“Eat more vegetables!” Clearly great advice for our patients with Type 2 Diabetes, however what was your reaction when I made this command? If you’re anything like me, it was to do the exact opposite! It’s natural human nature to dislike being told what to do. This is where the practice of Motivational Interviewing can come in so handy when providing counseling and advice to our patients. During my undergraduate and graduate programs and in my subsequent dietetic internship, motivational interviewing was a very small subject area, despite this being something I use in my practice every single day! Because of this, I realized very early on, that if I was going to be a successful dietitian and CDE, especially in an outpatient setting, I needed to know more than just standards of care and best practice for diabetes and nutrition. I needed to better understand how to communicate these topics to my patients in a non-commanding, collaborative way.
If you’re not familiar with Motivational Interviewing, it is a counseling technique that seeks to move patients from a state of uncertainty about changes toward finding internal motivation to make changes in behavior. We all know change is HARD and as a Registered Dietitian, I often find myself saying “This is why I have a job”. Motivational interviewing helps people commit to the difficult process of behavior change. It guides patients to better understand what there intrinsic motivators are for change and moves them to state these motivators out loud. This second step is the most important. As opposed to simply stating a need to change, hearing themselves express a commitment out loud and the reasons why they are committed has been shown to help improve a patient’s ability to actually make those changes. One of the first few questions you may ask a patient to start off a session in the context of Motivational Interviewing is:
- One a scale of 0 to 10, how important to you is making a change to your lifestyle (or medication or self-monitoring) to help better manage your Diabetes?
- What makes that importance a 7 rather than a 6? What makes it feel important to you today?
What your patient answers to the second question are his or her intrinsic motivators. When we begin to hear “yes, buts” during your appointment (ie. “Yes, but I don’t have time to check my blood sugars”) reflecting with the patient back on these intrinsic motivators will be a helpful tool to prevent coming up against resistance (“On the one hand, It sounds like you have a very busy schedule. While on the other hand, I know how important controlling your diabetes is to you because you want to be an active grandfather. I know you understand how important self-monitoring your blood sugar is to help control your diabetes. What might you be able to do this week to improve your health in order to increase your quality and quantity years of life”.)
Jotting down your patients intrinsic motivators may be helpful when his or her motivation wanes in subsequent appointments. You might be able to remind them of what help prompt the initial changes they made to their health. If you’d like to learn more about Motivational Interviewing and how to incorporate it into your practice, one of my very favorite resources are the FREE tips my fellow dietitian Molly Kellogg, RD, LCSW (http://www.mollykellogg.com/counseling-tips/). Try incorporating one concept into your counseling each month and spend the month really practice that concept for the whole month until you feel comfortable with it. Then move onto another concept.
Motivational Interviewing has truly changed my practice in a very positive way. Practicing the techniques as I encouraged above was not easy and often felt awkward, however helping patients better reach their goals has made it both rewarding and helped make me more effective as a clinician.