Motivational Interviewing-Steps to Behavior Change
Are you motivated by someone telling you what to do or are you more motivated to do something when it is your own idea and choice to do it? You probably agreed with being more motivated by your own ideas and decisions. Do you think your clients feel the same way when it comes to their wellness pursuits? Here we’ll share information on motivational interviewing and how it can help your clients discover their own reasons and motivation to live a healthier life.
What is Motivational Interviewing (MI)?
“. . . a collaborative, person-centered form of guiding to elicit and strengthen motivation for change.”(1)
Motivational interviewing originally had its roots in addressing the behavior change obstacles problem drinkers encountered (2). MI uses the individual’s own motivation to change, and commit to that change. Unless someone perceives there is a good reason to change a health behavior, they probably wont do it. As we’ve all experienced in one way or another, just informing someone of the reasons why it would be good to change an unhealthy behavior doesn’t mean they’ll take action (3).
Behavior change begins when a person feels there is a problem or a need for them to change (i.e., medical situation, wanting to set a positive example for family, an upcoming event, etc.) (4). MI is about helping your client discover their reasons for wanting to change and strengthening their intrinsic motivations (and commitment) to achieve these changes (5).
We tend to believe what we hear ourselves say (2). Let the client tell you the reasons they want to change and what the positive benefits will be for them. It may be tempting to ask them about the challenges they foresee for themselves with making these behavior changes (e.g., I’ll miss eating ice cream every night, exercising will take time away from other activities I enjoy, etc.), but by turning it around to focus on the positive outcomes, they’ll better believe in the possibility of accomplishing change (I’ll have more energy to keep up with my kids when we go hiking, I’ll use my creativity and enjoyment of cooking to make healthier side dishes).
Five Principles of MI
Motivational interviewing is based on five principles (2,3,5,6):
- Expressing empathy: This is about sharing an understanding of a client’s situation and what may be causing their ambivalence. It is not sympathy or always agreeing with the person. It requires you to hone your active listening skills, understand their situation, reflect on what they are communicating, and accept without judgment (2,3,5). Avoid offering advice or warning them of what could happen if they don’t change their behavior (5). Clients need to feel they are being listened to and understood (4).
- Avoiding argument: Arguments are counterproductive and can make the client defensive and resistant (2,3,5). The goal of MI is to motivate clients to make changes. Recall that we tend to believe what we hear ourselves say, so avoid having the client argue against the behavior change.
- Supporting self-efficacy: Help your client realize they have the ability to change, and maintain that change (2,3,5).
- Roll with resistance: Understand your client may have a different perspective of the situation, so roll with it. Don’t argue about the changes, rather take the opportunity to explore what the client may perceive and keep them involved in finding solutions (5). You need to adjust, not your client.
- Develop discrepancy: This is when a client grasps where they are today and their future goals. It’s an opportunity to explore the consequences their actions may have on their values and achieving their goals (2,3,5).
When a client has mixed feelings or views about making a change, this is referred to as ambivalence (2,3,5). They may argue for reasons not to change. Ambivalence is normal. When they talk about making the change, they may include “but” statements, such as “I want to exercise, but don’t have the time,” or “I want to add more vegetables to my diet, but my family wont eat them” (2). The goal is to get them to start “change talk” to help them pinpoint their motivational reasons. Change talk includes: (2)
- Desire: What does the person want to do?
- Ability: Can they do it? How?
- Reasons: Why do they want to make the change?
- Need: Is there a need or necessity to make the change?
The above four types of change talk, DARN, are precommitment. There are two additional types of change talk, commitment and taking steps, when the client has committed to and has begun taking action (2). As clients expand to using these last two types of change talk, it predicts a more durable change of behavior (2). When a client shares an action they’ve taken to attain a goal, such as increasing how many days they are exercising or walking distance they’ve added, affirm their efforts! As you may have noticed, MI techniques can also be used to facilitate progress through the Stages of Change Model (2-3). Developing rapport with your client is also key to the success of MI (2-3).
Motivational interviewing helps your clients discover their reasons and motivations for making behavior changes. Through supportive dialogues that center on expressing empathy, avoiding arguments, supporting self-efficacy, rolling with resistance, and developing discrepancy, you are collaborating to help them increase their odds of achieving and maintaining these changes (2).
Discover more on behavior change and how to help your clients live a healthier life with NASM’s Behavior Change Specialization.
- Miller, W.R. and Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.
- Rollnick, S., Miller W.R., Butler, C.C. (2008) Motivational Interviewing in Health Care. The Guilford Press. New York, NY.
- Bundy, C. (2004). Changing behavior: using motivational interviewing techniques. Journal of the Royal Society of Medicine, 97(Suppl. 44):43-47.
- Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th edition revised. Jones & Bartlett Learning, Burlington, MA.
- Treatment Improvement Protocol (TIP) Series, No. 35 Center for Substance Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 1999. Report No:(SMA) 99-3354.
- McIntosh, L. (2006). Using and building motivational interviewing skills-part 1. MI assessment. Addiction Messenger, 9(10)1-3.