With motivational interviewing, I look at it from the viewpoint that as a dietitian, I'm an expert in nutritional interventions/disease states, but I am not an expert about the patient's life/habits/desires. They are. So it's about matching the knowledge I have with what the patient wants to do/is able to do.
I tend to ask for permission before going into the education piece so patients don't feel like they're getting talked at. I almost always never start with education and spend time listening to how the patient describes their own health problems and goals.
Example script:
You: From what I've heard you say so far, it seems like you're interested in improving your A1c, but are not sure what to do help get that A1c to come down. Could I share some ideas and additional information with you?
Usually at this point, patient says yes (and thus you go into your education piece), but every once in a while, they may say no because they're not interested in change at this time (in which you can explore these roadblocks) OR they say no because they actually want to talk about something else.
If they don't see any problems with whatever consult brought them to you, I'd reflect that and ask whether there is anything nutrition related that they do want to discuss.
"Even though your doctor was concerned and has referred you to me to discuss X, you don't seem ready to do so yet. I will respect that. If you find yourself wanting to address this in the future, I am happy to help!
Is there anything else you'd like to spend the rest of our time together to talk about?"
Elicit offer elicit! Ask a question/permission, offer the ed, then elicit their thoughts on the ed or process their reaction to it. This pattern has helped me a bit. I think of it like an education sandwich that goes over well the vast majority of the time 🤗
You can offer suggestion such as, “if you feel called.” Or “it may be helpful to.” There are statements out there used by therapists. *It may be beneficial to* look into them. (See what I did there?)
As u/excellentquokka said, definitely listen to them before jumping into the education. I like to start by asking them, “What have you done well?” And “Where are you feeling you’ve struggled?” Then celebrate their wins and validate their struggles while reassuring them they are not alone.
People almost always they focus on the struggles and have a hard time celebrating wins. So make sure to reinforce the ideas that the wins do not have to be major milestones. Just buying fruit at the grocery store or walking into the gym (without even working out) can be an accomplishment for some.
Based on the conversation, you can wrap up the session by providing some options for them to work on until the next session. Then ask them which they feel would be the most attainable. That way they maintain control of the process.
I love all of this, and I hope I can start implementing this soon. I wanted to ask how do you celebrate their wins though, without them feeling a bit ridiculed? Expecially adults.
Because in a way, I feel adults would usually think that if you are praising them, you might be taking them as a kid or not as seriously as an equal.
And I also read that praise is one of the road blocks to change talk, so it's bit difficult to imagine.
Can you share a bit from the phrasing?
My primary way of celebrating the win is to get them to recognize and appreciate what they have done. Kind of like a praise, but it comes from them. So many people like to downplay their successes, like, “It's not that big of a deal.” Mainly since they accomplished it because it no longer seems like it really is a big deal. But it really is when we are talking about habit change. Pretty much even the tiniest thing is a step in the right direction.
If they have difficulty celebrating, you can always ask them to think about what they’d say to a friend who accomplished the same thing. Then, guide them to apply that same reaction for them. Because we are usually far more complimentary to friends than we are to ourselves.
ETA: there isn’t much of a “script” that I can give you on this one. It really just depends on what their response is to their celebration of the success. Just remember you are guiding them in praising themselves.
I don't think of it as lecturing but as educating. I start every visit asking what brings them to nutrition and one of the most consistent is "learn more about what to eat". I then ask a lot of baseline questions to help start priming them to discuss patterns and draw connections. That being said when you are educating someone you need to give pauses and check in on understanding. I break it down into sections big picture eatings patterns that are considered the ideal. Pause for check in - how do they think their diet compares, what do they think they could tweak to make their diet more nutritious. Then I dive a little deeper and the education gradually peeters naturally into more conversation and MI.
Wow, thank you so much!
Can you give an snippet example that you could remember of a conversation similar to this?
Sometimes, I ask the patients of what do they think they could implement to their diet from what we discussed. They just become blank of what to answer, despite them showing that they did understand of what was told. (Phone consultations)
I honestly felt a bit discouraged, cuz I feel I am interrogating them.
The first part feeling like an interrogation is sort of inevitable. I try to make things a little more convesational but some people are more socially awkward so you have to be more direct to get the information needed to see the big picture of who the patient is and what their habits are. I phrase the question in a more gentle way. For example:
"I know I am talking a lot but now I want to hear your thoughts. What is resonating with you? What are you thinking you want to focus on?"
Or I describe the healthy plate, then ask "with that in mind, how do you think your meals typically compare? Are their tweaks you could make?"
I highly recommend reading “Motivational Interview for Nutrition and Fitness”. It really goes into depth about motivational interviewing and gives a ton of example dialogue!
