Three Reasons Why Motivational Interviewing is Such a Powerful Tool

Whether changing behaviour is a concern for yourself, your colleagues or your clients, there is a body of verifiable, evidence based practice for getting results. In this article Trevor Simper gives the 3 reasons why motivational interviewing is such a powerful tool for helping people change, explains a little more about what MI is and, finally,  gives us the three core processes for mastering skilfulness in behaviour change.

Three reasons why MI is such a powerful tool for helping people change:

• Change is often approached by confrontation, sometimes gently, sometimes forcefully, and we respond badly to confrontation.  We respond with ‘reactance’ but MI is the opposite to this approach and focuses on coming alongside others, dramatically increasing success.
• MI can be understood easily and is born from a very long-standing and highly developed approach to helping people (person centred counselling).
• You can begin to employ MI immediately after a single workshop, I’m not suggesting you master MI after a single workshop, you do however, get positive results immediately and, more often than not, the wish to develop your skills further.

Change is of course happening all the time, change is either easy, difficult or even near- impossible depending upon the nature of the change and the readiness of the person, people or organisation involved. We, individually, go through life changes which are not always volitional, ageing is the key example, and obviously changes such as this go better for us if we are good at adapting and adjusting. There is an old adage about having the strength to change what you can and having the sense to accept what you can’t… but before we fall too deeply into the depths of all the things that cannot be changed, let’s talk about what happens when change is possible, but not necessarily easy.

Very often when it comes to affecting the volitional behaviours of your customers or clients those people are at least to some extent ambivalent about change. Ambivalence is that see-saw where people feel at least two ways about an issue they face.  If I am a smoker I may, for example, agree with you that smoking is bad for me, beat myself up about it, try to hide the behaviour from my children, but still I smoke. Maybe I smoke because it relieves stress, maybe I see it as an alternative to ‘losing it’ maybe it keeps my hands occupied, gives me a reason to go outside and chat with a colleague, perhaps it has always been there for me as a friend, transpose this to drinking alcohol: ‘I really should cut back, but when I get in after a long day- it just takes the edge off’ and: ‘it changes my head space’. Exercise is another classic: ‘I should do more, feel better when I do it, but, I haven’t got the time, it’s too hot…’

To be clear, all these behaviours, whether the example is adding a behaviour (exercising) or taking one away (alcohol) have ambivalence attached to them, if you are not ambivalent then you have probably changed that behaviour already…

In these examples (I am using health behaviours for illustration only, but of course this idea relates to any volitional behaviour: which car should I buy? Do I stay or leave? And obviously some behaviours, and our potential influence over them, need greater/lesser degrees of ethical consideration) each person will have an alternative feeling about their behaviour: ‘It causes cancer, makes my clothes smell bad, I don’t want my children to be negatively affected by my behaviour…’ which represents the other or positive side of their ambivalence.

So how do you help resolve this ambivalence in a client?  A good way of thinking about this is that people really don’t like being told what to do, and in psychology their response to your telling them off is referred to as ‘reactance’ essentially that if what I say is perceived as telling you off, you may well respond with reactance, you essentially defend yourself against the perceived attack. I say: ‘you really ought to cut down on your drinking’ and you say: ‘Yeah, I really should, but actually I…’ followed by all the reasons you should keep on drinking! So first off we could avoid this by overtly and clearly asking the client for the reasons they like to drink i.e. what is good about it? and then listen to them, carefully, acknowledging the reasons they express before asking if there is anything not so good about the booze? What happens here is the individual explains both sides of their ambivalence, and we side-step the reactance. We can then choose to reflect back, starting with the positive: ‘there are some good reasons to drink, it takes the edge off, alters your head space after a busy day’ and then the negative: ‘you also have some not so good concerns about drinking; hangovers at work, concerns your colleagues can see you’ve had a heavy night, concerns about your health…’ what this does is present back to the client and in a specific order, i.e. reasons to maintain the status quo followed by the reasons for change, and of course we tend to respond to the last thing we have heard. And as this is a ‘reflection’ the person is listening to- i.e. a reflection of what they have said themselves, they are effectively arguing themselves into change and we are facilitating that argument.

Professionals starting out in this approach to helping their clients change behaviours often begin with concerns about how reflection might work (‘won’t it sound like i’m parroting them?!) you discover, however, that the people, we often warm to the most, are also naturally reflective when they speak and this is something which can categorically be learnt. On the note of learning, I think you would be forgiven for suggesting empathy is an inherent personality trait of a person rather than a learnable facet such as say: learning to drive, but empathy can be learnt through learning the approach and skills involved in motivational interviewing, and we have recorded this learning, tested it and published the results in peer reviewed science journals for example: Increasing empathy in trainees .

Three processes for developing skilfulness in motivational interviewing:

• Develop good core skills (I learnt my MI early on by completing workshops at introductory, intermediate and advanced levels)
• In between the workshops (1-2 days each) I practised skills with my clients who, in my case, were focused on issues including: improving their health, losing weight, cutting back on booze, improving their fitness, tackling disordered eating.
• After the initial training got me started it was being brave enough to have my practice ‘coded’ which really made the difference. This involved me asking clients if it was ok to have our conversations recorded for the sole purpose of my practice being assessed and under the proviso their conversation would not be used for any other purpose. I was concerned I might be overly criticised by the MI trainer (a Member of the Motivational Interviewing Network of Trainers). However my concern was unfounded as the feedback picked up on everything I was doing well and then included, in simple terms, what I could try next to advance my skills. It really worked, after only three such ‘codings’ I moved from beginning competency to proficiency and to cut a long story short, a 5 point scale is used and my scores moved from an average of 3.7 to 4.0 then to 4.6 between coding 1 and coding 3. The person coding is completely independent of my ‘coach’ so the score is not marred by bias, the coder does not even know what order the conversations are in, so essentially is not ranking them by 1st,2nd,3rd, but rather on the skilfulness of the work.

Motivational Interviewing then, is about resolving a client’s ambivalence, via a core set of learnable skills and now serves as a frontline approach in healthcare, drugs and alcohol, substance abuse work as well as promoting physical activity, adherence to treatment regimens and as a highly effective tool for teacher-student and professional-customer communications.

Dr Trevor Simper
Motivational Interviewing

Trevor is an MI trainer, coach, researcher and University lecturer and delivers Motivational Interviewing Training in Perth, for beginner to advanced level MI practitioners via workshops and coaching .  If you would like to read more about Trevor and his workshops on Essemy click this link.