MOTIVATIONAL INTERVIEWING

THE PROVEN COUNSELLING TECHNIQUE TO REDUCE AMBIVALENCE AND ENCOURAGE CLIENT BEHAVIOUR CHANGE

By Lorne Opler, M.Ed. CSCS

EVEN IF YOU HAVE NEVER HEARD OF MOTIVATIONAL INTERVIEWING, YOU COULD EASILY FIGURE OUT WHAT IT MEANS.

“Motivation” refers to the ability to inspire and empower others. Combine motivation with interviewing skills and you have Motivational Interviewing (MI) – an evidence-based interviewing

technique designed to motivate clients to change behaviour. As a formal definition; “MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”

Originally created in 1983 by two psychologists, William Miller and Stephen Rollnick, as a counselling intervention to motivate people recovering from alcohol addiction to change behaviour, MI has since been embraced across the helping professions, including the fitness industry, to encourage behaviour change.

There are four fundamental principles of MI:

• Express empathy

• Supporting self-efficacy

• Roll with resistance

• Develop discrepancy

Empathy is the capacity to see the world through the client’s lens; to be able to identify with how and what the client is feeling. Empathy not only engenders a greater sense of rapport with the client based on a mutual capacity to understand each other, but it builds the client’s trust in their trainer; a feeling that their trainer can relate to them.

Supporting self-efficacy neatly ties into the ability to relate to and empathize with your client. A concept first developed in 1977 by the socialcognitive psychologist Alfred Bandura, self-efficacy in its simplest terms refers to a person’s belief that they can succeed at a particular task or in a particular situation.

An effective fitness professional intuitively possesses the skill to motivate a client to believe they can succeed in their fitness goals. And when you can put yourself in your client’s shoes by recognizing where they are emotionally in their fitness journey (expressing empathy), you create much more of an emotional investment in wanting your client to succeed (supporting self-efficacy).

Rolling with resistance may initially seem like a negative concept but do not be fooled by the word “resistance.” This concept is a positive when it comes to building a healthy rapport with the client, reflecting the trainer’s respect for the client and the trainer’s capacity to practice principle number one, expressing empathy.

Rolling with resistance means accepting and respecting where the client is along his or her journey towards better health and fitness. If a client seems hesitant or unwilling to try something new, do not fight the client’s position, do not challenge it, reject it, or resist it. Instead, “roll with it”. Roll with the client’s resistance. Accept that the client is not ready for whatever change you are recommending and respect where they are at that moment. At some future point they will come around to your suggestion when they are ready. But do not push it. Remember, the whole concept behind MI is to help people overcome their ambivalence towards making a positive behaviour change. The basis of ambivalence is doubt and hesitation. Challenging a client’s ambivalence by not respecting their readiness to change not only dismisses their feelings but, moreover, undermines the sense of trust and positive rapport you are trying to build with them.

When it comes to gently nudging your client past their state of ambivalence and towards making a positive behaviour change, one of the best MI techniques is developing discrepancy. According to dictionary.com, discrepancy is defined as: “the state or quality of being… in disagreement….; inconsistency.”

When a client hires a trainer to help them achieve their fitness goals, they are doing so because there exists an evident and obvious inconsistency between the client’s current state of physical conditioning and their desired/ideal state of health. To help a client overcome whatever ambivalences and hesitations they have towards making that behaviour change, a smart trainer will encourage the client to talk about these discrepancies because openly verbalizing the discrepancies to someone else makes them more real. They are no longer simply hiding inside one’s head. Articulating these discrepancies makes the client more accountable to the trainer too. And being held accountable to someone improves the chances of successfully making a behaviour change.

So, what tactics does a trainer use to encourage the client to articulate the discrepancy between where they are and where they would like to get to? By using four techniques known by the acronym OARS:

1. Open ended questions. These are questions to which the answers require thought, reflection, and contemplation as opposed to close ended questions which only require a “yes” or “no” answer. A close ended question could be, “Have there been barriers that have prevented you from achieving your fitness goals?” All the client needs to say is “yes” or “no.” The trainer can hardly glean any information from this answer to help the client. But turn this into an open-ended question, “What have been the barriers in your life that have made it difficult for you to achieve your fitness goals?” and now the trainer has information to use in helping the client move past their ambivalence.

2. Affirmation. Affirming the client’s strengths and existing assets that can help them overcome their ambivalence to behaviour change.

3. Reflection. A complement to affirmation, reflecting involves repeating what the client shares about their current situation, their desired goals, and the discrepancies that exist between the two. By repeating back what the client articulates, the trainer not only better retains and remembers this information, but it shows the client that the trainer is actively listening to the client speak. And that is critical for gaining the client’s trust.

4. Summarizing reinforces reflection by having the trainer gather all the information the client shared at the end of the session and packaging into a review of what was shared and a “next steps” overview for what is to come.

By using the four principles of MI, augmented by the four techniques to develop discrepancy, the trainer can confidently support in helping their client move from ambivalence to accomplishment. And in the end, that is the goal of every good trainer.

Lorne Opler, M.Ed., CSCS, is an Adjunct Professor at Seneca College in Toronto, Ontario where he teaches Introductory Nutrition. He has specific interests in the areas of exercise and mental health, nutrition and mental health, fitness for older adults and people with disabilities. His freelance fitness articles appear in Muscle and Fitness magazine, ACE Fitness, and the Washington Post. Visit his website at trainerlorne.com.