Hello, my name is Sarah Deitz and I'm a registered dietitian nutritionist and today I am going
to be talking about the therapeutic relationship between the provider and client.
This is part of my masters program in applied nutrition.
Today you are going to hear me say maybe us or we during the conversation and that is
referring back to the provider or the educator.
Creating a supportive environment needs to be as unique as the individual coming for
counseling.
Learning how to adapt is essential for a supportive environment or creating behavior change.
One of the more essential pieces is learning how to become an active listener.
We must be present to learn about the client and to find ways to facilitate behavior change.
Often we are guilty of thinking about nearly a hundred other things when we need to be
simply listening to the client's experiences and journey.
Once we develop the skill of listening, then we will be able to see the client's ambivalence
and bring about their intrinsic desires to change.
After we display genuine concern and interest, the client may feel more apt to open up.
We should position them as the leader in their own health decisions.
Behavior change can be facilitated when the client learns they have the control over the
nature, the timing, and direction of the learning process.
Giving this type of control back to the client helps them to feel respected and valued.
As educators we can help the client define even more strongly as the leader of their
own healthcare by using motivational interviewing or MI.
MI is a client-centered approach.
Looking at the slide you can see that we have tried to emphasis this by placing the person
in the middle.
We can get an idea of what motivational interviewing is, but it needs to be remembered that the
person is the center.
You will start to see some key phrases and key words that help to define it.
Even though you can't learn motivational interviewing in one slide.
Motivational interviewing is a client centered approach that we, as educators, may use to
help our patients break through the ambivalence they are experiencing about particular health
behavior changes.
We can facilitate that through open-ended questions, reflective and active listening,
change talk, affirmations, and summarizations.
Ways to show that we are really listening.
In creating an atmosphere that adopts an empathetic, nonjudgemental, and encouraging tone helps
to further establish the supportive client-provider relationships.
As this supportive relationship is built, we want our clients to feel that they are
safe to express their honest feelings.
We also want our clients to feel appreciated and understood.
Changing health behaviors really isn't easy, especially when it is something so defined,
like food.
We all have our specific connections to food.
Using these characteristics will help the educators create a caring atmosphere that
will allow the client to feel safe while expressing their thoughts and opinions.
The client will be more likely to disclose personal information and past successes when
they are in a supportive relationship.
The previous slide help to define MI, but I wanted to discuss something that I feel
is more of the core.
And that something is empathy.
Empathy is an emotion, but it can also be learned.
Even though it can be learned, it must be practiced in the most genuine manner.
So if we come off as fake or insincere, then our clients will dismiss the rest of our attempts
at eliciting behavior change.
The initial meeting is critical as our clients may be apprehensive or anxious about meeting
a new provider.
I encounter this frequently, no one is ready to change as soon as they walk through our
doors.
Practicing empathy will allow us to put our clients at ease and keep them coming back.
The most common definition of empathy is that it is a true understanding of another's unique
perspective and experience without judging, criticizing, or blaming.
The reason that I chose this picture is that it helps us to further define empathy.
As an educator, we must shift our focus from ourselves to our patients.
The old saying of putting ourselves in another's shoes is almost correct, but we have to adopt
the patient's identity when we are in their shoes.
We have to try and see the problem from their perspective, with their world experiences.
However, we honestly can't lose sense of self at the same time.
Empathy can be tricky while we are learning it, but it is so beneficial when it is understood.
The spirit of motivational interviewing is elusive and ever-evolving.
It has been said that MI has changed over the years, because it was never really controlled.
It has been used wide spread and it has been subject to influence.
This freedom is good because it is what has made MI such an effective approach as it has
become enhanced with use.
The original 1983 definition of MI was a patient communication style that utilizes guidance
and goal directing in order to elicit and emphasize individual motivation for change.
This original definition has really never been lost, but it has evolved to become the
spirit of motivational interviewing.
That spirit is made up by the four characteristics you see.
Collaboration, acceptance, compassion, and evocation.
The first piece is collaboration.
It focuses on building a supportive relationship, while empowering the client to accept their
responsibility of change.
We do not leave the client alone to change, we help give them the tools and confidence
to change.
The provider should also work to avoid creating an expert/recipient role, as this will really
slow progression.
The expertise of both parties needs to be respected; the provider with the nutrition
knowledge and the client with their own life experiences.
The second piece of MI is acceptance.
This includes accepting the autonomy and perspective of the client.
As we convey acceptance to the client, through reflective listening and affirmation, we should
be helping them to improve their self-efficacy.
Improving self-efficacy while accepting autonomy and perspective will help to reduce barriers
while attempting to elicit an individual's motivation for change.
Compassion is the third piece of the spirit of MI.
It focuses on conveying concern for your client's personal health interests.
It is similar to empathy and should be used regularly.
Demonstrating genuine compassion while allow a more solid client-provider relationship
to be built and respect to be gained.
The fourth and final piece is evocation.
This is an idea that focuses on the development of interventions based on the clients own
thoughts.
As the client-provider relationship becomes more solid, the provider should work to elicit
internal motivators to change.
Open-ended questions should be used to develop rich discussions to develop what is truly
important to the client themselves.
A technique that may help strengthen MI is the transtheoretical or stages of change model.
This model helps the educator to see where their client is currently at.
The stages include precontemplation (which is no intention to change/resistance to change),
contemplation (the need to change is recognized, but they are stuck in ambivalence), preparation
(pros outweigh the cons, committed to taking steps to change), action (behavior change
has occurred and it includes day 1 to 6 months), and maintenance (where you have engaged in
behaviors for 6 months and you are starting to benefit).
I really like this model because it can move forward and backwards.
It is important for the provider to remember that they need to reassess their client at
every session to see where they are at.
If they go from preparation to contemplation, then the provider needs to adjust to help
them move forward again.
MI is actually only effective in the stages of precontemplation, contemplation, and preparation.
These are the stages that occur before actual behavior change is initiated and they are
defined by high levels of ambivalence.
That's why MI is so good, because it helps to move out of ambivalence.
The first stage we are going to look at is the precontemplation stage.
Here we should be providing information about health and while discussing health, we need
to gauge emotional awareness and develop discrepancies between where they are now and where they
want to be.
Remember to be positive to create that empathetic and supportive environment.
Listen for statements of change to maybe have the client elaborate on.
It is important to work in a fashion that avoids arguments as a client in this stage
may forgo future counseling sessions if this one is negative.
The second stage of change that can be impacted by MI is the contemplation stage.
Here the client is beginning to recognize the need for change.
It can be really frustrating for the provider as ambivalence is strong.
Discrepancies should be discussed to elicit change.
Remember to always practice compassion again.
Adopting new behaviors can be very overwhelming and frustrating for the client.
They may even strongly doubt their ability to change at all.
Always remember to respect your clients level of self-efficacy, especially if they aren't
progression like you would like them to.
The third and final stage of change that is effected by MI is the preparation stage.
During this stage the clients have decided that the benefits of change are greater than
the risks and they plan to adopt that behavior change in the next 30 days.
The providers should really work with the clients to evoke appropriate client centered
goals.
Compassion should be had here for the client's journey and their chosen goals.
During this stage, the provider may also work with the client to strengthen their self-efficacy
and their intrinsic motivation; while the individual progresses towards the action stage.
Using a combination of the transtheoretical model and MI helps strengthen the client-provider
relationship by facilitating behavior change, motivation, and intrinsic evocation.
These interventions should be intertwined to help the client reach the end goal of the
maintenance stage.
Thank you so much for listening and learning with me today; I appreciate it!
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