Motivational Interviewing

 

How to Ignite Motivation for Change with 8 Simple Techniques

Igniting the motivation to make changes is hard.

People often fail to make changes even when they know they should. The problem isn’t a lack of information. It’s a lack of motivation.

Motivational interviewing is a counseling method designed to help people make different choices by finding the internal motivation to change their behavior. Dr. Bill Matulich, a clinical psychologist in San Diego, California who has been teaching MI for decades, defines it simply as “an effective way of talking with people about change.”

To understand motivational interviewing, let’s consider the story of a friend of mine, Matt.

Matt heard the same speech from his doctor:

Your blood pressure is too high. You’re at risk for heart disease and stroke. You really need to lose weight, and quit smoking.

They’d been having this same conversation every year for a decade. Matt knew he should change, but he hadn’t. He felt frustrated. His doctor felt frustrated to be giving the same speech he gives to so many people, and it rarely seems to sink in.

It’s a widespread problem: According to the United States’ Center for Disease Control, lifestyle changes could reduce the death rate by up to 40%. Just by making different choices! But even though patients like Matt – and many others – “know” they should exercise more, eat healthier and avoid tobacco, finding the motivation to make those changes is a lot harder than it sounds. That’s the bad news.

The good news? Motivational interviewing is a communication technique that shifts the dynamics of accountability and motivation around change efforts – with powerful results. A recent meta-analysis of 72 clinical trials found MI to have a significant and clinically relevant effect in 75% of the studies for behavior changes like quitting smoking, decreasing alcohol use, and losing weight. 

This stuff works.

So how does it work?

 

MI flips the traditional model on its head.

Traditionally, an expert gives advice and assumes that people will change their behavior once they have information indicating they should. It’s a top down approach, and it encourages passive listening. The motivation is completely extrinsic: “My doctor told me I have to…” This is the conversation Matt had for a decade about losing weight and quitting tobacco.

Motivational interviewing, on the other hand, takes a more collaborative approach. The interviewer encourages clients to talk about their need for change and their own reasons for wanting to change. The goal is to elicit that person’s intrinsic motivation.

Here are 8 skills one uses to practice motivational interviewing – explained by examining how Matt’s typical conversation with his doctor could be different with MI.

8 Skills to Practice Motivational Interviewing

According to the Motivational Interviewing Network of Trainers (MINT), 4 principles form the spirit of motivational interviewing: partnership, acceptance, compassion, and evocation. A motivational interviewer must work collaboratively and avoid the “expert” role, and trust that the best ideas for how to change come from the client. To that end, these 8 skills, which share many overlaps with Six Seconds’ EQ Model and Learning Philosophy, help bring the theory of motivational interviewing to life.

Ask open questions – Instead of giving Matt a diet and telling him it’s important to follow it, the doctor may ask: “What do you think is going well with your eating?” Or, “What strategies have worked for you in the past?”

Express empathy – The doctor could say, “Matt, I understand that it has been difficult for you to exercise and lose weight in the past. Many of my patients find this to be difficult. I think it is still important for us to try to find ways for you to work on this.” This is the EQ skill of increasing empathy.

Offer positive feedbackAffirmation is a crucial part of motivational interviewing. If the doctor asked, “What strategies have worked for you in the past?” Matt may tell him about a time in the past when he ate healthily or exercised regularly, but then fell off. The doctor should affirm the value of that effort or any ongoing efforts that come up: “This is hard work you are doing.”

Elicit self-motivation – Instead of telling Matt that he should quit smoking and lose weight, his doctor could ask questions that help him think about the problem – and what could be done – in different ways. A few examples include:

  • “Matt, how do you feel about changing your eating or exercise behaviors?”
  • “What are the most important things to you? What impact does your weight have on that?”
  • “If you decided to change, what might your options be?”
  • “How can I help you succeed?”

These are just a few questions of many that a doctor could ask. But there is a fundamental truth behind it all: When patients develop the plan, it’s more successful.

For more questions, check out this document on Motivational Interviewing from the Rudd Center at the University of Connecticut.

Reflect back thoughts and feelingsUnderstand what the patient is thinking and feeling, and then say it back to them. If Matt says he eats junk food at night when he watches TV and he wants to stop, the doctor could say back, “Eating junk food as you watch TV is one thing you’d like to change.”

Summarize key points – This is similar to reflecting back thoughts and feelings, but it’s a long reflection of more than one statement. The doctor could day, “Matt it sounds like you are really committed to change because you want to live long enough to see your grandchildren. From what you told me, some challenges are your tendency to eat junk food when you’re stressed and watching other people play sports instead of exercising yourself…”

Roll with resistance – When patients express reasons for not achieving goals, the physician can help them find ways to succeed. If Matt says, “I just always gain the weight back after I lose it,” the doctor could say, “That is a common problem. What would make you more confident about making these changes stick?” This is closely related to the EQ skill of exercising optimism – helping people see there are many options even when they can’t see them.

Provide personalized feedback – This is an opportunity that is a natural result of asking more open ended questions. It’s important to keep avoiding the expert role as you give feedback. The doctor could say, “Matt, you said that one of your first steps will be to keep a food log. Some of my patients have found it helpful to use this app called MyPlate…”

Don’t Underestimate Intrinsic Motivation

Six Seconds’ research found that engaging intrinsic motivation is the EQ skill most highly predictive of good decision making, and at its heart, motivational interviewing is an effective technique for engaging intrinsic motivation.

Whether you are a coach, leader, teacher, parent or just someone who knows someone else who wants to make a change, try it out and see what happens.

 

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Michael Miller

Writer at Six Seconds
Michael Miller is a writer and contributor for Six Seconds who lives in Santa Cruz, California. He is passionate about living a balanced, healthy lifestyle and helping others to do the same. You can reach him at [email protected]

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