What is Motivational Interviewing?

Add textMotivational interviewing, or MI, is a technique that coaches, therapists, or other helping professionals can use to help people uncover and grow their motivation to change. It starts from an assumption that people often make, and therefore are able to solve, their own problems (this is based on similar logic to cognitive behavior therapy, which focuses on how our reactions and interpretations to the world lead to our emotional response).

I like to think of motivational interviewing as conversational judo. Like many martial arts, MI is not so much about exerting force of your own as it is about using the force of your “opponent” to create movement.

Five key principles of using MI are:

  1. Show empathy for the person you’re talking to–let him know you understand his perspective. A common way to do this is through the technique of reflective listening, which essentially involves restating what you’ve heard and asking questions to prompt the conversation along.
  2. When the person says something that demonstrates a discrepancy between their goals or values and their behaviors, point it out. For example, if someone wants to lose weight but drinks beer six nights of the week, you can say “You say you want to lose weight, but then you also drink beer a lot. What’s going on with that?” Pointing out discrepancies can create dissonance, which people find unpleasant and try to resolve.
  3. Don’t argue! Avoid confrontation as much as possible. For example, note that in the discrepancy example above, it’s really just a gentle statement of something you observed. If the person were to push back and argue “I drink beer because I need to relax after a long day at work,” you would not follow up with more information about the caloric content of beer. Rather, you’d go with the flow and say, “Ok, it’s important to you to de-stress and beer helps with that.”
  4. Roll with resistance. This is where the judo piece comes in. It’s the second part of not arguing–not only will you not fight back, but you more the conversation along to where the person leads it. Maybe now you’re talking about stress instead of weight loss in the example I’ve been using. That’s ok; chances are, the person perceives his stress as related to his attempts to lose weight, so talking about it may help to break down a barrier to change.
  5. Be a cheerleader and show confidence in the person’s self-efficacy. When you use MI, you have a constant idea that the person you’re working with is capable of improving his situation. This attitude should show. One way to demonstrate it is to ask the person to do a little problem solving: What would it take to motivate you to drink one less beer per night? How do you think you could improve your attempts to lose weight?

I think MI is one of those things that’s easy to understand but hard to do. It’s important to practice the technique so that you can find the particular language and positioning that works for you and is a natural fit with your style. It always bothers me a little when we do brief trainings for health professionals on MI and then expect them to be able to perform it successfully in the field. Success with this takes time.

Have you ever used MI? What worked well for you and what was hard?