#187 Using MI in Nutrition Sessions or Conducting a Motivational Interview in a Nutrition Context?


Are you a nutrition counselor and using MI when it seems to fit? If so, your sessions may be more effective than before you learned about MI. They can be even more effective when you make the final shift to conducting an actual motivational interview in your nutrition setting. There is a difference, and it matters.

If you want to go fast, go alone.
If you want to go far, go together.
African proverb

Have enough courage to trust love one more time
and always one more time.
Maya Angelou

Here is an example of beginning to use a bit of MI in a nutrition session. A WIC nutritionist asked me if she should respond to change talk she hears during the “assessment” portion of a session or wait until the “educating” phase. When you conduct a session as a process of assessing and educating the client, it is not motivational interviewing. There may be some benefit to employing the concepts and skills of MI. I suggested she respond to the change talk right after she hears it (Tips #69 & #121). This will help the client notice her own change talk and make it more likely she will take it into account during any planning for change. This integration of some MI skills into sessions is the first step in moving toward full MI.

When we make the final shift to motivational interviewing, we keep in mind the four processes of MI: Engaging, Focusing, Evoking, and Planning (Tips #114 – 118). Our “assessment” and “educating” then fit inside those processes, rather than the other way around.

Here is an example of how “educating” happens when it is fully integrated into an MI session. You are engaged with the client, have heard what he wants from nutrition counseling, and are working to find a behavioral focus. He suggests one that you know will not help him achieve his stated health goals. You ask permission to provide some information. He agrees, you provide it, and you follow up by asking for his response (Tip #147, Providing Advice Effectively). In this way, your “educating” is in the service of the client’s process of focusing on the changes that best fit his goals. Later in this session, he may be in the planning process, and you notice that he is missing some information about foods that will support his plan. You ask permission to offer this information, do so, and engage with him about his response to it. Here your information fits inside his planning process if he wants and is ready for it.

Because of their complexity, nutrition sessions are some of the most difficult to transition all the way to MI. Additionally, requirements in your nutrition setting may complicate the session further. Most of us need to spend many months or even years getting used to the complexities of our specific nutrition specialty before we feel confident it’s ingrained there in the background. Only then can we focus on the quality of these important conversations about change.

Ask yourself, what is the frame you have in your head now? Is MI something you have incorporated into the strategies you learned in school? If so, are you comfortable enough in your work to make this final shift to fully conducting motivational interviews? You may find it useful to review Tip #73, Advancing Your Skills, for steps to move forward.

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