rationale: Directive language can be more harmful than helpful. It can be tempting to offer advice. We want to keep the client actively engaged in the conversation. In this scenario, we elicit a response using what the client already knows. If the client is unable to provide an answer, a follow-up could be “A few options could be” or “what about” or “you might want to consider.
If you found this guidance to be helpful as we did, you’re going to want to check out Amy’s comprehensive Counseling Skills for Dietitians Course, approved for 16 CEUs. This course includes an overview of evidence-based counseling/therapeutic models, trauma-informed care as well as the neurobiology behind behavior change.
Next up? A few quick do’s and don’ts.
Do’s and Don’ts
A few final tips for using motivational interviewing in your nutrition counseling sessions.
- Do make space for your client’s concerns and fears
- Do spend more time investigating your client’s “whys” before delving into the “hows”
- Do collaborate
- Don’t pressure
- Do praise efforts
- Don’t use scare tactics
Notes from the field
With practice, Motivational Interviewing has the potential to make your client sessions more productive, more effective, and even more fun. As a dietitian, you want to help your clients. Motivational Interviewing empowers your client to be their own best change agent.
“It is amazing to see the impact of motivational interviewing among my clients and members. When done correctly, motivational interviewing piques my client’s interest in making healthy choices by exploring their important reasons to change. Clients typically already know what they “should” be doing regarding their health, but there are many reasons why they maintain their status quo.
Motivational interviewing helps get to the “why,” which, to put it simply, increases the client’s chances of making meaningful changes.”
“Motivational Interviewing enables us to help clients achieve their goals by supporting them through the process of recognising their individual personal goals, supporting them in identifying appropriate ways to achieve them and further supporting them to review, modify and achieve those goals. It allows for the control to remain with the client, which is massively important for long term maintenance of their achievements.
Motivational Interviewing allows for a more collaborative, supportive, and ultimately more effective relationship with clients.”
Favorite motivational interviewing tools and resources
Ready to get started? RD2RD has curated tools and resources for you to bolster your MI progress in each nutrition counseling session. They are created by your peers and available for you to purchase and start using today.
First stop? Download this complimentary Motivational Interviewing Cheat Sheet with a list of change words to look out for as well as a comprehensive list of questions to use in your counseling sessions.
Here are a few other favorites:
- Complete Guide to Motivational Interviewing: Dietitian Workbook + Client Education
- Exploring Motivation Worksheet
- Motivational Interviewing – Using the Stages of Change
- Taking Motivational Interviewing to the Next Level
- Video Lesson, How Motivational Interviewing Works with Intuitive Eating
Key takeaways: Motivational Interviewing
Motivational interviewing is the counseling strategy that keeps your sessions client-centered.
Your client is the expert in their own life.
Together, you collaborate to find the best path for them to create lasting behavior changes. By asking open-ended questions, reflecting on what you heard, and summarizing the conversation, your nutrition clients feel seen and understood.
Collaboration leads to powerful changes.