Motivational interviewing is a style of counseling developed by William Miller and Stephen Rollnick in the 1980s to influence change in people with alcohol addiction. Today it is used to treat a wide range of behavior changes, including dietary habits. Motivational interviewing calls for a collaborative partnership between a client and counselor where the responsibility for change lies with the person who wants to lose weight.
Traditional Weight-Loss Counseling
In the May 2007 Issue of Today's Dietitian, Ellen Glovsky explains that health-care professionals are often trained to convey information about what dietary changes are needed and why they are important. But if the only exchange between the counselor and the client are facts about diet and weight loss, the behavior change element is left out. Traditional counseling methods do not take the individual and his motivations into account. This leaves the counselor persuading or arguing with the client, at which point the client begins to resist, and the likelihood of behavior change is reduced.
Developing Discrepancy
A major key in motivational interviewing is the counselor helping the client to see a discrepancy between where he is now and where he wants to be. The obese client must see a substantial benefit to weight loss. Although these vary among individuals, typical advantages include improving health conditions, looking better, feeling more confident, and having more energy.
Rolling With Resistance
In the book, "Motivational Interviewing: Preparing People for Change," Drs. Miller and Rollnick describe the human nature of resistance. If a weight loss counselor tells a client what to eat or how to exercise, the client has a natural instinct to go against that advice and explain why it will not work. In motivational interviewing, the counselor does not give advice: he acknowledges the client's reluctance and ambivalence when a suggestion is not well-received, and invites him to explore new options and consider various perspectives.
Encouraging Change Talk
In motivational interviewing, the counselor elicits arguments for change from the client rather than directing new behaviors. When talking about the pros of change out loud--known as "change talk"--the client hears her own positive arguments. Hearing herself argue for change promotes a movement from ambivalence toward commitment to changing eating and exercise behaviors.
Effectiveness
There are few studies to demonstrate that motivational interviewing is more effective for the obese client than other counseling styles. In the August 2005 issue of the MINT Bulletin, Shawn Jeffries describes the difficulty in demonstrating the benefits: The major issue, he says, is that obesity is not a behavior, but a condition. There are studies that display results regarding change in diet and exercise behaviors. One such research project published in the May 2007 issue of Diabetes Care found female subjects with type 2 diabetes who received motivational interviewing lost more weight than those who did not, presumably because they attended sessions more regularly and had better self-monitoring techniques.
References
- Today's Dietitian; Motivational Interviewing �?? A Unique Approach to Behavior Change Counseling; Ellen R. Glovsky, Ph. D, R.D., L.D., and Gary Rose, Ph. D.; May 2007
- MINT Bulletin; Obesity: Another Perspective and Practice Suggestions; Susan Butterworth and Shawn Jeffries; August 2005.
- Iowa Practice Improvement Collaborative: Motivational Interviewing
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