Bringing About Meaningful Behavior Change

Meeting new people can lead to many things in life. For personal trainers and behavior change specialists specifically, the situation can offer up opportunities to network, connect with someone in a new field or part of town, and potentially even gain a new client exists. How this meeting and potential relationship unfolds is ultimately up to you and your approach.

Before we jump right in: If you are interested in the behavior change - as it relates to nutrition - check out this free nutrition and behavior change mini-course we released. 

Ambivalence and behavior change

When people discover they are speaking to a personal trainer, they shift the conversation towards their own practices, challenges, and excuses. Here is where ambivalence becomes evident.

Ambivalence is when we feel conflicted, often regarding changing habits. We may know that our stomach will be upset, or we might feel guilty if we eat too much yet indulge ourselves.

We also know that exercise and being physically active are extremely important; however, only 24% of the population meets the Healthy People 2020's objectives for aerobic physical activity and muscle-strengthening activity (Healthy People, 2020). Generally, personal trainers respond in one of two ways:

Option 1: Respond relatively quickly to the interested individual with advice and direction based on a combination of research and personal experience. The expert in us wants to scream and shake people to grasp the importance of being active!

 Option 2: Continue to let the individual dig deeper into these topics by using a framework of open-ended questions and practices to elicit change talk. Expert advice and direction may still be given, but it is balanced by the individual's involvement in the decision-making process. This ultimately allows the individual to make their conclusions on how best to reach their goals.

 In case you hadn’t guessed, Option 2 tends to be the more extended, more involved method of effecting behavior change, but it is also the stronger, more effective one. This style of intervention and discussion is known in clinical circles as Motivational Interviewing.

What is MOTIVATIONAL INTERVIEWING?

Enter Motivational Interviewing (MI). MI was founded by Stephen Rollnick and William R. Miller in 1983 (Rollnick, 2020). Initially used in mental health situations, MI has found successful applications in healthcare, criminal justice, education, and, most recently, sports.

The best way to describe MI is through its guiding spirit. It is truly a dance and a sweet science not unlike the chess match that is boxing. The "Spirit" of MI is collaboration, evocative interaction, and consistent respect shown for the client's autonomy (Rollnick, Miller, & Butler, 2008).

In this way, a partnership and shared responsibility exist in achieving behavior change.

Applied to the gym, trainers and clients must feel comfortable enough with each other to be vulnerable. A level of selflessness and a sense of genuine caring for another human being must be present.

As the old saying goes, “nobody cares how much you know until they know how much you care.” Not only is listening for what is essential to your clients the right thing to do, but it also makes your life easier and will help them remain intrinsically motivated.

Coaches should be wary of telling clients what they need to do too much. Even if WHAT you are telling them is evidence-based and proven, it can come off as preachy and ultimately is less effective if overdone.

MI can teach you to take two steps back and eventually learn to guide your client to the best conclusions. Motivational interviewing is not a Jedi mind trick to get your clients to do what you want or not to complain, but like Socrates and Yoda, MI seeks to guide its students to the answers that already lie within them.

See also: A Look at Motivational Interviewing in Fitness

The Rules of Motivational Interviewing

R: Resist the Righting Reflex

• The urge to fix is powerful when we see or hear errors.
• Whichever side of ambivalence you argue for, your client is likely to argue for the opposite. When you tell your client all about the adverse effects of sugar, be ready for a response in defense of sugar. This is human nature.
• We tend to believe ourselves the most. Our thoughts and spoken words are the most impactful.

U: Understand Your Client’s Motivations

• Change will come as a result of your client’s desires and motivations more than your own. I have yet to eat any vegetables or gain any muscle for my clients!
• Spend time finding their WHY!

L: Listen to Your Client

• We have two ears and one mouth for a reason…
• Listening is a complex skill that requires a baseline of mindfulness and presence.
• Listening may also mean asking the right questions, affirming, reframing, and summarizing conversations so that both sides are clear on what was said and intended.

E: Empower your Client

• You may be the expert when it comes to exercise, but they are the expert when it comes to themselves. They are the CEO, director, and hero of their behavior change.
• This aspect is essential in goal setting and evaluation. Knowing that one has the autonomy to plan and strive for goals with the support of their coach is very empowering.

