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Nutrition Counseling MI
Terms in this set (68)
• Open questions
• Affirm Efforts and Strengths
• Restate what you hear
• Make a guess about
meaning and say it as a
You can reflect
• Body language
• Tone of voice
• One word
• A phrase
• An emotion
• A whole concept or process
Types of reflections
• Reflection with a reframe
• Reflection with a twist
When to reflect
• After an open ended question
• When client is thinking about change
• When you hear ambivalence
• When you hear strong feeling
• When you sense resistance
What to reflect
• Change talk: desire, ability, reasons,
need, commitment, taking steps
• Short summaries
Powerful reflections are...
• Statements, not questions
What reflecting does
• Maximizes information exchange
• Conveys respect and empathy
• Highlights and encourages change talk
• Reminds us that almost all the
answers are in the client
What reflecting does pt2
• Slows down the process when stuck
• Helps clients see & work through ambivalence
• When you don't have a clue what to do
• Builds engagement
• Provides the client feedback
• Targets specific behaviors
• Increases confidence
Types of affirmations - Appreciation
• Thanks for coming in today
• I know it was hard to tell me
that. I'm glad you did.
• I know it was not easy to keep
this appointment. Thank you.
Types of affirmations - Steps/efforts
• That's a useful step you took.
• That's a great suggestion.
• I would find that difficult to deal with
• You can be very persistent when you
set your mind to something.
Types of affirmations - Strengths/process
• You clearly want to do as much as
you can for your health.
• You are creative with ideas of how to
• When you do it this way... this
• You are someone who...
What to affirm
• Efforts not outcomes
Developing your style
• Each client is different
• Attend to cultural differences
• Reflections work better than cheerleading
• What seems to work for you?
• Think to put answer
• Delay in answering
• Encourage active
• Tell me about your experience with
• How could you see adding some highcalcium
• What long-term consequences of diabetes
concern you most?
• What do you need from me about this?
We all change when...
• we want to, when it matters
• we know how
• we believe we can
The Four Processes of Motivational
What does resistance look like?
• "yes, but..."
• "Well, I guess I could try."
• Patient has not done what they had
• The patient does not return for a
• Body language
What is resistance?
-what happens when we
expect or push for a change when
our patients are not ready for that
-It's not something that
exists in people in a static sense. It
arises as a normal, expected product
of the interaction.
Internal resistance (ambivalence)
Conflict between two parts of
a person over a proposed
Humans resist when
• We feel we are not in control
• We believe we do not have
• We don't know what is going on
Our role in resistance
• The Righting Reflex
• Knowledge of long term health
• Picking up patient's anxiety or urgency
• Investment in being successful
• Pressure from others
• Promote choice and control
• Roll with resistance
• Questioning style
• Affirm and Reflect
• Track readiness
• Provide advice respectfully
Promoting choice and control
• Let clients choose what to work
• Ask permission before offering
advice or information.
• Suggest experiments
ROLLING WITH RESISTANCE:
• Express empathy
• Reflect ambivalence
• Acknowledge resistance
• Support choice
What to do when resistance arises
1) State what you see/hear
2) Acknowledge the resistance
3) Shift back in your chair & breathe
4) Offer to let go
5) Invite working together
Providing advice and maintaining
• Elicit What client already knows and
wants to know
• Offer: information in neutral manner
• Elicit client's response to,
interpretation of the information
• What have you already heard about ...?
• What do you know so far?
• What questions do you have?
• How might I help you?
• I have some information (or handout)
about... May I share this with you? or
Would you like to hear it?
• "You should..."
• "You have to..."
• "You need to..."
Tell the truth without pushing
• The word "you"
• A desire for client to change
• Assumption of change
• When liquids are measured this way it is
• This is the amount of rice that contains...
• Others have found that...
• You might consider...
• Research shows that when...
