Motivational Interviewing for Dietitians
As RD’s we are trained to give information – diets for hypertension, diabetes, cardiovascular disease, etc. We have a plethora of knowledge that can help our patients but how do we know they are actually ready and willing to hear what we have to say?
How do we work with a patient so our knowledge and expertise do not fall on deaf ears?
I remember the first time I went to see an accountant after starting my working career. The majority of what he said went over my head and I was lost in the sea of information. After a while I felt like I was in the cartoon of Charlie Brown hearing the adults say “wha wha wha wha.”
How do we engage our patients in a way they truly hear us, feel ready and prepared to receive the valuable information we have to assist their health?
The first step is engaging them: without engagement, there will be no further productive conversion.
Research shows people make up their mind within the first few minutes of meeting a practitioner whether they will be able to help them. First impressions do count.
One key element I learned from Motivational Interviewing (MI) is presence. It may seem trite but how present are you when you meet a patient? Are you looking at your phone, thinking about your last patient, what you are going to do after work, or something else?
In MI we say we listen with our bones.
Active listening and presence takes practice. Are you giving your patients your undivided attention while listening to their situation with curiosity, delight and without interruptions? Are you trying to understand them or thinking about how you will FIX their problem?
In the past, I was always trying to do the later versus the former before I learned MI. Learning MI is like learning a language and takes commitment to the process by attending workshops, hiring an MI coach and consistent discipline to the practice.
In MI we learn the patients are the experts in themselves. Although we are the nutrition experts we learn how to collaboratively combine our expertise with our patients – knowledge of who they are and how best they make changes.
We don’t take the bait when a patient states “just tell me what to eat.” A response could be, “when you’ve made dietary changes in the past, what worked for you?” This question is evoking what makes the client successful rather than trying to tell them what to do.
Change talk is when the patient is the one arguing for change and what they will do versus us telling them how to make the change.
People are more persuaded by what they hear themselves say than by what someone else tells them (Self-perception theory by Pascal).
Many times we miss change talk because we are intent on talking about our own agenda. Rather than thinking you have to give all the information upfront, consider giving your patient information in eyedropper size bites when they are ready and open to receive it.
When the patient speaks, take time to reflect back what you heard them say. As you reflect their feelings and thoughts, carefully listen.
Reflective listening allows your patient to hear their own thoughts and feelings and allow them to share from a more authentic place.
You might be surprised they will bring the focus of the real importance of their visit, thus opening up the dialogue for behavior changes to address.
Practice doing reflections, and keep questions to a minimum. Staying out of the question and answer trap will give you more information that you ever realized.
A small change in how you engage with your patients as a practitioner can mean a big shift for the patient and helping them feel supported and willing to change.
In MI we have a saying we refer to as the “Michelangelo Belief”:
The capacity and potential for change and adherence is within every person.
Drawing out that potential for dietary change may require more than a session or two or it might take much less information than you think it will.
MI gives us a platform and language from which to draw upon to help our patients with behavior changes they are ready to make?using our expertise in the most effective way that is dancing with our patients rather than wrestling with them.
