Motivational Interviewing

Think back to the last time you wanted to change a habit. Maybe you felt like you should wake up earlier during the week, or lose five pounds, or call your mother more often. What stopped you from doing it? A lot of the time the answer is ambivalence: the inability to successfully take action due to conflicting or contradictory feelings about a certain topic. While waking up an hour earlier would give you time to go to the gym, it might also mean that you have to sacrifice your hour of TV time the night before. Calling your mother would make her happy, but then she would ask you again why you’re not married. Losing five pounds might make your jeans fit better, but chocolate is delicious.

As a registered dietitian nutritionist (RDN), I would say that at least half of my job is helping people overcome ambivalence. Most of my clients know that they should eat more vegetables, drink more water, and cut back on sugar. So how do we help motivate people to successfully make beneficial changes for their health? One effective counseling strategy is called motivational interviewing.

The guiding principle of motivational interviewing is that motivation to make a behavior change should come from internal drive rather than external pressure. The purpose of this technique is to create a collaborative relationship and guide the client into coming up with his or her own goals for health that are realistic, attainable, and sustainable.

When I use motivational interviewing in a counseling session, I start out by building rapport with my client. I introduce myself, explain the purpose for the visit, and give an outline of what he or she can expect from the session. An important part of this process is emphasizing that the client will direct the meeting. Rather than saying: “My name is Zoë, and I’m here to give you some nutritional tips for managing your diabetes,” I might say: “My name is Zoë, and I’m here to find out what your goals are for your own health.” These subtle shifts in language help empower the client to start thinking about nutrition and health in his own way.

The initial goal of a motivational interviewing session is to elicit “change talk.” A mother might say: “I’ve been noticing myself gaining weight recently and it’s making it harder for me to go outside and play with my kids.” This indicates that she is in the contemplation stage of change, but still has some ambivalence that is holding her back from moving into the preparation stage and setting a solid goal. Once a client begins to use this type of language, I can use certain strategies to help break through that ambivalence. These include (but are not limited to):

Affirmations: Recognizing a client’s character strength: “You are committed to controlling your blood sugar so that you can have more energy throughout the day.”

Reflections: Paraphrasing what the client says in a way that reflects underlying meaning: “You want to find a way to cut back on red meat because you’re worried about the effect that too much saturated fat might have on your heart.”

Summaries: Providing brief synopses throughout the counseling session of what has been discussed so far to ensure that the counselor and client are on the same page: “So far, we’ve established that you want to aim to take a daily thirty-minute walk and eat ice cream after dinner twice a week instead of every day.”

Affirmations, reflections, and summaries help to keep the conversation moving and focused on the client’s thoughts and feelings. At the end of the session, I will ideally have helped the client determine what is important to him regarding nutrition and health and set at least one concrete goal.

Motivational interviewing is one of several behavior change strategies that focuses on partnership, empathy, acceptance, and compassion. I like it because it emphasizes clients’ individuality and allows them to take charge of their own health. It also fosters self-efficacy, which is an individual’s belief in their own ability to be successful. This is an essential element of behavior change; personally, I’ve only been able to effectively make a change when I think positively about my power to do so. Although motivational interviewing is traditionally a technique used in a dual relationship between counselor and client, it has elements that you can use for personal reflection and goal-setting in your own life. Next time you have a health-related habit that you want to change, try to explore areas in which you might have ambivalence. Sometimes just taking the time to figure out where your resistance is coming from is enough to get the ball rolling to set and meet achievable goals.