#188 Motivational Interviewing and Eating Disorders

Motivational Interviewing was first developed in the addictions field for work with clients who were deeply ambivalent about making changes. Because of the complex nature of disordered eating, our clients are often of two minds about making the changes necessary to recover. No matter your take on whether eating disorders involve addiction, the illness is a complex process that involves specific behaviors.

For things to reveal themselves to us we need
to be ready to abandon our views about them.
Thich Nhat Hanh

Tell me then, what will you do
with your one wild and precious life?
Mary Oliver

Here is a definition of Motivational Interviewing: 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 for change.

Decades of research have shown that MI is the most effective approach to helping ambivalent clients buy into changing. There are two roles for MI in eating-disorders work. The first is helping clients make the behavioral changes that lead to recovery. A few examples are: planning meals the night before, engaging in self-care activities when tempted to binge, or stocking the kitchen with a range of appropriate foods.

The other place for MI is in making a decision to commit to programs or processes that will lead to recovery. There are many routes to healing from disordered eating. We may have ideas about which treatment approaches will work best for this person and what the appropriate level of care is at a given time. For example, we might want to recommend exposure work for anxiety, education about nutrition and physiology, body-image exercises, mindfulness training, yoga, a meal support group, residential or family-based treatment. MI helps us make these recommendations in the manner most likely to gain acceptance, and provides us a model for guiding the client toward a decision. Some clients are ambivalent about whether to engage in treatment at all or about how to characterize their struggle.

We can become frustrated when a client does not take our advice about the path that will best get her where she wants to go. The spirit and strategies of MI provide the most effective way for us to communicate with the client about change and decision.

Developing competence in MI makes all our work go more smoothly. For example, attending to the engagement process (Tip #115) when first meeting a client sets up the session to be one of collaboration rather than conflict.

When a client seems to be resisting everything you offer, MI training helps you stay attuned to the resistance process and to respond effectively (Tips #9, #103, #130). You can recognize resistance when it first appears, especially in the early stages of change where commitment and motivation are lowest. MI provides language and techniques to help us roll with resistance and not allow it to get entrenched.

Resistance is also less likely to emerge when we employ the stance and skills of MI. This is particularly true when we provide advice. More on the MI manner of providing advice in Tips #59 and #147.

A final benefit of MI lies in our process of professional progress. For those of us who wish to continually improve our competence, MI skills can easily be broken down and worked through in step-by-step practice.

There are limitations to MI for ED treatment. For our clients who are dealing with the aftermath of trauma, MI does not address the symptoms per se. Often, our clients do not want to discuss or don’t acknowledge past trauma that we see as affecting their behaviors in the present. Because the MI process is respectful, it can help the client feel safe enough to eventually engage in trauma work with others on the team.

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