by Tara MacGregor PACFA Reg Clinical & APD
Well, here is the tough news.
The evidence is IN.
I was shocked to discover when I came out of uni that no matter how great my educating skills were, how glossy and clear my diet sheets were, how high the risk for my client, how gently or directly I coerced, frightened or instructed my clients or how shiny my cheer leader pom-poms were………….. I still met people on a daily basis who did not change.
This was a huge dilemma for me. How was I to be effective? The tools of my trade were not getting the desired outcome.
My first challenge was to redefine what effective meant. It could no longer ‘pass muster’ with me that imparting knowledge was effective work.
Effective work started to take on new meaning when I re-trained in client centred communication skills. Most relevant of these to Dietetics was Motivational Interviewing (MI).
Through studies and coaching and practice, practice, practice…..I learned that effective work involved coming alongside the client and joining with them in a shared understanding of what they wanted for their health. MI taught me that advice giving has it’s place but I needed a sound rationale from the client AND an agreement from them to proceed before I launched! I learned to shut up.
So What is Motivational Interviewing?
Here is how the ‘Grandfathers of MI’ Miller and Rollnick1 define it:
‘Motivational Interviewing is a form of collaborative conversation for strengthening a person’s own motivation and commitment to change’ [my emphasis]
Motivational Interviewing starts with the assumption that the client already has much of the resources and knowledge required to improve their behaviours in meaningful ways. In MI, it is the practitioner’s job to guide the client to tap into their resources and harness their knowledge into a focused plan. The MI practitioner takes responsibility for providing education or advice when required by the client in a manner that is useful to the client.
Hmmmmm…..education on the client’s terms. Revelatory!
Motivational Interviewing respects that ambivalence about change is part of the human condition. We all flip-flop about taking care of ourselves. Just take a quick minute – do you floss everyday? You know you should right, but………it’s too time consuming, it hurts, does it really matter that much? This aspect of being human does not respond well to judgement, education, threats or coercion. It does respond well to being met and understood.
Hmmmmm…… no more fighting with the client. Revolutionary!
Ok time out here. I’m not claiming we were taught to fight with our clients. I’m referring to that ‘tight bind’ feeling you sense when you really need a client to do something different and they just won’t. You can’t help but think to yourself ‘This client is so resistant’. This is fighting with the client. It’s a bad deal for you and the client.
Why is MI good for clients?
It a nutshell: MI is empowering, affirming and deeply respectful.
MI refuses to pigeon hole clients as ‘resistant’. This is a big step forward for everyone concerned.
For the client, the experience of participating in a conversation based on the skills and spirit of Motivational Interviewing is one of being heard, affirmed and challenged to think deeply about what matters to them and the change they are contemplating in their lives. MI guides the client to consider clearly from their own knowledge, what is happening and what could happen with regards to adopting new behaviours. They are given room to move and invited to think.
Why is MI good for the Practitioner?
MI enables the practitioner to be effective and to stop wasting time on strategies that do not work for facilitating behaviour change.
Motivational Interviewing proposes that it is not the practitioner’s job to force or make change happen. This fresh perspective on the role of the health practitioner invites the practitioner to skill up and get clear on what is their role and what work belongs to the client. It’s a game changer that can help minimise burn out and infuse work with new meaning and purpose.
About The Author and Trainer
Tara is an APD, Counsellor & Psychotherapist and member of MINT (Motivational Interviewing Network of Trainers) a not-for-profit organisation based in USA with international membership. Members of MINT have a central interest to improve the quality and effectiveness of counselling and consultations with clients about behaviour change. Members of MINT must complete a rigorous application process and attend a three-day MINT approved trainer training prior to gaining membership.
Read more about Tara here.
1 Miller W.R. Rollnick S. Motivational Interviewing; Helping People to Change. 2013 3rd Ed. Guildford Press