Communication is key for behavior change

Communication styles play a huge role in ensuring your clients' experience resembles a beautiful partner dance instead of a wrestling match. Three main ways to organize and become more aware of your tendencies are listed below. MI is grounded in a healthy mix of all three styles.

FOLLOWING

• Most useful at the beginning of discussions as it allows your client to decide where the conversation will flow.
• The following is also most appropriate when empathy is needed. Stop and listen. Be mindful of the body language and tone of voice your client is displaying.
• Expresses a spirit of trust that allows one to feel in control without being pushed or pulled against their will.

DIRECTING

• This style is most useful when explicit instruction and force is needed. For example, if you are in danger, clear direction is most effective.
• Often the style most sought and expected by clients when coming to an expert.
• Effective style when educating and delivering critical information.
• Expresses a spirit of knowledge and expertise, and can be dominating.

GUIDING

• Guiding is the most useful communication style for those patient enough to resist the righting reflex while also providing some direction.
• This style recognizes the guide's expertise in helping the client to overcome ambivalence regarding sought-out behavior changes.
• Expresses a spirit of trust and confidence that we can do this together.

Extending these styles shows the use of three communication skills within them. These are asking, informing, and listening. The percentage of these skills used during each communication style is very telling.

In each, we spend about one-third of the time asking questions. However, when we look at directing versus following, we see polar opposite amounts of either informing or listening. Over-directing and over-following preferences can sway and even cloud the effectiveness of motivational interviewing.

It is challenging yet essential for us to improve our listening and guiding skills while walking alongside people on their paths to successful behavior change. Motivational interviewing provides a highly effective framework to do so.

As personal trainers, coaches, and mentors, it is our responsibility to continue to grow and learn to share our expertise most effectively. I have yet to meet a coach who does not express a desire to help those they work with. Motivational Interviewing (MI) provides the tools and guidance for professional personal trainers to walk beside clients on their journey to build productive habits and make positive strides in their health and wellness.

HOW TO GUIDE WITH OARS

Let’s begin with an example conversation had between coach and client when discussing activity goals. We will use the client “Natalie” as our subject. Natalie is a 54-year-old woman who works in an office, has type II diabetes, and has arthritic knees with some associated pain.

She has a son and daughter, both of whom are former athletes who enjoy biking, hiking, and rock climbing. Natalie was recently referred to you by one of her friends, who happens to be your client.

OARS is an acronym for Open-ended questions, Affirmations, Reflective Listening, and Summarization. This is a useful framework in MI to help people find effective solutions for themselves.

O: Open-Ended Questions

• Example 1: Close-ended Question
  • Coach: You need to be active. Have you been exercising?
  • Natalie: Yes, I know it is essential. And I try to take hikes with my children when I can, but my knees always hurt after.
    
    
  • Coach: It can be helpful to do regular strength and stretch exercises. Have you done anything like that?
  • Natalie: No, but I know I should.
  • Coach: Okay, well, I'm glad we figured that out.
  • In this example, the client does not share much, and the outcome is questionable.
    
    
• Example 2: Open-ended Question
   
  • Coach: What aspects of being active are most important to you?
  • Natalie: I am not sure. I know I need to be active. My doctor tells me that it will help my diabetes, but I struggle to fit it into my schedule. And every time I do make time to hike with my children, my knees kill me afterward! I don't know what to do.
    
    
  • Coach: Okay, it is good to hear you recognize the importance of being active and made efforts in the past. What exactly tends to get in the way of fitting activity into your schedule?
  • Natalie: Thank you! I just feel so tired during the week after work, so I don't exercise. And then, I think the hardest part is getting over the mental hurdles. I know that I will enjoy myself with my kids, but I dread the pain I feel for the next few days! I am also starting to feel my age and hate that they have to wait for me so much.
  We can see in this example how much more information can be elicited and the ambivalence evident. As we are listening, we must be on the lookout for specific wording that indicates ambivalence.
  For example, any time the word “but” is used to present a dichotomy of thinking, we see ambivalence.
  Some examples of good open-ended questions and lead-ins are:
  
  
  • “tell me more…”
  • “What is most important?”
  • “What exactly is important?”
  • “May I ask you…”
  • “What do you notice in this situation?”
  • “What have you tried to do in the past?”
  • “Help me understand…?”

