Motivational Interviewing

You can’t tell people what to do. Even if you are the boss, you might get push back, you might get resigned compliance, you might even get resentment. But you won't get much enthusiasm. There’s a better way. We can get people to talk themselves into doing what they already know is the right thing to do. It’s a method called Motivational Interviewing. Not to be confused with Situational Interviewing like in a job interview when you are asked to “tell me about a situation where you made a mistake, how did you handle it?”

Motivational Interviewing is different. It is a style of talking to people about changing their behavior but without giving advice. It helps people explore their own motivation to change and guide them toward more desirable behavior. I came across the technique by volunteering as a facilitator for drug & alcohol addiction support groups. But it has application in a variety of settings including management, parenting, and coaching.

Let's get started with a Motivational Interviewing conversation. Start by building rapport and showing respect. Asking permission is a great way to show respect. “Is this a good time to talk?” “Would you mind if I ask you a few questions?” “Can I help you with that?”

Within Motivational Interviewing lies a tool for eliciting behavior change without giving advice. It is summed up with the acronym:

OARS: Open-Ended Questions, Affirmations, Reflections, and Summaries.

Open-Ended Questions cannot be answered with a short response like “yes”, “no”, or “twice.” They are used to help people open up and explore their own thinking. The best questions start with the word “What…?” These are the most open-ended questions that really get people thinking. They are Wisdom Access Questions. Examples of Open-Ended Questions: “What changes are you considering?” “What will your life look like after you lose weight?”

Affirmations help people acknowledge their positive behaviors to build confidence in their ability to change. Examples of Affirmations: “You are very brave to admit that.” “I like the way you handled that situation.”

Reflections, or using Active Listening and paraphrasing, is a way to confirm understanding. It helps people to hear what the words they use sound like. Then when they confirm it, it builds their commitment. People want to make the words they say come true. Examples of Reflections: “What I hear you saying is….” followed by “Did I get that right?”

Summaries pull together what was discussed to find general themes. It can form the basis for helping people develop action plans and next steps. Examples of Summaries: “During our conversation we discussed three ideas…” followed by “What next steps might you take to get started?”

Look at desired goals and current behaviors and then amplify the discrepancy between them. You ask what the desired behavior looks like. For instance, you might ask the client what their ideal weight might be, then ask about their current diet and exercise. Then ask if they can achieve their ideal weight without making a change. Then ask what changes they might make.

Identify the source of ambivalence to change, where ambivalence has a special meaning in this context. It is not the usual sense of people just not caring. Here ambivalence is a conflict between reasons to sustain their current behavior and reasons to make a change. This ambivalence leads to making no change at all – in other words, getting stuck.

A great way to help people overcome ambivalence is by asking scaling questions. Can I get a volunteer? Someone who wants to break a bad habit or start a good habit?

Q: May I ask you a few questions? (ask permission, show respect)
A: Yes

Q: What behavior do you want to change?
A: I want to quit smoking. (for example)

Q: On a scale of 1 to 10, how important is it to you to quit smoking?
A: 8

Q: Why did you rate it that high? *
A: Because I want to be healthy. (Change Talk)

Q: On a scale of 1 to 10, how confident are you that you can quit smoking?
A: 6

Q: Why did you rate it that high? *
A: Because I am trying a new medication. (Change Talk)

*Notice the follow-up questions where I ask “Why did you rate it that high?” to get Change Talk. Then encourage the Change Talk using OARS (Open questions, Affirmations, Reflections, Summaries). When people hear themselves saying things out loud they want to make the words come true.

Other questions: “Why did your rate it an 8 and not a 5?” “What will it take to move that to a 9 or 10?” But if you ask “Why did you rate it that low?” you will get unhelpful Sustain Talk. They will talk about reasons NOT to change. Don’t go there!

In summary, you can’t tell people what to do even if you have a position of power as the boss, parent, or coach. They might follow your orders but without full commitment and maybe even with resentment. Instead you can help them talk themselves into making changes using Motivational Interviewing. Help people explore their own motivation, resistance, and ambivalence and then guide them toward more desirable behavior. Treat them with respect, ask permission, ask open questions, give affirmations, reflect and summarize. With Motivational Interviewing, people will move forward thinking it was their idea all along!

References:
SMART Recovery Facilitator Training
How to Do Motivational Interviewing by Bill Matulich