Motivation is the fuel needed for change. Without it, it is difficult to create the inertia to move past status quo. People often gravitate to what is known rather than the unknown and live in a state of being comfortably uncomfortable instead of making behavior change. Motivational interviewing techniques can be applied, not just between therapists and their clients, but as a general tool of communication to facilitate motivation for change.
“Tell me what to do and I’ll do it”. I wish it was so simple to elicit behavior change!
Direct persuasion is not an effective method for resolving ambivalence. When trying to encourage someone to make a behavioral change, motivational interviewing helps people explore both parts of the ambivalence in order to make a decision.
Telling an undecided person what change is best for them often pushes the person to the opposite side ambivalence. Instead of planning for behavior change they may start to tell you why the other way is better or why a certain plan it isn’t going to work. The result of this conversation is the opposite of what you intended.
Motivational interviewing is a style of therapy that was developed to elicit behavior change in problem drinkers. The fundamentals of this therapy are:
- Encourage the person to have ownership of the situation and the solution,
- Enhance self-efficacy: the ability to navigate and decide for oneself
- Assume competency: the person is capable of identifying problems, thinking of solutions, and carrying out plans when a behavior is identified as inconsistent with their goals.
Motivational interviewing is NOT:
- Persuasion using reason, logic, and warnings
- Agreeing or disagreeing with their plan
- Directly challenging
- Judging or criticizing
- Blaming or labeling their behavior
- Analyzing and explaining why they need to make a change
Here is an example of how I would use motivational interviewing in therapy with a person who is drinking problematically and trying to decide about making a change.
An effective approach to motivate behavior change:
- Patient: I think I need to quit drinking.
- Doctor: Really? You were just telling me what a great time you had the other day.
- Patient: Ya, I did. But there were 6 other days this week that I drank too much. I blacked out and my family is furious with me.
- Doctor: Do you think you can cut down?
- Patient: What? NO! I can’t believe you could suggest I cut down. You know I can’t control this once I start drinking. I have to stop entirely.
- Doctor: Wow- you have really thought this through. I understand why you feel you need to stop if you lose control over the amount you drink as soon as you start. I did notice your liver is showing some damage in laboratory tests. You’ve mentioned X future goals for retirement and I’m concerned if you get permanent liver damage it might hold you back from your goals. What is your plan? What steps do you want to take?
You can imagine how the conversation would go differently if I took a different approach.
Less effective communication to incite motivation for change:
- Patient: I think I need to quit drinking.
- Doctor: Yes, you do. You are killing your liver and your family is upset. I think you need to go away to rehab because you can’t stop on your own.
- Patient: I’ve stopped on my own before and I can limit my drinking. I didn’t drink for a week recently and I didn’t have withdrawal so I know I am not addicted.
This person was opening up the conversation and I shut it down by being directive and telling them what to do. People like to have a choice.
Invite a person to think about a new way to solve a problem instead of telling them what to do.
Motivational interviewing techniques don’t only help with recovery from addictions but can be used when helping any person find the motivation to change. From parents motivating children or leaders motivating colleagues- the fundamentals are the same and are effective for behavior change.
Example of motivating behavior change in others:
Somebody asked me how to help their spouse go back to therapy. “I have tried nagging and telling them why they should go back. They are depressed and complain about it but never schedule the appointment.” The person felt the stronger they pushed their spouse the more likely the spouse would take action. It had been 2 years and an appointment still had not been scheduled.
We discussed approaches that may be more effective in motivating behavior change and brainstormed an approach using motivational interviewing techniques.
Soon enough, the spouse again brought up that they felt depressed and the idea of returning to treatment. Instead of the usual response to tell the spouse all the reasons they need to go back to therapy the person simply stated, “I don’t know if it’s a good idea. What do you think?” They even included a negative statement that would seem like it was meant to dissuade, “It’s really hard for you to schedule appointments with your work hours”.
The next time I saw them they gleefully reported that it only took that one time of changed communication style and the spouse had scheduled an appointment and returned to treatment. ONE time of allowing them to drive the decision and come up with their own plan elicited the motivation for behavior change that 2 years of telling the spouse what to do hadn’t.
When you’re tempted to tell a person why they need to do X, Y, and Z consider using motivational interviewing techniques instead. Allow the person to identify what they want to be different. Do they have a sense of their goals? How does _____ interfere with the things they would like to do?
People are often at different stages of readiness to change. By asking non-judgemental, inquisitive questions it can help a person elucidate the issues and motivate them to alter their behavior much more effectively than trying to tell them their problem and the solution.
Have you tried this technique? Has it helped you motivate others? Give us your pointers on how it works for you.
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