A: Affirmations

• Affirmations provide significant opportunities to reinforce positive thoughts, strengths, and behaviors. These affirmations can build confidence in one's ability to change and must be delivered genuinely.
  
  
• Example (continuing from Natalie’s open-ended question response):
  • Coach: I appreciate you sharing and being so honest with me about your pain and your desire to be active with your children. I can tell that you are a dedicated mother…

R: Reflective Listening

• Often, miscommunications occur as a result of ideas and feelings not being expressed clearly. Other times, communication breakdowns occur due to a lack of hearing or misinterpretations of what is meant. Reflective listening requires the listener to think reflectively and respond accordingly. This requires the listener to clarify statements to truly understand the intent and meaning of what is being said. As opposed to inflecting upwards as in a question, the reflection's inflection is kept down.
  
  
• Example (continued further):
  • Coach: It sounds like you might be worried about your inability to keep up with your kids while hiking…
    
    
  • Natalie: I am! I want to be able to spend time with them, and if I can’t do the same things they enjoy, how will I be able to do that? They don't want me to be in pain, either.
    
    
  • Coach: You are wondering what you can do to spend time with your kids when the things they enjoy tend to cause you pain.
  • Natalie: It feels like a lost cause sometimes.
• More examples of eliciting reflective listening:
  • “It sounds as if…”
  • “So, you feel…"
    
    
  • “You are considering…

S: Summaries

• Summaries are a great way to clarify and reinforce essential landmarks in the conversation. By recapping, and potentially reclarifying what has been said to this point, the coach may now move forward with action steps towards the desired goals, or reclarify and understand that particular topic.
• Example:
  • Coach: Let me see if I understand correctly so far. On the one hand, you recognize that being active is vital for your health, quality of life, and relationships with your children. Yet, on the other hand, it is difficult for you to find the time and energy to exercise. It also sounds like you are fearful of injuring yourself while trying to spend more active time with your children. Did I miss anything?
    
    
  • Natalie: No, I think you got it right.
  • Coach: Okay, great! I think we have successfully identified some of the reasons we want to remain active and some of the obstacles. Now, how can I help you to overcome and address these challenges?
    
    
• Summaries offer the coach the chance to clarify the conversation and politely close and move forward from a topic.

There are many nuances to a conversation and more so to guiding and facilitating healthy behavior change. Motivational Interviewing offers a detailed framework for skilled intervention. If you have ever thought to yourself, “I am never going to be able to help this person.

They simply don’t listen to me,” then you need to give MI a try. Step back. Listen, affirm, reflect, and summarize. Practice these skills with your friends or with family members. I guarantee you'll love the things you start to learn about other people and how you can impact those you thought were lost causes.

Above all else, your clients will begin to achieve the results you've been seeking.

See Also:

• Force of Habit: How Behavior Change Science Impacts Success
• Behavior Change Science: Help Clients Stick With Their Program
• How to Help Clients Change Their Eating Habits
• Nutrition and Behavior Change: Strategies for Helping Clients

References

Rollnick, S. (2020, March 30). Motivational Interviewing. Stephen Rollnick. https://www.stephenrollnick.com/about-motivational-interviewing/.

Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational Interviewing in healthcare. The Guilford Press.

Search the Data: Healthy People 2020. (2020, July 17). Retrieved July 19, 2020, from https://www.healthypeople.gov/2020/data-search/Search-the-Data

Motivational Interviewing: Open Questions, Affirmation, Reflective Listening, and Summary Reflections (OARS). (2007). Retrieved July 19, 2020, from https://www.homelesshub.ca/resource/motivational-interviewing-open-questions-affirmation-reflective-listening-and-summary

 Rollnick, S. (2020, March 30). Motivational Interviewing. Stephen Rollnick.      https://www.stephenrollnick.com/about-motivational-interviewing/

Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational Interviewing in healthcare. The Guilford Press.