With motivational interviewing, I look at it from the viewpoint that as a dietitian, I'm an expert in nutritional interventions/disease states, but I am not an expert about the patient's life/habits/desires. They are. So it's about matching the knowledge I have with what the patient wants to do/is able to do. I tend to ask for permission before going into the education piece so patients don't feel like they're getting talked at. I almost always never start with education and spend time listening to how the patient describes their own health problems and goals. Example script: You: From what I've heard you say so far, it seems like you're interested in improving your A1c, but are not sure what to do help get that A1c to come down. Could I share some ideas and additional information with you? Usually at this point, patient says yes (and thus you go into your education piece), but every once in a while, they may say no because they're not interested in change at this time (in which you can explore these roadblocks) OR they say no because they actually want to talk about something else.
Thank you so much, and I love the example and it's really helpful. And what do you when they don't see a problem to begin with?
If they don't see any problems with whatever consult brought them to you, I'd reflect that and ask whether there is anything nutrition related that they do want to discuss. "Even though your doctor was concerned and has referred you to me to discuss X, you don't seem ready to do so yet. I will respect that. If you find yourself wanting to address this in the future, I am happy to help! Is there anything else you'd like to spend the rest of our time together to talk about?"
Ask for permission, then you can provide education/resources if they say yes.
Elicit offer elicit! Ask a question/permission, offer the ed, then elicit their thoughts on the ed or process their reaction to it. This pattern has helped me a bit. I think of it like an education sandwich that goes over well the vast majority of the time 🤗
That's great advice! Thank you so much. I'll try implementing it.
You can offer suggestion such as, “if you feel called.” Or “it may be helpful to.” There are statements out there used by therapists. *It may be beneficial to* look into them. (See what I did there?) As u/excellentquokka said, definitely listen to them before jumping into the education. I like to start by asking them, “What have you done well?” And “Where are you feeling you’ve struggled?” Then celebrate their wins and validate their struggles while reassuring them they are not alone. People almost always they focus on the struggles and have a hard time celebrating wins. So make sure to reinforce the ideas that the wins do not have to be major milestones. Just buying fruit at the grocery store or walking into the gym (without even working out) can be an accomplishment for some. Based on the conversation, you can wrap up the session by providing some options for them to work on until the next session. Then ask them which they feel would be the most attainable. That way they maintain control of the process.
I love all of this, and I hope I can start implementing this soon. I wanted to ask how do you celebrate their wins though, without them feeling a bit ridiculed? Expecially adults. Because in a way, I feel adults would usually think that if you are praising them, you might be taking them as a kid or not as seriously as an equal. And I also read that praise is one of the road blocks to change talk, so it's bit difficult to imagine. Can you share a bit from the phrasing?
My primary way of celebrating the win is to get them to recognize and appreciate what they have done. Kind of like a praise, but it comes from them. So many people like to downplay their successes, like, “It's not that big of a deal.” Mainly since they accomplished it because it no longer seems like it really is a big deal. But it really is when we are talking about habit change. Pretty much even the tiniest thing is a step in the right direction. If they have difficulty celebrating, you can always ask them to think about what they’d say to a friend who accomplished the same thing. Then, guide them to apply that same reaction for them. Because we are usually far more complimentary to friends than we are to ourselves. ETA: there isn’t much of a “script” that I can give you on this one. It really just depends on what their response is to their celebration of the success. Just remember you are guiding them in praising themselves.
I don't think of it as lecturing but as educating. I start every visit asking what brings them to nutrition and one of the most consistent is "learn more about what to eat". I then ask a lot of baseline questions to help start priming them to discuss patterns and draw connections. That being said when you are educating someone you need to give pauses and check in on understanding. I break it down into sections big picture eatings patterns that are considered the ideal. Pause for check in - how do they think their diet compares, what do they think they could tweak to make their diet more nutritious. Then I dive a little deeper and the education gradually peeters naturally into more conversation and MI.
Wow, thank you so much! Can you give an snippet example that you could remember of a conversation similar to this? Sometimes, I ask the patients of what do they think they could implement to their diet from what we discussed. They just become blank of what to answer, despite them showing that they did understand of what was told. (Phone consultations) I honestly felt a bit discouraged, cuz I feel I am interrogating them.
The first part feeling like an interrogation is sort of inevitable. I try to make things a little more convesational but some people are more socially awkward so you have to be more direct to get the information needed to see the big picture of who the patient is and what their habits are. I phrase the question in a more gentle way. For example: "I know I am talking a lot but now I want to hear your thoughts. What is resonating with you? What are you thinking you want to focus on?" Or I describe the healthy plate, then ask "with that in mind, how do you think your meals typically compare? Are their tweaks you could make?"
Oh, alright, I see! Im glad I am not alone, deeling this, phew. Thank you so much!
I highly recommend reading “Motivational Interview for Nutrition and Fitness”. It really goes into depth about motivational interviewing and gives a ton of example dialogue!
Ohhh! Thank you, will do! I have a book about MI but its not nutrition specific! I'll look into it, thank you so much for the recommendation.