• The AHA recommends
Elicit response to information
• Open-ended questions
• Encourages active learning and
• May show you misunderstanding
• "What do you know about the benefits of
breastfeeding?" "What information might
you need from me right now?"
• "Moms find it convenient because they
don't have to prepare formula." "Breastfed
babies are healthier."
• "What is your response to this
information?" "What are your thoughts at
Making the transition
• Open-ended question
• Mention facts and ask
permission to talk about it.
The tip of the iceberg
• "I want to lose weight."
• "My doctor told me to see you."
• "What does this blood test mean?"
• "Help me follow this diet."
• "I don't want to have another heart
• Helps you understand the
• Boosts the client's motivation
"How important is it to you right
now that you get to the gym 3
times a week on a scale of 1 to
10, where 1 is not important at
all and 10 is as important is it
could possibly be?"
Benefits of exploring importance
• Develop rapport
• Increases motivation to
• Allows you to handle
Readiness for change
(What will I gain or lose if I change)
Readiness for change
(How will I do it and can I?)
Making the transition
• Once a focus is agreed on...
• Summarize importance
Tell me on a scale of 0 - 10 how
confidence are you right now that you
are going to use this book to keep track
of your carbs in the next two weeks?
Where 0 means you know you won't
and 10 means you know for sure that
you can do it."
• How confident are you now that you will make this
change? 0 to 10?
• What makes it a ___ instead of a ___ (lower)?
• What would cause your confidence to go
up a few points?
• How can I help you succeed?
• Tell me more...
• How would it be if you broke down the change a bit into
Reflect and ask for more
• Explore what is in number
• Reflect and summarize
• Reflect obstacles and ask to
• Helps you & client clarify plan
• Obstacles will emerge
• Boosts the client's confidence
• Time bound
Consider a smaller step
"I hear you are not sure you can do that.
Might there be a smaller step you are ready
"Some people find that it works to break this
down into smaller steps. Would you like
"Some have..." "you might consider..."
Summarize plan and confidence
"so your plan this week is to...
and you feel quite confident you
can do it because... with the
Stages of Change
• Taking Steps
Searching for Change Talk
• Pick out change talk
• Go back to 4:30 in the
podcast and search again
• There is at least one
example of each type
Responding to change talk
• Elaborate with open questions
• Affirm efforts and strengths
• Reflect the change talk
• Summarize all the change talk
"In what way?"
"Tell me more"
"How did you do so well?"
"What/who supported you to do that?"
"What do you see doing this week?"
"What is your next step?"
Reflect what patient is already doing
and strengths you hear
"You are already someone who..."
"That took a lot of courage/persistence..."
"You are a person who can make changes."
"Anyone would find that difficult."
• So you want...
• So, you know that you could...
• You really care about...
• You know that this would be good
• This week you will...
• You have been doing...
• Reflect a bit of the situation
• Reflect things that are Important to this
• Affirm some strengths/efforts
• Reflect ability
• Reflect commitment/plan
• How did I do and/or what's next?
Any definition of MI includes...
1. MI is a particular kind of conversation
2. MI is collaborative (partnership, honors
autonomy, not expert/recipient)
3. MI is evocative (seeks to call forth the
person's own motivation and commitment)
Why should I use it?
Motivational interviewing is a personcentered
counseling method for
addressing the common problem of
ambivalence about change
How does it work?
Motivational interviewing is a collaborative,
goal-oriented method of communication with
particular attention to the language of
change. It is designed to strengthen an
individual's motivation for and movement
toward a specific goal by eliciting and
exploring the person's own arguments
The spirit of MI
• Rolling with resistance
• Importance and confidence to change
• Change talk
• Giving advice
The four processes of MI
Other simple formats
• Exploring Importance and
Confidence to make a change
• Attend to change talk
When you have little time
• Ask permission to bring up your
• Ask permission to give advice
• Summarize and ask a key question
• Be willing to talk about time
Client-centered style in groups
• Offer choice
• Ask permission
• Evoke group wisdom
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