How to Help Someone Make a Change
Why Motivational Interviewing works- and contradicts what most of us believe about changing someone’s mind
Motivational interviewing is gaining ground with therapists, nutritionists, doctors, and coaches across the world - because it works |
Photo by Ground Photo on Shutterstock | used under license from Shutterstock
One of the most powerful lessons I ever learned about behavior change came from watching one of my brother’s friends narrowly avoid a disastrous marriage.
John* is one of my brother’s most grounded and logical friends. Extremely careful with his finances and planning, he surprised his friends a few years ago by dating a woman with whom he constantly fought and walked on eggshells.
When they got engaged, his friends protested. They told him everything they didn’t like about his fiancee, the effect she had on him, and the giant mistake he was making. The more adamant they got, the more John dug in his heels and marched towards the altar.
Suddenly, a couple weeks before the wedding, he called everything off.
John later shared that the decision was triggered by a casual remark a friend said to him as they hung out one evening:
“You know, I’ve always admired how thoughtful you are with your money and career. Do you feel like you’re applying that same thoughtfulness to your personal relationships?”
His friend left after that but the question hung in his mind. Shortly after, he made a new decision.
At the time, the power of this one comment amazed me. It shifted the course of this man’s thinking when nothing else could and led him to call off a wedding that his friends and family had bought tickets and resigned themselves to.
Looking back a few years later, I’m no longer surprised. After becoming a Nutritional Therapy Practitioner and studying the research behind behavior change, I realized that the comment is actually consistent with one of the most effective approaches to behavior change: Motivational Interviewing.
I want to share what Motivational Interviewing (MI) is, what makes it so effective, and how it flies in the face of what most of us believe about helping someone make a change. Importantly, though I describe how MI works in a therapeutic relationship, the same principles apply to conversations with friends, family, or anyone you are trying to help make a real change in their behavior.
What is Motivational Interviewing?
Motivational Interviewing (MI) is a client-centered counseling approach developed by clinical psychologists William Miller and Stephen Rollnick in the early 1980’s. Miller and Rollnick were interested in understanding the principles of approaches that led to effective change and from their research, the principles of MI were born. MI is designed to help individuals explore and resolve ambivalence or resistance to change in order to guide them towards making positive changes in their lives.
MI can be broken down into four fundamental processes:
Engaging: Creating a strong therapeutic connection with the client, based on safety and trust.
Focusing: Honing in on a specific topic or change the client wants to make.
Evoking: Using questions and reflective listening to draw out the client’s goals and motivation for change.
Planning: Developing a change plan with the client, involving specific steps and strategies collaboratively agreed on.
While some of these processes may sound like the basic steps of therapy or helpful conversation, there are a few points that make MI unique and more effective than other approaches to behavior change.
#1. MI is collaborative and client-centered
At the core of MI is the belief that a client has intrinsic motivation to change and is worthy of unconditional positive regard. From this perspective the role of the therapist is to facilitate and evoke the client’s motivation through reflective listening, open-ended questions, and guiding the client to explore their own goals and solutions. Rather than taking on the role of the expert, the therapist puts the client in the driver’s seat and simply helps them unlock their own power.
Unconditional positive regard is central to the spirit of MI. According to Miller and Rollnick, and based on the ideas of psychologist Carl Rogers, “When… people experience being accepted as they are, they are freed to change.” Laura Curtis and Dawn Clifford elaborate on this on their book “Motivational Interviewing in Nutrition and Fitness”:
“By adopting an attitude of unconditional positivity toward people trying to change, you give them support to take responsibility for their behaviors and accept themselves as they are.”
Contrast this with the approach taken by many doctors and teachers who quickly jump to telling those in front of them what they must do. They pre-suppose they know what someone should do and why. Oftentimes, when a person fails to take a certain course of action — whether losing weight, managing cholesterol, or studying for an exam — they make negative assumptions about the person’s character.
A meta-analysis examining the impact of healthcare providers — including doctors, nurses, midwives, and dietitians- using MI showed that it outperforms traditional advice-giving in 80% of cases. The effects were high whether the goal was to help someone quit smoking, treat diabetes, lose weight, or exercise more.
