Motivational Interviewing
Motivational interviewing is a form of counseling that gives clients a chance to explore and resolve ambivalence. Motivation to change must come from the client. The professional should not coerce their clients into changing. The goal is to get clients to the point where they have persuaded themselves to change their behavior. Motivational interviewing is based around the stages of change (precontemplation, contemplation, action, maintenance, and possible relapse).
Self-efficacy is when you believe that you can succeed and/or carry out a specific task. Asking clients about their likelihood of not overeating during a special event is an example of assessing self-efficacy: “On a scale of 1 to 10, what do you think the chances are of you not having second helpings at Thanksgiving?”
Principles of motivational interviewing
The following principles of motivational interviewing may help you and your clients:
- Express empathy
- Avoid argument
- Support self-efficacy throughout counseling
- Make it clear that you do not seek to remove personal choice or freedom
- Ask clients to frequently repeat their intentions out loud
- Summarize/paraphrase what your clients have said
- Have clients elaborate on both the good and the bad points of their current diet/lifestyle (eg, get to eat favorite foods when they want to, but not satisfied with health)
- Ask clients to describe the worst-case scenarios, if they do change habits and if they do not change habits
- Request your clients’ permission before providing any information and only provide information based on substantial research (not your own opinion)
- Give objective feedback in a neutral manner
- Never lecture clients or give information that they have not asked for
- Have clients brainstorm ways to help themselves before suggesting your own ideas, and summarize all of the ideas at the end of the session
- Attempt to have clients assess discrepancies between their current behavior and the behavior necessary for goal attainment
- Use open-ended questions, whenever possible
- Do not draw attention to resistance or ambivalence, if this appears throughout the session, but instead try to steer clients toward a new thought altogether
- Practice more reflective listening when clients are speaking about making a positive change, and do not focus on reflection when clients are speaking about not making a change
- Do not attempt to force clients who are not ready to make a change into feeling differently, but instead validate that they are not ready, reminding them that only within themselves do they have the power to change
- Help clients identify supportive people in their life
- Remind clients that if one idea for behavioral change does not work, they have the ability to find other ideas
- Share stories of how others have overcome similar obstacles (often helpful)
- Do not fill silence—allow clients to remain silent for as long as you can
- Ask clients to go through an entire average day, exploring what they eat, when they eat, how they felt, etc—much like keeping a food journal, another excellent tool for initiation of meaningful conversation
Signs of resistance to change
Look for the following signs of resistance to change, also known as counter-motivation:
- Arguing
- Interrupting
- Denying
- Ignoring
- Changing the subject
- Daydreaming
- Reminiscing
References and recommended readings
Institute for Motivation and Change. About motivational interviewing. Available at: http://www.miinstitute.com/index.php?page=about_motivational_interviewing. Accessed October 19, 2012.
Motivational Interviewing Network of Trainers (MINT). Motivational interviewing. Available at: http://www.motivationalinterviewing.org/. Accessed October 19, 2012.
UCLA Center for Human Nutrition. Motivational interviewing algorithm. Available at: http://www.cellinteractive.com/ucla/physcian_ed/interview_alg.html. Accessed October 19, 2012.
University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions. Motivational interviewing. Available at: http://casaa.unm.edu/mi.html. Accessed October 19, 2012.
West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care [serial online]. 2007;30:1081-1087. Available at: http://care.diabetesjournals.org/cgi/content/full/30/5/1081. Accessed October 19, 2012.
Review Date 10/12
G-0717
