Motivational interviewing is an evidence-based counselling method and approach, that is client-centered, focused and goal orientated. It is a collaborative approach that supports the client’s own personal values and concerns, and strengthens their motivation for change.
Motivational interviewing is based on the premise that everyone possesses the ability to change. The intention is to facilitate, empower and support clients to progress towards a positive lifestyle change.
How does it work?
The principles and skills of motivational interviewing are too many to include in this post, but do involve expressing empathy, developing discrepancy, avoiding arguing, rolling and dealing with client resistance, reflective listening, eliciting and reinforcing change talk, looking back and looking forward, focusing on the client’s values and concerns, emphasising personal choice, and supporting self-efficacy.
One of the core principles of motivational interviewing focuses on intentionally eliciting change by helping the client to explore and resolve their ambivalence. This is achieved by creating a discrepancy between the client’s current situation and the desired one – both viewpoints (the pros and cons) are discussed with the client.
By exploring the pros and cons with the client, and allowing the client to express their own arguments for and against change, it helps the client to recognise the differences between their present behaviour and the preferred change. The aim of motivational interviewing is for the client to present the arguments for change.
As a result, clients are more motivated to change when they see what they’re currently doing will not lead them to a future goal, i.e. improved health and wellbeing. This process helps to encourage, empower, move, and motivate the client towards change.
The practice of motivational interviewing can be done quite briefly (within 5 minutes) by asking one or two key questions, or it can be practiced more extensively (20 – 30 minutes) as part of a longer consultation. Alternatively, it can be carried out over the course of a number of follow up sessions…
What are the benefits of motivational interviewing?
There are many benefits of motivational interviewing, including:
- gaining client rapport quickly
- reducing client anger and resistance
- increasing retention and engagement in treatment
- resolving ambivalence (and preparing client for change)
- increasing client motivation and change talk
- increasing client confidence in their own ability to make a positive lifestyle change
Motivational interviewing is particularly useful in helping clients who are ‘stuck’, resistant and angry, as well as clients who are in the early stages of behaviour change…
Who can motivational interviewing help?
Motivational interviewing was first used in the 1980s to treat alcohol abuse, and was used to motivate clients to modify their drinking and to reduce their risk of developing ill health. Since then, the practice has grown in popularity and is much more extensively used in a range of settings, including health care, mental health, child welfare, corrections and forensics to name some examples.
The approach is used to address an array of behaviour change issues, including:
- a range of addictions, such as addressing tobacco, alcohol and/or drug use
- losing weight; addressing overweight and obesity in clients
- improving nutrition/eating and exercise habits
- improving the management of diabetes
- improving stress management
- reducing risk of HIV; improved safe sex practices; use of contraception
- lowering blood pressure and cholesterol levels
- improving the adherence to medication
- improving the adherence and retention in treatment, including improved attendance at follow up visits and group programs
In essence, motivational interviewing can be used to address any behaviour that places the client at risk of developing ill-health and/or prevents them from managing their chronic condition effectively.
The traditional approach vs motivational interviewing
The traditional approach of working with clients has been one of providing advice and telling clients what they ‘should be doing’ to improve their health and wellbeing. Such a stance, however, can often lead clients feeling resentful and disempowered, and as a result, can lead to client resistance, denial and anger.
As there is now a growing drive towards client-centered care, and with more clients wishing to play an active role in their own health and wellbeing, motivational interviewing replaces the traditional approach of giving advice.
Motivational interviewing is a more efficient communication style that contributes to better health outcomes for the client, both in the short-term and long-term.
Why the comparison to ballroom dancing?
The spirit of motivational interviewing involves working with your client in a collaborative effort to promote a positive behaviour change. It is seen as a friendly partnership between equals, rather than an association with a superior and authoritarian figure as such.
As with ballroom dancing, it can only occur in partnership with another person. In this instance, the counsellor/helper is the lead dancer. And as the lead dancer, the helper takes steps forward by subtly and gently guiding (‘leading’) conversation towards change. It encourages the client to follow as they answer a series of open ended questions. At times, the client will also lead as they present their arguments against, and for change.
The helper and client go on a journey together – they are in step, on the same wavelength and ‘dancing’ at the same pace. As a result, conversation flows – it is easy, smooth and graceful as clients are gently navigated towards positive change.
Of course learning how to ballroom dance with ease and confidence takes time and practice, so does feeling comfortable and skillful in motivational interviewing. However, when practiced regularly (with every client), and when done effectively, the results are positive – clients are engaged, empowered and motivated to take action.
In contrast, motivational interviewing is not a tennis match (back and forth counter-arguing and rebuttals), nor are we wrestling in conversation with our clients… Motivational interviewing is not about asserting your viewpoint and directing your client to what they ‘should’ be doing.
So when you’re in consultation with your client, and are starting to feel frustrated or are experiencing client resistance, ask yourself, ‘Am I ballroom dancing right now? Am I providing client-centered care? Or am I playing tennis back and forth with this client? Am I in fact being ‘superior’ and are wrestling with my client?’
Want to learn more? Want to know how to use this highly effective approach with your clients?
Want to ballroom dance and improve your knowledge, confidence and skills in motivational interviewing?
If you would like to learn more and would like to learn how to engage and communicate with your clients that will motivate them for change, rather than against it, then sign up for one of our upcoming training days in motivational interviewing.
Alternatively if you would like a session on motivational interviewing presented in your workplace, please contact us today.
Our training programs are ideal for professionals who would like to offer extended support (or brief intervention depending on time), and would like to increase their skills, knowledge and confidence in motivational interviewing to enable them to do this.
Applying the principles of motivational interviewing in every client consultation is possible and achievable. Let us show you how.
We hope you enjoyed this article and until next time wishing you all great health and wellbeing!
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Miller WR & Rollnick S (2002). Motivational interviewing: preparing people for change. 2nd ed. New York (NY): Guilford Press.
Miller WR & Rollnick S (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York (NY): Guilford Press.
Rollnick S, Miller WR & Butler C (2008). Motivational interviewing in health care: helping patients change behavior. New York (NY): Guilford Press.
Rosengren DB (2009). Building Motivational Interviewing Skills: A Practitioner Workbook. New York (NY): Guilford Press.