Susan B. Dopart, MS, RD, CDE, is a medical nutrition and wellness consultant. She specializes in child and adult medical nutrition-related issues associated with insulin resistance, diabetes and endocrinology. Before establishing her own practice, Susan worked at UCLA as both a medical and kidney dietitian.
She is a member of the Motivational Interviewing Network of Trainers and conducts weekly workshops in Motivational Interviewing for clinicians wanting to learn collaborative language skills to assist with behavior change.
Susan has written and contributed to multiple publications, including The Huffington Post, SELF Magazine, UCLA Medicine, Sports and Cardiovascular Nutritionists SCAN publications, Diabetes Health and Diabetes Forecast.
Susan is the author of A Recipe for Life by the Doctor’s Dietitian, Healthy You, Healthy Baby: A Mother’s Guide to Gestational Diabetes, A Healthy Baker’s Dozen: Gluten-free low sugar cookies, and 101 Ways to Control your Diabetes.
Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Susan Dopart on the show today. Susan, welcome to Nutrition Experts!
Susan Dopart: [00:00:45] Thank you Mathea for having me. I really appreciate it.
Mathea Ford: [00:00:49] Great! I’m Excited to have you on the show and share your expertise with my tribe. Can you start with telling my listeners a little more about you and what you do?
Susan Dopart: [00:00:59] Sure! I’m a Registered Dietitian and Exercise Physiologist and also what we call a MINT – Motivational Interviewing Network Trainer. And so I have a private practice in Los Angeles and I do motivational interviewing trainings on a weekly basis both in person and virtually. And I also actually have four books out as well on different nutrition topics but mostly they really related to insulin resistance and diabetes.
Mathea Ford: [00:01:33] So, can you talk a little bit about motivational interviewing I’m sure dietitians have heard about it maybe even done a little training on it but can you go through and kind of talk through what it is and why we would want to use that?
Susan Dopart: [00:01:49] Sure. Well, Motivational Interviewing is a collaborative partnership language that helps evoke someone’s own motivation for change because when you think about it everyone’s ambivalent about something and most people are very ambivalent about changing their diet. You know the last thing they want to hear from a dietitian is just eat chicken and broccoli. How do we have a conversation with a client? So, they’re the one talking about change versus us the dietitians telling people what to do. Years ago, I was working at UCLA as a renal dietitian and I remember one Sunday a physician had written a diet order that said no cholesterol, no salt, no phosphorous, no potassium, no sodium. And underneath the diet tech wrote “no fun.” And I thought to myself in that moment that’s what patients think of us. We’re no fun. Right? And how do we have a different conversation so that someone isn’t cringing when we’re walking in the room? “I know another person just telling me what to do. Telling me what I can’t eat.” Fast forward about 15 years ago, I read the book Motivational Interviewing and thought “well, this is a great way to help people with changes that they’re struggling with.” And so I trained in it and about 10 years ago I became a trainer and I will say it is completely rocked my world. It is a beautiful way of being and talking to people that you evoke their motivation for change. And I would say more lasting change than the typical way we usually talk to patients in terms of just telling them what to do.
Mathea Ford: [00:03:45] Can you give us an example?
Susan Dopart: [00:03:48] It’s a way of coming alongside your clients and reflecting what you hear and reflecting with their own internal wisdom is about how to have a conversation. So, I thought I could do with you is a lot of times we ask a lot of questions and people in my training say I wish I just knew the questions to ask. And we think of questions as looking at the problem from the outside and what we call reflections and I’ll get to that motivator. Reflections are looking at the prompt from the inside. So, how do we as clinicians trust that the person that’s in front of us has the answer inside of them and reflect what we hear? So, we get to what will make them be successful. So, let’s just do a little little role play. If you’re willing to play and we call it in Motivational Interviewing Checklist versus the Conversation. So, we can have two different conversations one. The first one will be the checklist and the second one will be the conversation. So, tell me where did you go on your last your last vacation? Your last trip?
Mathea Ford: [00:05:03] Orange Beach, Alabama.
Susan Dopart: [00:05:06] Okay. And how did you get there?
Mathea Ford: [00:05:08] I flew there and drove home.
Susan Dopart: [00:05:12] And how many hours did it take to fly there?
Mathea Ford: [00:05:17] 5 – 6.
Susan Dopart: [00:05:18] How Long did it take to get home?
Mathea Ford: [00:05:22] A day and a half. We stopped halfway.
Susan Dopart: [00:05:26] And there, who’d you go with?
Mathea Ford: [00:05:28] My husband and my two children.
Susan Dopart: [00:05:31] And how many days were you there?
Mathea Ford: [00:05:34] We were there a week.
Susan Dopart: [00:05:36] Okay. So, let’s rewind. Let’s pretend that we never had that conversation. That’s our Checklist Conversation. So tell me about your last trip?
Mathea Ford: [00:05:50] Well, I went to Orange Beach, Alabama with my family for a beach vacation.
Susan Dopart: [00:05:56] So, you got to be at the beach? You know enjoyable atmosphere with the people that you love?
Mathea Ford: [00:06:03] Absolutely right on the beach. Got to go out to the sand every day and yeah! Or sit in the pool. Whichever one I wanted.
Susan Dopart: [00:06:12] You had a choice?
Mathea Ford: [00:06:14] Yes.
Susan Dopart: [00:06:14] Yeah. About how you wanted to be in nature and enjoy yourself?
Mathea Ford: [00:06:21] Yup!
Susan Dopart: [00:06:21] No real responsibilities of usual daily life?
Mathea Ford: [00:06:26] Right! I Just had to make sure my kids were fed.
Susan Dopart: [00:06:31] Yeah! Everyone fed and happy.
Mathea Ford: [00:06:33] And sunscreen. That was a responsibility sunscreen.
Susan Dopart: [00:06:37] Right! So, you do sunscreen and then the rest of the time you got to just chill and relax?
Mathea Ford: [00:06:42] Yeah! I actually usually read a book or two and I read one called Story Brand by Donald Miller.
Susan Dopart: [00:06:51] To expand your horizon to help out with your show?
Mathea Ford: [00:06:56] Yeah! It’s just it’s a really good book about telling stories. We all know telling stories is more compelling than just facts.
Susan Dopart: [00:07:07] Right! You love a story then?
Mathea Ford: [00:07:10] Yeah!
Susan Dopart: [00:07:10] If I can summarize you, you had this lovely vacation where you went with your family. You’ve got to be in nature, you’ve got to be by the beach or be at the pool. You didn’t have as many responsibilities as you have in daily life and you’ve got to expand your mind with some new cool book.
Mathea Ford: [00:07:28] Absolutely! Yup!
Susan Dopart: [00:07:32] So, how did you feel with the first conversation versus the second conversation?
Mathea Ford: [00:07:38] Well, the first conversation it wasn’t a Yes/No questions but it was almost Yes/No questions. It was like not… Normally, I probably answered them just a little bit more because I don’t really know you that well if you were my friend and you’re like “Where did you go on vacation or what did you do on your last vacation?” I would have elaborated but because I don’t necessarily know you personally and talk to you on a regular basis I really didn’t feel like you wanted me to elaborate. Didn’t really feel safe to do that. Yeah!
Susan Dopart: [00:08:13] Absolutely. And how did you feel in the second conversation?
Mathea Ford: [00:08:20] I felt like you were listening and kind of following what I was saying and then asking follow up questions and really interested in what I was saying.
Susan Dopart: [00:08:35] Interested in you as a human being.
Mathea Ford: [00:08:36] Yeah!
Susan Dopart: [00:08:39] So, that’s just a little snippet of asking a bunch of questions which creates that Yes/No answer and promotes what we call disengagement. Right? And the second way was reflecting. I say all the deliciousness of what you are telling me to move the conversation forward. Part of what we want to do in motivational interviewing is reflect what we hear and Stephen Rollnick is one of the authors of the MI says that 90 percent of people do not know how to reflect. They just know how to ask questions or give advice. So, how do we help people in a different way and reflect what we hear? And there’s two different types of reflections and motivational interviewing. One is called Simple where you just reflect basically what you heard. But the common way or the most effective way to help a client is reflect in a way we call a Complex Reflection which adds meaning to what we heard to move the conversation forward.
Mathea Ford: [00:09:48] So what would have been a complex reflection in that back and forth we just had?
Susan Dopart: [00:09:57] Basically, when you talked about being at the beach or at the pool said you’ve got to be in nature, you’ve got to enjoy yourself. Those are things you didn’t say but I added meaning to what you said to help you want to talk more.
Mathea Ford: [00:10:17] Okay. That makes sense. So, a simple reflection is really more just like “So, I hear you saying that you went to the beach?”
Susan Dopart: [00:10:25] Exactly! Exactly! Does it really do… It doesn’t do anything. Someone says “Yeah! I went to the beach!” You know but if I add meaning to what you said it makes someone go in their head and think about saying more. Now, it’s a guess on my part and a lot of complex reflections are guesses but we say in motivational interviewing it’s okay to guess because if you’re wrong the client will correct you and tell you what their truth is. And that brings me to another really important part of motivational interviewing which is called The Spirit of MI which is compassion, collaboration, partnership, and evocation. And even though we are experts in nutrition in our field we are not the expert in the client in front of us. So, how do we combine our expertise with their expertise in them and have what we call Equal Power Sharing. Because if we keep telling people what to do it’s human nature that they’re going to take the opposite approach and tell us why it’s not going to work for them. And there’s a big problem with that. If you’re telling someone you need to exercise and they tell you all the reasons why it’s too much work for them or does not going to fit in their schedule. When someone says that out loud it reinforces to their brain that they’re not going to do it. They become more committed to it. Right? So, Bill Miller one of the other authors of MI says “don’t take the good lines because if you’re taking the good lines of you need to exercise, you need to eat healthfully your client is going to take the more reluctant or resistant lines and say you know that’s not going to work.” You know “I can’t do that, I’ve tried that before.” And the problem with that is they get more committed to that. And it creates more ambivalence. So, we try to evoke the good lines. So, when you’ve exercised in the past or you’ve lost weight, what worked for you? They have to go in their head they have to say it out loud which reinforces to them. How they’re successful and then all you have to do is reflect it back. “So, when you were able to exercise in the past you got up early in the morning or you joined a class or you took a walk with your spouse.” You just have to reflect whatever they said to move that conversation towards change. MI is a language. It’s a language that gets layered in your brain the more you use it. And a lot of times clinicians say “Oh! I know MI. I Went to a class or I took a webinar or I went to this introductory day of it.” And the problem with that is it’s a great way to start to learn MI but it’s because it’s a language you can’t learn French or Spanish in a day. So, it’s you know you have to be committed to really putting in time to really learning it so you can utilize it effectively with clients.
Susan Dopart: [00:13:46] And one thing I say in my training as well, is it worth it? Well, if you find yourself having the same conversation with your clients where you’re the one arguing for change and they keep staying stuck in their ambivalence. Then maybe there’s a different way that you could talk to them so that you are truly getting them to talk about change versus you talking about change. You know and if you feel like you’re always stuck in the water with people this is a way to help move through that stuckness.
Mathea Ford: [00:14:23] You mentioned the four processes or the Spirit of MI – engage, focus, evoke plan. And you talked a little bit about evoke. Can you talk about each of those a little bit deeper?
Susan Dopart: [00:14:35] Sure! Sure. And what was interesting is motivational interviewing is in its third edition now so and that came out a few years ago and that’s when they added these processes called Engage, Focus, Evoke, Plan and a lot of times you hear people try to get to the plan immediately. “Well, what’s your plan? What do you want to do?” Without ever using the other three processes. So, engage. That’s the process where you know you really get getting someone on board with a conversation with you. And research shows that a client will make a decision about whether you can help them in the first one to two minutes. So, how do you engage someone and make those two minutes really count? Right? And part of that is reflecting what you hear so they feel safe. Because if someone feels they don’t feel safe if they feel like you’re going to tell them what to do or give them advice that they’re not sure they want there’s not going to be engagement. And without engagement there’s really not going to be a conversation. Steven Rollnick says “20 percent of the conversation is engagement.” Right? And so when someone walks in my office I’ll say “you know thank you for coming in.” That’s a great way to to show engagement. “Thank you for being here. Tell me what would be most helpful today? What would you like things to look like?” And you see people kind of look at you like “I’ve never heard that one before” you know and then they kind of start to relax and they go in their head and they think about their motivation but why they’re there and then all you have to do is do a few reflections and within two minutes they’re engaged. They feel safe. You create what we call a working alliance with them because without a working alliance, people don’t change. They don’t come back. You have to create that working alliance from the get go. And once you have that then you can you know ask some open ended questions like “Tell me what would be most helpful today? What would you like to talk about? What would you like to work on?” That’s the focus because many times they have like a lot of things in their head. And if you haven’t found the focus then you can’t go on to working on what they really came for. Right? So, someone says “you know I’d really like to figure out a way to lower my blood sugars.” You know a reflection might be “So, you came here because you really care about your health and your diabetes? You really want to figure out a way how to get those blood sugars down that’s why you came in?” It’s a complex reflection that leads towards change. We’re always trying to go towards what we call Change Talk. In Motivational Interviewing, we say there’s three types of talk there’s Discord, there’s Sustained Talk and Change Talk. And our goal is to always pull. We call it Pulling for Change Talk. So, the other types of talk, one is called Discord. You want to… That’s when there’s smoke in the room. Conversations going South. You know someone says “you know you don’t understand me. You don’t get my world.” You know you never want to have conversations that lead towards that. And if you hear that you have to repair you have to say “I’m sorry” or else there is no working alliance. There won’t be any conversation about change. Sustained Talk is about someone’s ambivalence. It’s about you know just their wanting and not wanting incompatible things at the same time which is many times thought of as resistance. But it’s really just ambivalence. And a clinician can invite ambivalence with what they reflect. For example, here’s how you do it. Someone could say you know it’s in response to that same conversation with the diabetic. “You really want to change your blood sugars and yet it’s really hard for you and you’re not sure how to do that?” I just reflected on the second part of my reflection someone’s struggle which the client will talk about the next thing that you said. So, the next part they’ll talk about their struggle. If I flip it and say “although, this is really really hard for you you came here because you want to figure out a way to help your blood sugars come down.” The next thing they’re going to talk about is how to get their blood sugars to come down. So, it all depends. We have so much control and direction in how the conversation is going to go and we don’t even know it. We don’t even know it. But many times I mean I work with a lot of dietitians who are working to learn Motivational Interviewing and there’s a few of them. They’re always reflecting the struggle and the whole conversation is about the struggle. Right? And if you flip it you can acknowledge the struggle because you want to be empathetic but you can reflect what we call the dream or the vision or the values that you’re pulling someone’s brain to go towards what makes them be successful. What makes them go in the direction of change. And if you know how to do that it makes your job so much easier. You know you get out of that struggle with clients you know you get out of that stiffness. At the end of the day your life is so much easier. You know it’s so much more simple because your clients are happy. They’re talking about change, they’re talking about ways they know they’re successful in their lives and they want to come back because they know that you’re going to help them get through what’s getting in the way of them not being successful.
Mathea Ford: [00:20:42] And then the Change Talk is really when you’re kind of making, they’re making those decisions. Those commitments I guess. Or how is that different than this?
Susan Dopart: [00:20:54] There’s different types of that getting into a little more details. Some motivation, everything. But there’s two types of Change Talk. There’s Preperatory Change Talk where they’re talking about their desire, their abilities, the reasons for change or their needs and then there’s Commitment Talk which is like what you said “I’m willing to do this. My plan is to do this.” We say in Motivational Interviewing “If you’ve done a good job of engaging, finding the focus and evoking what makes someone successful the plan or the commitment language will just emerge. You know you don’t even have to ask about it.” So, when you’ve been successful with checking your blood sugars you set a timer or when your blood sugars were more even keeled you made sure to have protein at every meal and then someone just blows it up. “Yeah! You know I realize now talking to you I was able to control my blood sugars when I included protein at every meal and I watched my carbs or whatever it is.” You’re trying to go in and say “I must be a detective about what has made them successful in the past.” And can they pull from that? And use it in their current situation with whatever they’re ambivalent about.
Mathea Ford: [00:22:16] When you think about clients and kind of how they do a little bit of resistance or you said it’s ambivalence. What is typical that people are going to… Or you see clients usually showing what kind of ambivalence, what kind of resistance?
Susan Dopart: [00:22:36] I mean everyone’s ambivalent about something. Right? You know “should I pay bills or should I go to the movies? Or should I go for a walk when I get home from work or should I sit in front of the TV and watch Netflix?” You know it’s like so many things in our life we’re ambivalent about and we’re procrastinating about. And like I said it’s thought of as resistance so how do you know a lot of times people will come in and they’re resistant because you know they think you’re dietitian you’re just going to tell me what to eat. Right? And food is very intimate. Right? Many times people don’t want to be told what to eat. I will say if someone is super motivated and comes in I don’t need to use Motivational Interviewing but most of the time I will use it because people have been ambivalent. They’re struggling with how to be successful. They may say something like “and I’ve seen a lot of dietitians in the past. Nothing’s worked. I’m just here because my doctor told me to come in.” Those are some resistant statements. So, I’m just going to reflect what I hear and say “So, you know you haven’t had a lot of success in the past. You had experiences with people telling you what to do it really hasn’t worked. And even though your doctor said for you to come in I’m wondering you know you had a choice about that. You had a choice about whether you want to come in and I’m wondering what made you decide to really make that appointment to come in?” Okay? They have to go in there. They have to think about their motivation. You have to say it out loud which reinforces to their brain why they came in and then all I have to do is reflect it to make the conversation move towards change because what they’re doing is they’re throwing out a smokescreen and we don’t want to do is take the bait. Don’t take the bait with a smoke screen or sometimes your clients will say to a dietitian “well, tell me what you eat?” You don’t take the bait. Never. You never tell what you eat. You emphasize autonomy. You say “well, you know what I eat is going to be completely different than what you eat. Because we’re different people we have different physiology. So, today we have to figure out what’s going to work for you. What’s going to be the way that’s going to work for you. And together we’re on this journey to figure out how to help balance your food, control your blood sugars. Tell me you know even though you’re struggling with this now, is there anything that’s worked for you in the past?” Right? Because remember we’re trying to evoke what has made them successful. So, there’s a lot of different ways you can navigate these Motivational Interviewing conversations. But if you have resistance you have to roll with it. We don’t head into it. You just roll with it. So there’s nothing left to resist against.
Mathea Ford: [00:25:37] Because all the things they’re saying are things that are things that they’ve been successful with in the past. Or they’re telling you what they’re they’re struggling with so you can I guess you’re reframing it for them in a way by reflecting.
Susan Dopart: [00:25:53] Yeah! Another thing that’s you know interesting with dietitians when people come in they start confessing. Right? Like you know “I haven’t done this, I haven’t done that, I have done that.” It’s kind of like you’re the parent. You know, way to kind of deflect that in Motivation Interviewing, you know “let’s put that aside. You showed up today. I’m making what I call an affirmation. I’m noticing what they’re doing well and affirming that you know you could have canceled, you could have no showed but you came in today show and you really want to change this. So, I’m wondering what actually worked for you this week. Would you feel like you did well? Right?” I’m pulling for Change Talk. I’m pulling for them to tell me what they did well. Say it out loud. I reflected to have the conversation go towards change. Right?
Susan Dopart: [00:26:49] So you want to stay away from being punitive or you know being the taskmaster. Right? Or some things that are you know normal sometimes with conversations with professionals where you’re it’s kind of a setup for you telling someone what they didn’t do or they’re wrong or you know threatening types of statements because it doesn’t lead towards change.
Mathea Ford: [00:27:17] So, how do you dig a little deeper if you feel like someone’s not telling you the whole story so they’re just really “I came here cause my doctor wanted me to they’re like I don’t know why.” If they start kind of not telling you the whole story or you suspect like you mentioned you the food police sometimes they’re like confessing. But they also come in with a perfect story because they’ve been to so many dietitians. They know what they’re supposed to say.
Susan Dopart: [00:27:49] Right! Why Don’t we do a little role play? And you’d be that person and I’ll model it for you.
Mathea Ford: [00:27:54] Okay. So, where do you want to?
Susan Dopart: [00:28:01] So, you start with being just say what you just said and all.
Mathea Ford: [00:28:06] I don’t know. My doctor sent me here but I eat fine. I eat three meals a day. Good food. I always have vegetables. And I don’t know why I’m not losing weight.
Susan Dopart: [00:28:20] So, it’s a little bit of a quandary. You’re doing everything possible. You know how to do and yet the scales not budging.
Mathea Ford: [00:28:34] Yup!
Susan Dopart: [00:28:35] So, tell me a little more about that? Tell me about kind of what your day looks like and all the things that you feel like you’re doing?
Mathea Ford: [00:28:46] Well, I get up in the morning. I always have breakfast. I usually eat a bagel and I put a little bit of cream cheese on it and then I go to work, take my lunch. Always take a salad, put a bit of grilled chicken on it and then I use like a low cal salad dressing and I have an afternoon snack. I try to get a little handful of walnuts and then in the evening I come home and three days a week I walk for an hour on my treadmill and while after dinner and then dinner we usually eat as a family and we always have a green vegetable and some meat and potatoes or you know like rice or something like that. So, I am not seeing any change at all.
Susan Dopart: [00:29:39] You have a lot of things that you’re doing in your life. You’re making sure you have your meals and your snacks. You’re getting in your exercise, you’re really thinking about how much you’re eating. And somehow it doesn’t seem to be leaning towards the plate you want to go. So, I’m wondering in the past is there anything that has worked for you in terms of weight loss?
Mathea Ford: [00:30:10] I think it was being younger.
Susan Dopart: [00:30:14] Having a better metabolism.
Mathea Ford: [00:30:18] Absolutely! Now, that I am 45 seems to have slowed down.
Susan Dopart: [00:30:24] Going towards menopause. Right?
Mathea Ford: [00:30:26] Yeah! Yeah Something like that.
Susan Dopart: [00:30:29] So, I’m going to demonstrate something a technique in Motivational Interviewing called E.P.E – Elicit Provide Elicit – because I think a lot of dietitians will think “well, you know I’m trained to tell people what to do. What do I do?” Right? And so I’m going to demonstrate that. So. Elicit a minute I listed it for you. What has made you successful in the past. So Mathea, when you’ve lost weight I know you’re on a roll. You know when you’ve lost weight in the past. Besides being younger, is there anything specific that has seemed to work for you that you can remember?
Mathea Ford: [00:31:09] I did Weight Watchers and I counted on my points. And I did that. That seemed to work at least for like a month. And then if I didn’t count points it didn’t seem to work too much.
Susan Dopart: [00:31:25] So, you had to really be super conscious about every bite you made?
Mathea Ford: [00:31:35] Yeah! Paying Attention to portion and then just tracking it knowing kind of how much I could have.
Susan Dopart: [00:31:43] What helped with the tracking do you think would help you to likes to be focused with that and motivated?
Mathea Ford: [00:31:54] Well, at first you have to believe that it’s going to work. So, I just kind of said “Okay, I’m going to give it a try and give it an offer you know see what happens.” And then I did show some weight loss. And so after that it’s like “Okay, if I track I’m going to have the results” and it does keep me from going into the office, seeing people with donuts and going “Ohh! I cannot have a donut today.”
Susan Dopart: [00:32:22] So, the results really helped you and kept you on track with not getting sidetracked with things at the office?
Mathea Ford: [00:32:34] Yeah! Just knowing that if I eat that donut I’m going to have to not pay for it later. But just later.
Susan Dopart: [00:32:45] Well, you realize in that moment that eating the donut wasn’t going to lead you to the place you wanted to go?
Mathea Ford: [00:32:51] Right!
Susan Dopart: [00:32:52] Right. Yeah! And I’m wondering, you know we could in our session today, we could talk about food. We could talk about exercise. We could talk about sleep or you know mindfulness with eating or we could talk about something else. So, I’m wondering which of those resonate with you in terms of what would be most helpful to talk about in our session?
Mathea Ford: [00:33:22] Well, whichever one of those is going gonna lead to me losing weight.
Susan Dopart: [00:33:25] Yeah! Well, part of that is figuring out for you what makes the most sense to you today. Right. Because really it’s all about you. You’re the driver of this and how do we together figure out what’s going to be most doable or sustainable for you.
Mathea Ford: [00:33:46] Yeah! I mean I didn’t really enjoy accounting for food type stuff but I did see success with that in the past so that might be a good thing to talk about.
Susan Dopart: [00:33:57] Right. So, maybe kind of how do you balance your meals or work on your food without having to be so super tight about the numbers? That might be helpful.
Mathea Ford: [00:34:08] Sure!
Susan Dopart: [00:34:10] Okay! So, I just modeled what we call EPE (Elicit-Provide-Elicit) So, what I did is elicit from you what you’ve been successful with in the past. And then I provided you a number of options and the research shows and you provide options, everyone wants control and choice so they’re more likely to make a choice and pick the thing that they want to talk about so that you can actually go to you know Elicit Provide Elicit and you can elicit and give them information about that thing that they’ve gotten on board with. Even though it’s a little bit of a setup if you’re willing to trust that and use it your progress will be much quicker because someone’s brain will be more onboard with receiving and listening to information.
Mathea Ford: [00:35:04] Yeah! I felt like I was being really difficult but I know I’ve had a lot of people that talk us to like that like I’m doing everything perfect but yet you know you know there is something wrong because there’s it’s out of balance. So, yeah! That was good at being a really bad pain in the neck patient?
Susan Dopart: [00:35:25] No! You were actually a very normal patient. You know. I mean I always say “I’m the end of the line” when people come and see me. You know they’re like “I’ve tried everything! I’ve done this! I’ve done that!” And you know they show up because they really do want the help. So, how do you kind of reflect and hone in on what got in the way of them being successful? And that’s a question you can ask someone. You know “I wonder what’s getting in the way of you doing what you truly want to do?” You know they have to go in their head. They have to think about it. I have to say it out loud which helps them realize what is getting in the way. And then if you reflect that statement towards change you know it’s like makes your life and your work so much easier and so much more fulfilling.
Mathea Ford: [00:36:17] This is the thing I talk about sometimes with other RDs like if knowing how to lose weight was the way to lose weight then we would all be skinny. Right? But it is that next step after we know what to do. We know we need to eat healthier, not eat so many calories. You say that all the time but kind of having that in a way that is like “I understand what you mean” when you say the agreement and that kind of the working agreement like “Okay, we’re going to work together but I’m not going to be the food police” type of thing.
Susan Dopart: [00:36:56] And telling people they’re the driver. You know they’re the ones that are in control because emphasizing autonomy is really a way for people to think about “well, what is it that I truly want? What is it that I’m going to do? I need to take responsibility for my choices.”.
Mathea Ford: [00:37:12] Yeah! And they don’t come with a list of things that the dietitian told them to do. They leave with a list of things that they’ve agreed and feel like is possible over the next terrible long till they see you again. Right?
Susan Dopart: [00:37:27] Right! They start to leave with hope.
Susan Dopart: [00:37:29] Yeah! And that’s what we we truly want is how do we help people and keep our eyes on the horizon for change in people who don’t have hope for themselves. And that’s really what our true goal and mission is is you know a lot of times we say “meet people were there at” and in Motivational Interviewing, w”e don’t say that and say meet people at their dream. What’s their hope? What’s their dream? Why did they walk in that office?” Even though they’ve had all these lack of successes in their life. There is a part of them that is still looking for hope. That is still looking for a way to help their health, their life, their blood sugars or whatever it is. And how do you evoke whatever it is that’s there so that you almost work yourself out of a job. So, they realize they could do this. That it’s possible, it’s reasonable, sustainable and now we just give people lists of information and folders of things. Most the time it’s you know in the trash. You know it’s not. So, how do we really figure out the piece of what it is they really need so that when they leave they know what we know they have some hope about what they could do.
Mathea Ford: [00:38:52] So, how do you measure the results of Motivational Interviewing? Because I know we have Medical Nutrition Therapy Plans that tell us what to go through and what to track and all that stuff. But how do you measure the results when you’re working with patients when you’re using Motivational Interviewing?
Susan Dopart: [00:39:08] Well, there’s about 800 clinical trials that showed when clinicians use Motivational Interviewing there were much better outcomes. But I guess personally for me it’s you know now are people losing weight? Are their blood sugars they’re going down? Their A1Cs going down? Is their health changing? That happens all the time. I mean I have a man in my practice who is 75 years old and he came to me about a year or nine months ago. So, almost two years ago in December his A1C was nine and a half. His creatinine was 1.8, he’s 5 foot 8 and he was 330 pounds. And his physician said to him “you know I think you need to put your affairs in order because your health is not going in the right direction.” And he walked in and the physician said to me “I don’t know if this is going to work because he’s eats a lot, drinks a lot. Very overweight you know. Got a lot about risk factors but let’s see how it goes.” And I used a lot of Motivational Interview with him. He never knew about insulin resistance so we talked about that and you know when I basically made it his choice. “You know it’s your choice but this is what we could do together.” And you know this is one of those cool success stories where today he’s 158 pounds. He just… All he did was watch his carbs. You know we had a metformin. He brought activity back into his life and you know he was really meticulous about his carb intake. And I can say you know I saw him a couple days ago. I see him every two or three weeks and he said “you know my blood sugars are creeping up on meat and a little too many carbs. And I just need to you know cut back on that.” And I have to do is reflect that. That’s all I had to do. And he e-mailed me this morning and said well he e-mailed me “blood sugars less complex because look I cut back on my carbs and they’re coming right down.” So, he was the one giving the solution but that came from all the work we had done with Motivational Interviewing. And I truly believe he’s going to be one of the ones that completely maintains his weight and his A1C is now 5 which is unbelievable.
Mathea Ford: [00:41:34] Unbelievable. Yeah!
Susan Dopart: [00:41:36] But his Creatinine came back down to 1.2. So, you know he’s one of those success stories but you know he’s not unusual. I mean I have a lot of people in my practice that if you know they’re willing to go the road with you and their brains work well with Motivational Interviewing they can be quite successful.
Mathea Ford: [00:42:01] If you think about I did mention you know we have these Medical Nutrition Therapy Plans that when you get Medicaid or Medicare, you kind of have these guidelines that you follow. How do you still do that while you’re doing Motivational Interviewing? Is the Motivational Interviewing kind of the precursor to that? Or how does that work together?
Susan Dopart: [00:42:25] Well, I mean it’s easy to weave in Motivational Interviewing with your assessment but I mean one thing I always say in my trainings is “you may get the best assessment at the first session but if you haven’t created that working alliance with someone how good is your assessment if they don’t come back? If they don’t feel like you were able to create that alliance with them.” Right? So, you know engagement is easy. I mean if you’re reflecting within those first two minutes and creating engagement then someone is much more willing to have a conversation with you. And sometimes you know if you have questions to ask for your medical you know in respect your Medical Nutrition Therapy you can just say “you know I have a few questions I need to ask would that be okay?” Because a thing in Motivational Interviewing we say “when you ask permission, its about to show respect.” So, we always want to show respect. So, if you have to ask a few questions, you just ask permission to do that and then you kind of weave in the Motivational Interviewing with engagement, finding the focus of why they’re there and then evoking. So, it can be a very fluid conversation. You know when you watch it it can be very natural you know and it’s just where you’re evoking more of these solutions from the client versus us the clinician. And if we need to talk about things because of course we do you know especially with people who are diabetic or someone with gestational diabetes you ask permission. You get them on board with receiving information. And Stephen Rollnick you know one of the authors of MI says “if you trust the method and you slow things down in your mind, the progress will be much quicker” and a lot of times us as professionals we’re in such a hurry to get to the plan that we end up getting all this resistance and it slows our progress. Right? It creates people who are more resistant or reluctant to change. So, Motivational Interviewing, it’s a way of being with people. Are we present? Are we truly listening to what they need and reflecting that? Do we know really why they’re there? You know a lot of times we think “oh! They’re diabetic! They’re here because we have to talk about their food” but is that really why they’re there?
Susan Dopart: [00:44:56] Maybe they want to talk about you know Blood Glucose Management or they want to talk about exercise. You know the more we go with where they want to go, the quicker our progress will be. And so it’s just a lovely way of talking to people and making our job easier.
Mathea Ford: [00:45:16] Do you have any quick tips or thoughts for how the listeners could use this in their day to day life without obviously knowing the whole scope of Motivational Interviewing? Any little thoughts?
Susan Dopart: [00:45:27] Well, listening is hard. Most people don’t do it. And a way you can practice is maybe with start with a friend or start with their child is ask a question “how was your day?” And then whatever they say try to do a reflection of what you heard or add meaning to what you heard rather than asking a bunch of questions. And you know people laugh when I do the Checklist versus Conversation like I did with you. But yeah people do it. You know I’m a coder in Motivational Interviewing. So, what does that mean? When people are trying to learn the language they can submit a 20 minute tape, an audio tape of them having a conversation with a patient or a client and then it’s coded to the fidelity of the language and are you evoking Change Talk? Are you showing empathy and partnership? Right? And that’s a really great way to start to learn Motivational Interviewing after you’ve gone to an initial workshop because even if you actually never had the conversation coded, if you actually get permission from a client to tape a conversation and you just don’t use any names so it’s anonymous. You can hear what you said and what the client said and this is a very important point. When I became a coder, I started realizing that a code that you can almost 99% predict what a patient’s going to say based on what what the client says. What we say really does matter. Right? So if we are telling someone what to do we might get Sustained Talk, ambivalence. You know if someone feels judged, there’s gonna be discord but if we’re reflecting what makes them somewhat successful we’re going to get Change Talk. Right? So, how do we choose our words carefully so that we get more Change Talk? And part of that is through affirmations and reflections and reflections like I said are hard to learn. But if you practice in your day to day life it’s going to be more natural when you’re with the client. Now one qualifier I will say is it’s very hard to use motivational interviewing with your spouse or someone that you have an agenda about and then this is a very important point in Motivational Interviewing. We are guiding towards the possibility of change but we don’t have an agenda because if we have an agenda in our head we’re going to be forcing that agenda which is going to result in Sustained Talk or Ambivalence Talk. Like with my husband, he doesn’t like exercise so I can’t have a Motivational Interview and conversation with him about exercise because my agenda is I want him to exercise but I can have my conversation with him about something else. Something related to work where he just talks about what’s going on and I reflect. I add meaning to his statements about what what he’s feeling or thinking and that’s a way you can practice with with your friends or people that you come in contact with so that it’s more natural when you’re in the office.
Mathea Ford: [00:48:43] That makes sense. It does seem like you said it’s a language it needs practice and building up your skill level so. All right. So, my last question is what’s your favorite food? I try to ask everybody that. So, what’s your favorite food Susan?
Susan Dopart: [00:49:02] My favorite food is almond butter like fresh ground almond butter. And my treat of the day is I always come home and have a tablespoon or so of almond butter with a score of 85% dark chocolate and my favorite dark chocolate is Alter Eco. So, that’s kind of my treat with a cup of tea when I get home from work. I’ve done a big training or seen a bunch of clients. That’s kind of my transition before dinner.
Mathea Ford: [00:49:32] I love it. It’s almost like Reese’s but much better.
Susan Dopart: [00:49:35] Much better. Much healthier.
Mathea Ford: [00:49:39] Yeah! Yeah! Well Susan, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about Motivational Interviewing and just even making some small changes. If listeners want to connect with you what’s the best way to do that?
Susan Dopart: [00:49:58] My website is Susandopart.com S-U-S-A-N D-O-P-A-R-T.com and I have a lot of information on there about trainings both in-person and virtual trainings but I also have an MI blog and what I try to do is once a month or so I’ll put a type of tool for Motivational Interviewing like what type of talk are you hearing or how do you evoke Change Talk and you can read a couple paragraphs on each thing and you know a lot of times it’s a good way to reinforce in your brain how to use Motivational Interviewing especially if you don’t have time to go to a workshop or expand your use of it in any other way. It’s a nice way to read about things so. But I do have virtual trainings for people that aren’t in California. I started doing those about a year ago with Zoom. It’s actually as what you and I are on it right now it’s a pretty cool platform. It’s actually better than I thought. It would be because you can put people in virtual breakout rooms and show videos on the whiteboards and that’s pretty much the next best thing to being in-person. So, that’s a great way for people to learn those who don’t have access to workshops and other areas as well as being more affordable. So, you can if you have questions about Motivational Interviewing you’re welcome to email me at Susan@susandopart.com or send me a message via the website. But I’m just. I love this beautiful collaborative partnership language and I guess my hope is that more clinicians specially dietitians will get more proficient in Motivational Interviewing. So, thank you for having me on your show so I can spread the word and really really appreciate it and thank you for being my model for demonstrating the skills. Truly a pleasure to be here.
Mathea Ford: [00:52:05] Yey! All right! Well, guys it’s been another great episode of the Nutrition Experts Podcast. The podcast that it’s all about learning more so you can do more with nutrition in your life.
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