to change.58


Research has shown that patient or client-generated change talk at the


end of a session is most predictive of future change. Finally, providers using the motivational-interviewing approach are encour-


aged to “roll with resistance.” Resistant behaviors from patients or clients are many and diverse. They can include arguing, interrupting, ignoring, negating, disagreeing, excusing, blaming, minimizing, reluctance, pessimism, and unwilling- ness to change, among others. Resistant responses are to be expected; however, if resistance is persistent, the issue likely lies with the practitioner and how that practitioner is applying the approach. To roll with patient or client resistance, interviewers must avoid the “righting reflex”—the temptation to tell patients or clients the correct solution to a problem or to fix patients or clients’ problems for them, without allowing them to invite such advice or giving them the space to choose the solution for themselves.58


Although typically well-intentioned, the


righting reflex is a directive style of interaction with the patient or client that min- imizes the opportunity to enhance patient or client motivation via a patient or client-centered style of interaction.


Treatment Format and Structure


Given its conversational nature, motivational interviewing can be used during almost any encounter with a patient or client, including medical, dietetic, physical therapy, and counseling appointments. Research on the efficacy of motivational interviewing for weight loss has primarily examined the approach in the context of counseling appointments; therefore, the treatment format and structure details discussed here pertain mainly to counseling encounters. The patient or client-centered nature of motivational interviewing and its


focus on behavior-related change talk lends the approach to a format that is guided by change talk and patient or client priorities and desires rather than to one that is practitioner-generated and agenda-based. Motivational interviewing is traditionally delivered in person, but it can also be delivered via telehealth (ie, via telephone coach- ing or videoconferencing). Limited research has investigated delivery by eHealth (ie, via email, internet, social media, or smartphone applications); some efficacy has been demonstrated for this, but additional research is needed.64


Recommended length


of appointment varies considerably in the literature, with randomized controlled trials using appointment durations ranging from 20 to 60 minutes.65


The optimum


number of sessions is also variable; three to 11 sessions is the typical range studied in randomized controlled trials, although one trial indicated that sessions continued indefinitely until weight loss goals were achieved.65


The data on frequency of sessions


and treatment duration are also highly variable; a meta-analysis published in 2011 indicated that studies with a treatment duration of 6 months or longer demonstrated significantly greater weight loss among participants than did studies with treatment durations of less than 6 months.65


Of the studies that lasted longer than 6 months, the


number of sessions was typically four to six, and the sessions were typically spread out over 12 to 18 months. Lastly, research indicates that motivational interviewing is more effective in an individual (one-on-one) format than in the group setting.


Empirical Support


Motivational interviewing as a tool for weight management is supported by a wealth of evidence. A systematic review and meta-analysis revealed that, across randomized controlled trials of the effect of motivational interviewing on weight


CHAPTER 13: Counseling Approaches for Health Behavior Change 235


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