Next week I have the distinct pleasure of conducting a Motivational Interviewing training for the dietetic interns in the Boston area. This is the fourth year in which I’ve offered this training, and it’s one of my favorites.
When I was a dietetic intern in 1970-71, we were taught that our job was to “teach the diet” and do it with enough enthusiasm that your patient will want to change what they eat. I always felt as though I was wagging my finger (metaphorically, of course) at them telling them they are doing everything wrong. Dietitians are still often being taught this approach, and I can tell you from first hand experience that it rarely works. All you get is a patient with another set of dietary failures, a lot of guilt and recrimination, and not much positive change.
Fortunately, some dietetic training programs are beginning to teach the concepts of MI, and this is very exciting to me. MI is perfect for helping people with dietary behavior change, and there’s research literature to back that statement up. MI focuses on collaboration, acceptance, affirming the other’s autonomy, and compassion. When, what and how people choose what they eat is intensely personal, and changes must come from within, rather from an external source like a dietitian. Our job is to be a guide, helping the patient make their own decisions about changes they might like to make to their diet.
Let me add a caveat here. Of course we as dietitians are the experts in diet and health. That’s the knowledge base that we have, and are eager to share that with the patient. However, most of the conversation between dietitian and patient should be about the patient’s goals and values. We must remember, as in all applications of MI, that patients, and all people, are the experts in their own lives. They have everything they need to make positive health behavior changes, and we will help them find it together. Our expert knowledge can be helpful, but it’s not everything.