#2. MI explores uncertainty and ambivalence
One process that makes MI unique is that of evoking. In this step, the therapist uses open-ended questions and reflections to encourage the client to share their motivations and feelings around a behavior change.
More often than not, the process of evoking brings up ambivalence and a mix of feelings rather than a clear answer. A client may want to cook more at home, but share that they hate the time involved and the process of cleaning up. Or that they may want to cut down on sugar to avoid diabetes, but are worried about giving up the pleasure and comfort it brings them.
Though many counselors try to skip over ambivalence and get the client to make a decision, therapists practicing MI seek out ambivalence the way explorers pan for gold. They encourage the client to raise all of their competing feelings and desires while they sift for the emotionally charged nuggets that the client is wrestling to resolve.
By highlighting ambivalence, the therapist highlights a conflict between a client’s values and personal goals and their current patterns. By bringing this discrepancy to light himself, the client becomes far more likely to try to make a change than if he had never become conscious of it in the first place.
#3. MI encourages a client’s personal motivation and goals
Unlike traditional counseling, MI does not encourage a therapist to assume a client’s motivation or goals. These are explored through conversation with the client and are decided by the client.
I experienced the power of this aspect of MI in action when tutoring a high school student a few years ago. As I walked in the door of his home, his Mom said to me, “Good luck, but all Sam wants to do is play soccer. When it comes to school he doesn’t care.”
As I turned to her son, I asked him if that was true and he confirmed he would indeed rather be playing soccer.
Then I asked what he liked most about playing soccer and his answer was clear: Winning. Racing ahead of other guys and pulling ahead in a great game.
With an idea in mind, I suggested, “Since you like competition, why don’t we turn this into one? I’ll bet you $20 I can write a better essay than you can. Your Mom can be the judge.”
He looked at me in surprise and said, “That makes no sense, she’s biased to me.”
“So this should be easy for you,” I smiled.
A week later, Sam rightfully beat me. He wrote an essay that not only impressed his Mom, but his teacher. He also discovered a new motivation for performing well in school: winning. First against me and then, as he continued onward, against himself.
The story shows something important: we often don’t understand the intrinsic motivations and goals of others and label them “unmotivated.” In Sam’s case, I suspected he was highly competitive and motivated to win and just needed to work with him to connect this to academics.
The MI approach encourages a therapist to explore a client’s personal motivation and goals and discover them together. After all, no one knows what the client truly wants more than the client himself. The therapist’s main goal is just to help the client discover and align with his motivation and to help mentally unblock him from getting there.
#4. MI respects the client’s autonomy
Within MI, the client is the expert because he knows himself better than anyone else. He knows his daily routine, true motivation, desires, and goals. For this reason, MI always puts decisions in the hands of the client and respects his choices.
Rather than telling the client what to do, a therapist practicing MI will often ask the client for his ideas. For example, if I’m working with a client who expresses the desire to eat fewer unhealthy snacks, I may ask him whether he feels ready to give up snacking completely or whether he wants to upgrade the types of snacks he eats. If he wants to upgrade how he snacks, I’ll first ask him what ideas he has in mind for healthier snacks. I’m always willing to provide further information or ideas from my own training, but I’m interested in the client’s ideas first.
For many counselors, this can be a frustrating role reversal. For doctors, nurses, or nutritionists who are experts in what they do, it can feel like giving up the expert role in conversation strips them of their power and credibility.
At the same time, the power should rest with the client — because he is the only one who has the power to change. While guidance and steering may come from a therapist, the client must feel empowered in the direction he’s going and that it’s his own decision.
Conclusion
Returning to the comment that changed John’s mind, it worked because it embodied the principles of MI beautifully. The friend who spoke to John spoke to him out of true high regard and raised a question to him that probably led him to reflect on his values, motivations, and goals. It highlighted contradictions between his values and actions. And finally, rather than directing him as to what he should do, his friend respected his autonomy.
His friend’s comment conveyed that he didn’t need to be told what to do. With reflection, he could make the right choice for himself. He ultimately did, and today he’s much happier for it.
If MI offers any message about helping others change it is this: before you try to change someone, understand them from the inside. Learn what they want, value, and what internal conflicts keep them in place. Support them in seeing all of this themselves and you will not have to change them — you will be a supportive witness as they change themselves.
Name changed for privacy
