Motivational Interviewing

Motivational interviewing (MI) has its roots in the field of addiction treatment in the early 1990s. Since then, it has expanded to many other fields and is used in all types of behavior change counseling, including life coaching. Clinical psychologists William R. Miller, PhD, and Stephen Rollnick, PhD, the creators of MI, explain their approach as it applies to professionals working with clients on behavior change: “MI is designed to find a constructive way through the challenges that often arise when a helper ventures into someone else’s motivation to change” (Miller & Rollnick, 2012, p. 4). A concise definition of MI is “a collaborative conversation style for strengthening a person’s own motivation and commitment to change” (p. 12). High-quality listening is a basic feature of this collaborative style. MI is also designed to address ambivalence, which naturally, and often frequently, arises in the contemplation and action of change.

There are four principles operational in motivational interviewing: empathy, noticing discrepancies, dealing with resistance, and encouraging self-efficacy. Here we look at each one in turn.

Principle 1: Empathy

In coaching the process of change, the presence of empathy—respectful and appreciative understanding of the client’s experience—is essential. Without empathy, the helper in change is not a true helper, and the process is unlikely to go well. Empathy, and the acceptance that accompanies it, helps create the optimal environment for change. When a person does not feel accepted, resistance is a common response and behavior change becomes more difficult to accomplish. The collaborative process of MI is based on empathic understanding. Note that here is where Nonviolent Communication can play a significant role.

Principle 2: Noticing Discrepancies

In the process of trying to make a change in behavior or lifestyle, discrepancies between one’s goals and values and one’s actions naturally arise. It is not the coach’s job to point out these inconsistencies but rather to encourage the client to notice and identify them. When the notice emerges from the client, it will lead to internal shifts and new ways of thinking, feeling, and experiencing. Change follows from this natural process.

A study by France and colleagues (2016) found that a telephone motivational interview that encouraged blood donors to reflect upon their unique motivators and barriers for giving improved a variety of psychological markers. In comparison to controls, donors in the motivational interview group had significantly larger increases in feelings of autonomy, positive attitude, self-efficacy, and intention, and larger decreases in anxiety.

Open-ended questions and reflective listening (as discussed in the previous section on Nonviolent Communication) are effective methods to assist clients in identifying their discrepancies for themselves. An open-ended question is not a yes-no question. It evokes a longer, descriptive answer. An example is: What would you like to change in your life as you live it now? A good rule to apply in motivational interviewing is that more than half of all the questions you ask your client should be open-ended questions. Reflective listening, as noted previously, is important as a way to check that you have gotten what your client is trying to say. It is also important as a means of letting your clients know that they are truly heard.

Principle 3: Dealing with Resistance

Though resistance is often part of the change process, a significant amount of resistance on the part of a client can signal that something needs to change in the coaching relationship. Empathy, as a guiding principle in both motivational interviewing and Nonviolent Communication, is the key to flowing with resistance. Approaches that prevent empathy, according to Dr. Rosenberg, are: moralistic judgments, diagnostic labels, guilt-tripping, making demands, denying choice or responsibility, proposing rewards and punishments, and making comparisons. These are also likely to increase resistance. Confronting resistance directly does not work. Returning to empathy can actually help dispel resistance.

Principle 4: Encouraging Self-efficacy

Self-efficacy refers to our belief that we are capable of achieving our goals. An important aspect of your job as a coach is to help your clients arrive at this state of belief about themselves. In so doing, you will have assisted your clients in acquiring an incomparable tool that will serve their well-being for the rest of their lives. The first three principles of MI support the development of self-efficacy in clients by affirming them as individuals, providing an image of belief in them, and being empathetic and accepting of less than perfect adherence to expressed behavioral changes.

Self-efficacy creates an upward spiral of action and change. The more clients believe they are capable of making the changes they desire the more they will be able to implement those changes. With each achieved step, they believe more in themselves, which, in turn, inspires and brings about further change for the better.

Motivational Interviewing Research

Research has demonstrated numerous benefits of motivational interviewing (MI). One study examined therapist and client language and process within a motivational interview session focused on alcohol as predictors of a client’s decision to complete a written MI Change Plan (Magill, Apodaca, Barnett, & Monti, 2010). The participants were already in an ongoing hospital-based clinical trial. The data collected showed that therapist MI-consistent behaviors and client change talk were positive predictors of completing a Change Plan regarding alcohol use.

Motivational interviewing has been effective in facilitating entry and compliance in drug and alcohol treatment programs. A study measured the effectiveness of MI in a population of homeless, unemployed, and substance-dependent veterans who were wait-listed for a residential treatment program (Wain et al., 2011). The veterans underwent a single MI or standard intake interview. In the MI group, 95% entered the program, whereas only 71% of the standard intake group did so. MI group participants remained in the program longer and had higher program completion and graduation rates than the standard intake group.

A 6-month study conducted in a rural pediatric office found that the combination of practice guides and MI was effective in treating childhood obesity (Tripp, Perry, Romney, & Blood-Siegfried, 2011). Motivational interviewing techniques were combined with healthy eating and exercise guidelines. The results showed that though children were motivated for healthy lifestyle changes at first, they had trouble maintaining their motivation and compliance for longer than 1 to 2 months. Consistent use of MI along with diet and exercise counseling, however, resulted in lowered body mass index and waist measurements.

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