Motivational Interviewing: Approaches You Can Use Today
I’m Seth Bleecker, lead instructional designer here at Kognito. Many of our simulations draw on motivational interviewing (MI), an evidence-based counseling method that helps people change their behavior and make healthier choices.
I’m guessing you’ve heard of motivational interviewing before–it’s been around for over 30 years, and it has a strong evidence base in settings like healthcare, substance use treatment, and others. In general, motivational interviewing is a practical and effective way to support patients or clients. It’s thrilling to see that motivational interviewing training is becoming more widespread.
But if you’ve ever tried to apply motivational interviewing in your own practice, you might have found it isn’t as easy as it sounds. I’ve designed dozens of simulations that teach motivational interviewing skills, and I can say that it’s not just you: it’s a complex skill set that takes a long time to hone.
The challenge in designing a motivational interviewing training is that you, the practitioner, need something you can use right away. This is a problem I’ve tackled with multiple groups of experts over the years, and I’ve noticed some skills are easier to pick up than others.
So here are three simple things you can start doing right now to have better conversations about behavior change. They’re framed as extensions or modifications to what you’re already doing. And not only will they help you immediately, but they’re also stepping-stones toward expanding and improving your use of motivational interviewing.
1. Instead of giving information or advice, ask a question.
When you find yourself about to give some advice or share information, stop and see if you could ask a question instead. This sounds counterintuitive; isn’t the patient here because you know things they don’t?
Yes, that’s true. But when it comes to behavior change, there’s a lot more to it. Patients may already know a lot about healthy behaviors, reasons they should change, new approaches they could try, etc. Rather than trying to guess at what they need to know and what matters to them, you’ll save time by just asking. This will draw them in and quickly show you where to focus the conversation.
Here are some questions you could start using today:
“Your BMI is up since your last visit. What do you make of that?”
“If you wanted to eat better, what would you change?”
“What do you think would be a reasonable goal?”
2. Sandwich information between two short questions.
There are times when you really do need to share information with a patient. A quick and easy way to keep the conversation from getting one-sided is to sandwich that information between two questions. In motivational interviewing, this technique is called elicit-provide-elicit. I’ve also heard it called “ask-tell-ask.”
Start with a question that elicits the patient’s existing knowledge, like:
“What do you know about BMI?”
The worst case is they shrug and say “not much,” and you go on to explain. The best case is they already have some knowledge; they feel more in control of their health, and you can skip explaining the parts they know!
Then, you provide a small chunk of information. Tailor it to what they already know. If they voiced any misconceptions about the topic, this is a great chance to gently address them.
Finally, invite them back into the conversation with a question that elicits their reaction. Here are some examples:
“What do you make of that?”
“How does that sound?”
“How does that compare to your experience?”
3. Instead of criticizing, find something to affirm.
Research suggests this last skill is one of the most powerful things you can do to promote behavior change. And it only takes a moment, so you can work it into even the briefest of patient encounters.
Imagine a patient who says:
“We talked about cutting fast food out of my diet, and… I stopped getting fast food on the weekends, but during the week I just don’t have time for anything else.”
It would be easy to respond with something like:
“Eating healthier is worth the extra time.”
Or: “Maybe you could do it if you planned better.”
What happens if we say that? She feels bad about herself, maybe even feels defeated. That makes her less excited about eating healthier, because now she’s more afraid of failure. She might even slip into a more passive role, nodding along to whatever you recommend and then struggling to put it into practice.
We could also say nothing at all. If we do that, we tacitly agree that her change didn’t go the way she wanted it to.
What if, instead, we said something like:
“Saturday and Sunday are a significant chunk of your week! How did you manage that?”
In motivational interviewing, this is known as an affirmation. It does several subtle-yet-powerful things.
Most obviously, it creates a feel-good moment in a discussion of behavior change, and that alone can be powerful. But it also counteracts her internal narrative of “I can’t do this.” In other words, it “catches her doing something right” and emphasizes her power to change. Finally, it shows your interest and respect, strengthening her trust in you.
You can affirm lots of things, including strengths, good intentions, values, or even unsuccessful attempts at change! Consider these examples:
“When you set your mind to something, you stick with it.”
“You’re really taking this seriously.”
“You didn’t quit smoking, but you learned more about what works and doesn’t.”
Ready to get started with motivational interviewing training?
It can take years to master motivational interviewing skills like reframing and complex reflections. I very much recommend embarking on that journey–it’s amazing how motivational interviewing can transform your conversations! But you don’t have to be a motivational interviewing guru to start getting better results. Whether you’re talking with patients about chronic conditions, mental health, or substance use, I hope these quick and simple tips help you get up and running with motivational interviewing!
Interested in practicing motivational interviewing techniques? At-Risk in Primary Care is an interactive role-play simulation for emergency department personnel that builds their skills to screen patients for substance use, mental health disorders and suicide risk, collaboratively discuss treatment plans using motivational interviewing techniques, and refer patients to obtain further support. Take a demo here.