By Alicia M Jerome MS, RD, LD
Nutrition care is often framed around what needs to change: what to eat more of, what to reduce, what behaviors to initiate, and what patterns to shift. Yet in real-world practice, the most powerful factor shaping whether change actually happens is not the nutrition prescription itself. It is the way conversations unfold in the counseling room.
Motivational interviewing (MI), as presented in Motivational Interviewing in Nutrition and Fitness, 2nd Edition by Dawn Clifford, PhD and Laura Curtis, MS, RDN challenges a common assumption many practitioners carry into counseling: that motivation must be given, instilled, or created.1 Instead, MI is grounded in the belief that people already hold motivation within themselves. The clinician’s role is not to persuade, convince, or correct. It is to evoke.
Ambivalence Is Not the Problem, It Is the Work
Nutrition and dietetics professionals encounter ambivalence daily. Clients want to feel better, yet they want the comfort of familiar habits. They want improved biomarkers, but they want flexibility and ease. They want to prepare meals at home and yet they feel too exhausted at the end of the day. Clifford and Curtis emphasize that ambivalence is not resistance. 1 It is a natural, expected part of change.
Where traditional counseling approaches may attempt to push past ambivalence with education or advice, motivational interviewing moves straight toward it. MI recognizes that clients voice both sustain talk (“I don’t have time,” “Nothing has worked before”) and change talk (“I want to feel better,” “I don’t want my labs to worsen”).1 The counselor’s task is to listen for the seeds of change, reflect them (mirror or restate), and gently help the client explore the discrepancy between where they are and where they want to be. In doing so, MI treats ambivalence not as a barrier, but as the very terrain through which meaningful change is negotiated.
Why Persuasion Backfires and Partnership Works
Healthcare training has historically emphasized expertise, giving information, and problem-solving by the counselor. In nutrition counseling, this often translates into what MI calls the “fixing reflex”, the instinct to jump in with solutions the moment we spot a problem. Unfortunately, Clifford and Curtis note that when clients feel directed, corrected, or managed, they are more likely to defend their current behavior.1 The result is unintentional reinforcement of the very patterns we hope to change.
Motivational interviewing instead invites partnership. Rather than positioning the clinician as the authority who drives change, MI places the client at the center as the expert in their own life, values, barriers, and capacity.1 Conversations shift from “Here’s what you need to do” to “What feels important to you right now?” and “What ideas do you already have about where to begin?” This guiding style preserves autonomy, a critical ingredient in sustainable motivation, and strengthens therapeutic alliance, which remains one of the strongest predictors of clinical success across health behavior research.1
Evoking Change Talk: The Heartbeat of MI
Motivational interviewing is best understood not as a technique, but as a clinical stance. However, Clifford and Curtis clearly describe that one of its most powerful mechanisms is the intentional evoking of change talk.1 Change talk includes expressions of desires, needs, reasons, and abilities voiced by the client. When clients talk about change in their own words, they are not only describing it, they are strengthening their commitment to it.
This does not happen by accident. It is supported through careful use of reflections, open-ended questions, affirmations, and summaries that highlight capability, values, and momentum rather than deficits or failure.1 In practice, this might sound like: “A part of you is tired of feeling controlled by food, and you’re ready to feel more confident about your choices.” Such reflections acknowledge struggle while illuminating hope and capacity, two psychological conditions essential for behavior change.1
From Insight to Action: Moving Toward Change Without Forcing It
As motivation develops, MI provides a thoughtful bridge toward planning. The goal is not to rush to goal setting, but to recognize the moment when clients begin shifting from contemplation to readiness.1 Clifford and Curtis highlight that asking permission before offering ideas or collaboratively brainstorming possibilities and treating goals as “experiments” rather than rigid performance standards, which help clients maintain ownership of the change process.1
This reframing is especially important in nutrition and fitness contexts, where clients often carry long histories of perceived failure, shame, and discouragement. By treating goals as learning experiences rather than pass-or-fail tests, MI supports resilience, confidence, and psychological safety. Instead of reinforcing all-or-nothing thinking, it fosters an environment where progress is possible even when perfection is not.
Clinical Excellence Requires Relational Skill
For dietitians and nutrition professionals committed to evidence-based practice, motivational interviewing is not a “soft skill” or optional counseling flavor. Clifford and Curtis make clear that MI is a rigorously studied, theory-grounded approach with measurable effects on engagement, adherence, and outcomes in nutrition, weight management, diabetes, fitness, and chronic disease care.1
Just as we value accuracy in medical nutrition therapy, we must also value accuracy in communication. The ability to evoke rather than impose, to guide rather than persuade, and to cultivate trust rather than compliance represents a form of clinical excellence that is every bit as essential as knowledge of guidelines or dietary frameworks.
Moving Forward: Strengthening Competence in Motivational Interviewing
For many practitioners, motivational interviewing feels refreshingly aligned with why they entered the profession in the first place, to support, empower, and walk alongside individuals in meaningful, health-enhancing change. Yet it is also a skill that requires intention and training. It is learnable, practicable, and improvable over time.
Continuing education represents a meaningful opportunity not only to deepen understanding of MI, but to strengthen counseling confidence, refine technique, and translate communication theory into compassionate, effective practice. When nutrition professionals master the relational skills that allow clients to feel safe, capable, and genuinely heard, we do more than deliver information. We help create conditions in which change can truly happen.
Earn 22 CPE hours and take a deeper dive into this topic through Helm Publishing’s popular course: Motivational Interviewing in Nutrition and Fitness, 2nd Edition.
References:
1. Clifford, Dawn, and Laura Curtis. Motivational Interviewing in Nutrition and Fitness. The Guilford Publications, 2025.