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How we can use motivational interviewing

As Enablers of change, we’re always looking for useful tools to add to our toolbox. Recently we came across this idea of motivational interviewing and we wonderedjust what is this and how can we use it? In this episode, we’re going to explore motivational interviewing. 

Back in the 1980s, psychologists would often accuse their alcoholic clients of blatant lying and of being in denial. However, Bill Miller, a clinical psychologist in the US, thought that people who drank too much were usually already only too aware of their problem. He realised that we evoke resistance when we try to persuade people that they drink too much or need to make a change in their lives. Instead, he started asking them questions and listening intently to their answers. Stephen Rollnick, a nurse trainee in the UK, was working in addiction treatment and read one of Bill’s early papers about this new approach. A few years later they happened to meet in Australia (it’s the place to be!), and started collaborating on this new way of helping people change. They called it motivational interviewing. 

The central tenet is that instead of trying to convince someone to change, it is better to help them find their own motivation to change. When we start interviewing someone, we do not really know what will motivate them to change, we can only guess. But for this approach, instead of guessing, we just ask them! To do this well, we need a generous mix of humility and curiosity. The goal is to help them break out of their existing thought patterns and discover new possibilities. 

Rollnick and Miller define motivational interviewing as ‘a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence’. They say that it is defined by its spirit as a facilitative style for interpersonal relationships. In contrast with non-directive counselling, it is more focused and goal-oriented. 

Another more formal definition is that it’s ‘a client-centred, semi-directive communication approach that harnesses another person’s intrinsic motivation towards change by developing their awareness of discrepancies in their life and resolving ambivalence toward change in order to initiate and facilitate change.’ That is from the motivational interviewing workbook for change agents by Barbara Orr and Marilyn Stein. It is a bit of a mouthful though so we are going to break that down a little!

Psychology tells us that we all have intrinsic motivationthat is behaviour driven by internal rewards rather than from something or someone outside us pushing us to do something (that is the oppositeextrinsic motivation). Some examples of behaviour motivated intrinsically might be gardening or reading a book, when we do these because it makes us feel satisfied and happy. Consider the opposite. Someone says they will pay us for each book we read. That is extrinsic motivation, and the research actually says it reduces our enjoyment!

So back to motivational interviewing! This is where we seek to harness the intrinsic motivation already present and direct it towards a vision for change held by that person. Motivational interviewers do this by raising awareness of current behaviours and the consequences and problems this brings and the benefit of changing these behaviours, but by getting the person to identify this. Not just us saying it!

Orr and Stein say this is because we are respecting a person’s autonomy when we do this. Autonomy is the ability to make our own decisions. Having our autonomy threatened means that someone else is forcing us to do something or change. Motivational interviewing is designed to help acknowledge our autonomy.

So what are the principles of motivational interviewing? Orr and Stein suggest the following:

  1. Expressing empathy. This is really important because we are more open when there is empathy and we tend to shut down when it’s lacking.
  2. Developing awareness of discrepancies. This is the point of motivational interviewingraising awareness of the discrepancies between behaviours and vision. Raising awareness of the difference between these helps increase discomfort, which we need to experience to make the effort to change.
  3. Rolling with resistance. This means acknowledging resistance to change and reframing it as a strength or how we could use this to help diffuse resistance to change.
  4. Promote self-efficacy. Self-efficacy is the sense that we have control over making change. So high self-efficacy means we feel able to make changes, whereas low self-efficacy means we’re more likely to believe that anything we do will not make a difference. Motivational interviewing helps to highlight a person’s strengths and abilities so they see they can make changes.
  5. Amplify ambivalence. This is exploring what has people stuck and identifying anything that is holding them back from changing, as well as being explicit about what we might need to give up when we make changes.

 

If you’re thinking that motivational interviewing might be a useful tool, we thought it would be helpful to cover the core skills required. Stein and Orr list four skills, namely:

  1. Open ended questions
  2. Affirmations
  3. Reflections and
  4. Summarisations.


We think these skills are already part of what makes enablers of change effective, so it seems reasonable that we could use them for motivational interviewing.

It is worth reminding ourselves at this point that motivational interviewing comes from psychology, primarily as a counselling tool and has been used extensively in the health field. But that is not to say that agriculture has not tried this approach. We found several research projects centred on training veterinarians to use motivational interviewing. The researchers explored whether this training made a difference in the way in which vets communicated with farmers on herd health. The results suggest it did (Bard et al., 2022; Scrase et al., 2015; Svensson et al., 2020). We also came across the use of motivational interviewing for a project involving egg producers in the UK. Facilitators trained in motivational interviewing worked one-on-one with farmers to develop action plans for the health of the flock. The results show that this approach was effective in creating change on-farm Baker et al., 2020).

So motivational interviewing is a tool that sits between following (via active listening) and directing (through giving information and advice). It is designed to help empower people to change and is based on being curious and respectful. There is a helpful three-page guide available online if you are interested in learning more.

Well, you have read our thoughts, now we would like to hear yours! Add a comment below and tell us about your experiences with motivational interviewing. Have you heard about it? Used it? Please include any tips and further ideas about it. We don’t want this to be just a one-way conversationjoin in by sharing your thoughts and ideas with us! 

Thanks folks for reading this Enablers of change post. Remember to subscribe to our newsletter if you’d like to know when new episodes are available. And if you liked what you heard, please tell your friends so they too can join the conversation!

Resources

Baker, P. E., Stokes, J. E., & Weeks, C. A. (2020). Enabling behaviour change in laying hen farmers using motivational interviewing. Multidisciplinary Digital Publishing Institute Proceedings, 73(1), 16. Available online

Bard, A. M., Main, D. C., Haase, A. M., Whay, B. R., & Reyher, K. K. (2022). Veterinary communication can influence farmer Change Talk and can be modified following brief Motivational Interviewing training. PLoS One. Available online

Miller, W.R. & Rollnick, S. (1991) Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.

Orr, B., & Stein, M. (2016). Motivational Interviewing: A Workbook for Change Agents. Lulu Press, Incorporated.

Rollnick, S., & Miller, W. R. (1995). What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy, 23(4), 325-334. Available online

Scrase, A., Main, D., Haase, A., Roe, E., Whay, B., & Reyher, K. (2015). Using motivational interviewing in veterinarian-farmer communication: towards improved uptake of veterinary advice. In BCVA (pp. 203-204).

Svensson, C., Wickström, H., Emanuelson, U., Bard, A. M., Reyher, K. K., & Forsberg, L. (2020). Training in motivational interviewing improves cattle veterinarians’ communication skills for herd health management. Veterinary Record, 187(5), 191-191. