Counseling and Communication
Behavior change and the counseling relationship
Know the major frameworks. Transtheoretical (Stages of Change) - precontemplation, contemplation, preparation, action, maintenance; relapse is part of the cycle, not a failure, and the matching intervention differs by stage. Giving action-oriented advice to a precontemplator produces resistance. Social Cognitive Theory - self-efficacy, observational learning, reciprocal determinism, environmental cues. Health Belief Model - perceived susceptibility, severity, benefits, barriers, cues to action, self-efficacy. Self-Determination Theory - autonomy, competence, and relatedness support intrinsic motivation.
Motivational interviewing is the highest-yield skill. Its spirit is partnership, acceptance, compassion, and evocation. Use OARS (open questions, affirmations, reflections, summaries), elicit and strengthen change talk (DARN-CAT: desire, ability, reasons, need → commitment, activation, taking steps), and roll with sustain talk rather than arguing. Avoid the "righting reflex" - the urge to correct or persuade before the client is ready.
Communication craft: plain language, teach-back to confirm understanding, chunk-and-check, open-ended questions, reflective listening. Screen for health literacy and use a trained interpreter rather than a family member for sensitive information. Practice cultural humility - ask about food practices rather than assuming.
Trap: answer options that describe advice-giving or persuasion and label them motivational interviewing. MI is collaborative and directional toward the client's own reasons for change.
Rule of thumb: if you are talking more than the client, you are not doing MI.