Motivational Interviewing in Nutrition and Fitness

1. Motivational Interviewing: A collaborative approach to behavior change

Motivational interviewing (MI) was developed to improve the conversation about behavior change.

Client-centered counseling. Motivational Interviewing is a collaborative, goal-oriented style of communication designed to strengthen personal motivation for and commitment to a specific goal. It emphasizes the language of change, exploring and resolving ambivalence within an atmosphere of acceptance and compassion.

Evidence-based effectiveness. MI has been proven effective in various disciplines, including nutrition and fitness. It increases the probability of change by empowering clients to convince themselves of the need for change, rather than being told what to do by a practitioner.

Key principles:

• Expressing empathy and understanding
• Developing discrepancy between clients' goals and current behavior
• Rolling with resistance rather than arguing
• Supporting self-efficacy and confidence in ability to change

2. The Spirit of MI: Partnership, acceptance, compassion, and evocation

The curious paradox is that when I accept myself just as I am then I can change.

Partnership. The practitioner functions as a partner or companion, collaborating with the client's own expertise. This approach avoids the "expert trap" where the practitioner assumes they know what's best for the client.

Acceptance. This includes absolute worth (unconditional positive regard), accurate empathy, affirmation, and autonomy support. It creates an environment where clients feel respected and understood, freeing them to change.

Compassion and evocation. The practitioner acts benevolently to promote the client's welfare and elicits the client's own motivations for change. This approach recognizes that motivation and resources for change reside within the client.

Key aspects of the MI spirit:

• Respecting client autonomy
• Collaborative rather than prescriptive
• Evoking rather than installing motivation
• Honoring the client's wisdom and perspective

3. Four Processes of MI: Engage, focus, evoke, and plan

MI is a bit of a dance. The dance of the MI counselor with the client flows gracefully and even seems to have rhythm to its steps.

Engaging. This initial process involves establishing a helpful connection and working relationship. It sets the tone for the entire interaction and continues throughout the session.

Focusing. The practitioner and client together select a particular direction or target for the conversation about change. This may involve clarifying goals or identifying the primary issue to address.

Evoking. This is the heart of MI, where the practitioner elicits the client's own motivations for change. It involves drawing out rather than imposing ideas about change.

Planning. Once sufficient motivation is present, the conversation shifts to strengthening commitment and developing a specific plan of action.

These processes are not linear but rather interlinked and recursive, with the practitioner moving flexibly between them as needed.

4. OARS: Open-ended questions, affirmations, reflections, and summaries

The greatest compliment that was ever paid me was when one asked me what I thought, and attended to my answer.

Open-ended questions. These invite elaboration and help clients explore their own motivations, feelings, and ideas. They encourage deeper thinking and self-reflection.

Affirmations. Genuine statements that recognize client strengths and efforts. They build confidence and reinforce positive behaviors and attitudes.

Reflections. Statements that mirror back the client's thoughts and feelings. They demonstrate understanding and help clients hear their own change talk.

Summaries. Longer reflections that pull together multiple elements of what the client has said. They can be used to transition between topics or highlight ambivalence.

OARS in action:

• Use open-ended questions to explore client perspectives
• Offer genuine affirmations to build self-efficacy
• Use reflective listening to demonstrate understanding
• Summarize periodically to check understanding and highlight key points

5. Navigating ambivalence and resistance in clients

Ambivalence is often rooted in a discrepancy between an individual's values and actions.

Understanding ambivalence. Ambivalence is a normal part of the change process. It involves feeling two ways about a behavior change and is often characterized by a mix of change talk and sustain talk.

Rolling with resistance. Instead of arguing or pushing back when clients express resistance, MI practitioners "roll with it" by reflecting the client's concerns and exploring their perspective further.

Strategies for addressing ambivalence and resistance:

• Reflect both sides of the ambivalence
• Emphasize personal choice and control
• Explore the client's goals and values
• Use double-sided reflections
• Reframe resistance as a sign of engagement

Avoiding traps. Common pitfalls include the question-answer trap, the expert trap, the labeling trap, and the premature focus trap. Being aware of these can help practitioners maintain the spirit of MI.

6. Applying MI in nutrition and fitness counseling

You may be a font of nutrition knowledge, but the key to nutrition counseling isn't just what you know about food and the human body; it's also what you know about your client.

Client-centered approach. In nutrition and fitness counseling, MI shifts the focus from prescribing specific diets or exercise regimens to exploring the client's own motivations and barriers to change.

Exploring intrinsic motivation. MI helps clients discover their own reasons for making health-related changes, which are often more powerful than external motivators.

Key applications in nutrition and fitness:

• Exploring food relationships and eating patterns
• Addressing barriers to physical activity
• Developing sustainable lifestyle changes
• Promoting intuitive eating and joyful movement

Information exchange. When providing nutrition or fitness information, use the elicit-provide-elicit method to ensure the information is relevant and well-received by the client.

7. Addressing weight concerns and disordered eating with MI

The scale can only give you a numerical reflection of your relationship with gravity. That's it. It cannot measure beauty, talent, purpose, life force, possibility, strength, or love.

Weight-neutral approach. MI aligns well with weight-neutral approaches like Health at Every Size (HAES), which focus on health-promoting behaviors rather than weight loss.

Addressing body image. MI can be used to explore the roots of body dissatisfaction and help clients develop a more positive relationship with their bodies.

Key principles in addressing weight and eating concerns:

• Avoid weight stigma and bias
• Promote flexible, individualized eating based on internal cues
• Encourage enjoyable, life-enhancing movement
• Focus on overall well-being rather than weight

Disordered eating. MI can be a valuable tool in addressing disordered eating patterns by exploring ambivalence, building motivation for change, and supporting autonomy in recovery.

Last updated: August 30, 2024