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Managers, Coaches, Therapists. Motivational Interviewing for Working with Challenging Behaviour.
Helping people change their behaviour is a skill worth having whatever your role in life. If you’re a parent or a manager or coach and need to help members of a team work productively, or a therapist working with people with challenging behaviour or habits, you’ll know that finding a key to unlock the best in those around you is vital.
This hub looks at Motivational Interviewing (MI) as a skill for helping you do that. Motivational Interviewing was a ‘talking cure’ developed by R Miller in 1983 from his experience in treating people with alcohol problems. The principles are easily transferable to other situations and groups and you may find that you’re using a lot of the techniques already.
What drives us?
Our ‘reason why’ is our motivation for action and behaviour. And ‘why’ is a powerful question. Asked often enough to dig deep enough it will take you to the real emotion of an issue.
Experts say that primary motivators are pleasure and pain in that we want to move towards pleasure and away from pain. There’s a hub about the pleasure-pain principle here.
Perhaps you’ve have had the experience of hitting a brick wall or seemingly insurmountable problem that made you want to give up during a project. You felt that you should go on and complete it but that it would be easier to give up.
But if you remembered your reason for starting the project – what it would give you/your family/your community etc – you probably worked through the obstacle and your ambivalence and can came out the other side. You may have reached that conclusion on your own. Motivational Interviewing is a way of helping others find their ‘reason why’ so that it guides, drives and maintains behaviour change.
What is Motivational Interviewing?
Often people are aware of what they should be doing, but doing it is more difficult than staying as they are. Perhaps the status quo also gives them other advantages. This means they’re ambivalent about getting on and doing the ‘right’ thing. For example, if you overeat but want to stop, eating may give you satisfaction and fulfillment and you love food. On the other hand, change will bring better health and a slimmer figure.
MI focuses on exploring that ambivalence and resolving it, working on the basis that the answer is within the person himself. Therefore it:
- Supports a person’s change in behaviour in a way that fits with his own values. The manager/coach/therapist doesn’t impose change externally as an ‘expert’.
- Works collaboratively with the person by actively talking about and looking for change.
- Looks to help the person find his own motivation and commitment.
These are the 3 elements of Motivational Interviewing – autonomy, collaboration and drawing out/evoking the answer.
It sounds all very fluffy and a bit ‘hippy’ at this stage, but consider that behaviour is the result of how we feel and what we believe. In order to change behaviour we need to change the beliefs and feelings that surround that behaviour.
Think about your own experiences of reaching your own conclusions about something rather than having conclusions imposed on you. The answers that come from within may take longer to find but our commitment to them is greater and longer lasting, and we learn a lot about ourselves in finding them.
When would we want to use Motivational Interviewing at work?
- At work you may have an employee with many good qualities but a few poor or destructive ones. MI can help preserve the good and eliminate the bad, if that person can highlight the behaviours they need to change.
- For those with problems that become apparent during an appraisal or pre-appraisal, MI can help to resolve problems if the person wants to change their behaviours – he may be unaware of the problem behaviour.
- An open mind and willingness to commit to discussing change is needed on both sides.
- Journal of Royal Society of Medicine (supp 44, vol 97. 2004),
How do we get started with Motivational Interviewing?
You can see the ‘cycle of behaviour change’ illustrated in the picture below. It shows the dynamic process of change.
We’ve said that the elements of MI are autonomy, collaboration and drawing out the answers. There are 4 principles of MI that guide its practice. These are:
Stepping out of our own shoes so that we can step into another’s is the first step in empathy. In being empathetic you want to see the world and the situation through the other person’s eyes and experience it as he does. If you can do this the other person is more likely to be open and honest.
To practise gaining empathy, try this exercise with 2 other people. It’s something Anthony Robbins does with his students:
- One person is A, one is B and one is person C.
- Person A sits or stands so that she can’t see person B.
- Meanwhile, person B thinks of an emotional situation she’s experienced and takes a position – sitting, standing, crouching/whatever – that reflects that experience (for example holding your firstborn or hiding from arguing parents).
- Person C’s role is, with as few words as possible, to guide person A into the exact position that person B is holding. Have her mimic person A’s breathing rate, facial expression, blink rate etc s well as the body position.
- Person B should then be able to feel what person A was feeling and perhaps even guess at the experience that provoked the posture.
- Swap roles so that all 3 can experience empathy.
Self efficacy is your own ability to produce a desired effect: in this case, a change in behaviour.
MI looks for a person’s own strengths that will make this happen. Their self belief needs to instil the hope that they can make difficult changes. Do this by focusing on past successes, highlighting skills, strengths and abilities the person already has.
Roll with resistance.
MI says that resistance happens when a person has a conflict between their view of the problem or solution and that of the manager/coach/therapist etc. Resistance often stems from their ambivalence about change.
Roll with resistance by not confronting the other person when it arises and try to de-escalate a negative situation. This is often termed ‘dancing’ with him rather than ‘wrestling’ so that you are working cooperatively rather than in opposition.
When you’re working empathetically with someone, you may instinctively know what to do and how to achieve this.
The motivation for change happens when people see a mismatch between the status quo – where we are now – and where we want to be or what we want to achieve.
As a Motivational Interviewer, your role is to help the other person examine these discrepancies.
What are the Motivational Interviewing strategies?
We’ve looked at the 3 elements of MI (autonomy, collaboration and drawing out the answers) and 4 principles (empathy, support self-efficacy, roll with resistance and develop discrepancy). So what are the skills we can use to make this happen?
OARS is a mnemonic that sums up what are often called micro-counselling skills.
O = Open-ended questions. These are questions that can’t be easily answered by yes or no and usually begin ‘who’ ‘what’, ‘when’, where’, ‘how’ and, our old favourite, ‘why’.
A = Affirmations. Statements that remind the other person of their strengths. These must be genuine, no matter how small the achievement.
R = Reflections. Reflective listening shows that you’re listening and understanding the information the other person is exploring. It’s a paraphrase of what the person said, so take their words and turn them into your own in order to check and demonstrate that you’ve understood. Focusing on the perceived negative points of the status quo will help the person feel less comfortable about it and more able to want to move forward with positive change.
S = Summaries. A different type of reflection where you recap on what you’ve talked about in a session, so they often occur at the end.
Change talk is the indications that a person wants to change. They’re usually statements or comments made consistently in a situation, rather than a one-off or throw away remark.
Preparatory change talk comments often fit into the DARN mnemonic:
Desire – I want to change
Ability – I can change
Reason – It’s important to change because...
Need – I should change.
These may be followed by comments that indicate a potential positive outcome to MI. The CAT mnemonic:
Commitment – I will change
Activation – I am prepared and willing to change
Taking steps – I am taking these actions to change.
It’s unlikely that a person will say these specific phrases so you need to listen carefully for his own version of them. Try the following:
- Ask an open question that is likely to give a comment about change.
- Ask for the pros and cons of staying as things are and for change.
- Ask a person to indulge is imagination – what does life look like with the changed behaviour? Get him to expand on his answers and get to the detail of that picture.
- Ask about the worst thing that could happen if he doesn’t change.
- Ask how important change is, on a scale of 1-10. Use this as you progress through sessions together.
- Ask about a person’s values – what does he want in life, how does the status quo detract or contribute to that? What’s important to him in areas beyond the behaviour you’re discussing.
What about maintaining change?
Helping a person maintain their new behaviour is an ongoing process but less intense than the process that helped him change in the first instance. A few pointers for this are:
- Review what he’s achieved.
- Remind him that he did it by himself.
- Remind him that it’s his choice as to whether he maintains the behaviour.
- Avoid confrontation.
- Stay neutral.