Motivational Interviewing

Want your patient to shake a drug habit, stick to a diet, or muster the courage to finally make that change? Or perhaps you’re a manager, and your employee is at risk for dismissal. How do you create sustainable behaviour change?

You could tell them why you think they should change, and then ask them to do so. This approach will often appear succesful. People say they agree to change, but will often fall back into old habits. That’s because they’re not convinced of change themselves. External motivation is not enough for sustainable change.

The key to sustainable behavior change is to find that small, ambivalent spark in someone’s heart that knows they should change, and turn that into a raging fire. Motivational Interviewing helps you do that. ¹1Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.↖

What is Motivational Interviewing?

Motivational Interviewing is a counseling method developed by Miller & Rodnick, two clinical psychologists, in 1983. It promotes collaboration not confrontation, and aims to evoke someone’s own thoughts and ideas, instead of imposing your perspective on them. It emphasizes autonomy, and empowers people to take responsibility for their own actions.

Key principles

Motivational interviewing defines four key principles:

1. Express empathy by trying to see the world as they see it.
2. Support self-efficacy by highlighting previous successes and strengths they already have.
3. Roll with resistance, avoid confrontation and prevent arguments. Dance with them, rather than wrestle.
4. Develop discrepancy between the current situation and their values and goals.

Strategies

To achieve those four principles, it lists four key strategies.

1. Open ended questions
2. Affirmations help reframe behavior and concerns as positive qualities.
3. Reflections help express empathy and develop discrepancy by strategically mentioning information.
4. Summaries do the same thing, while also providing a way to structure a conversation and prevent resistance.

The strategies can be remembered using the acronym OARS.

Change talk

A central skill in motivational interviewing is listening for signs of change talk. These are subtle signs that indicate a willingness to change. They are divided into preparatory signs and signs of implementation.

Preparatory signs

• Desire. I want to change.
• Ability. I can change.
• Reason. It’s important to change.
• Need. I should change.

Signs of implementation

• Commitment. I will make changes.
• Activation. I am ready to change.
• Taking steps. I am taking specific actions to change.

The signs of change talk can be remembered using the acronym DARN-CAT.

Open-ended questions you can steal

The whole point of motivational interviewing is to elicit change talk. To do so, you must ask questions to which the answer is likely to be change talk.

Then, you elaborate:

• “In what ways?”
• “Tell me more?”
• “What does that look like?”
• “When was the last time that happened?”

Other questions are about developing discrepancy between where they are now and where they want to be:

• “What are the pros and cons of staying the same? And what are the pros and cons of changing?”
• “What are the good things and the not so good things of target behavior?”
• “How were things better or different before the target behavior emerged?”
• “If you were 100% successful in making the changes you want, what would be different?”
• “What are the worst things that might happen if you don’t make this change?”
  • “What are the best things that might happen if you do make this change?”

Yet other questions try to make behavior more intentional and goal-directed:

• “How would you like your life to be five years from now?”
• “On a scale from 1 to 10, how important is it to you to change the target behavior?
  • Why are you at __ and not at __ (a lower number than stated)?
  • What might happen that you could move to __ (a higher number)?”
• “What are your goals and values?” (consider using a card sort activity)
  • “How does continuing to do target behavior fit in with your goals and values?”