When it comes to nutritional counseling, dietitians can employ a variety of strategies and counseling techniques to help their clients enact positive behavior changes. One of these is termed motivational interviewing (MI), which invites clients to engage and share during their appointment with you, and to play an active role in developing a plan for their improved health.
No blog post on motivational interviewing would be complete without a mention of RDN Molly Kellogg, who provides training and educational materials for dietitians on the topic of motivational interviewing. Molly breaks down a motivational interviewing session as moving through four fundamental processes: 1) Engaging, 2) Focusing, 3) Evoking, and 4) Planning. Learn more about each stage on Molly’s site.
When you are in-network with various insurance companies, you have the opportunity to visit with your clients over the course of several appointments, which lends itself well to taking time to counsel clients at a pace that works for both of you. We invited our dietitian friends to share their tried and true motivational interviewing tips with us. Here is what they had to say.
Motivational Interview Questions to Begin the Nutrition Counseling Session
Lisa Andrews, Med, RD, LD and owner of Sound Bites Nutrition, LLC, first asks her client what they are most interested in getting out of today’s session, and how she can help them. Then, she lets them talk as much as they’d like, and reflects back on what she heard.
Ask Open-Ended Questions to Get Your Clients Talking
Gisela Belén Bouvier, MBA, RDN, LDN, MIEP, owner of Mindfully Intuitive Nutrition, provides the following tip: “My best MI tip is to always ask open-ended questions – it allows for the client to guide the conversation and also leads to building better rapport and finding the root causes or reasons for whatever health or nutrition concern we may need to focus on. It also builds trust and allows the focus to solely be on the client.”
Dietitian Kyla Kurczewski with KYLA Nutrition and Wellness, seconds the open-ended questions point: “Ask open-ended questions that challenge a client’s current belief!”
Mandy Enright, MS, RDN, RYT and creator of the couples nutrition blog and podcast Nutrition Nuptials, also suggests talking as little as possible so that your client is encouraged to talk as much as possible. “It’s amazing what someone can talk themselves into trying to do with just a few minimally-worded questions or reflective statements,” she says.
Reilly Brown, MS, RD and owner of Reilly B Sports, tries to engage her clients as much as possible. “Instead of telling them about nutrition or goals,” she says, “I always ask them what they think. Instead of saying ‘You are going to eat broccoli, celery and carrots this week,’ I would ask the client to list three vegetables they might eat this week. This helps with their interaction and also allows them to set realistic goals.”
Invite Clients to Come Up with Their Own Plan
Dana Cizinski, MS, RD, LC, owner of Dana Cizinsksi Nutrition and Wellness, guides people to make their own arguments for behavior change, which helps increase their follow-through with the plan. She suggests leading questions such as, “What would be good about…” or “What would make you want to change?” or “What thoughts about your health do you continue to come back to?”
Assess your client’s readiness to make changes by asking “On a scale of 1-10, how likely are you to make (self-identified) goal/change?” This is a great tip from RDN Rebekah Favia.
When to Use Motivational Interviewing
Dietitian Lauren Gursha, RD, LDN with Beacon Hill Nutrition, suggests using MI only in times of client ambivalence. Nicole Goodrich, MS, RDN, LDN, CHWC and president of Anderson’s Nutrition, on the other hand, uses MI in just about all of her sessions. Her tips include: Make sure you are empowering your clients to have autonomy. It is all about them, and not what you want them to do. By using open-ended questions and reflections, allow them to discover their own solutions.
What motivational interviewing tip would you contribute?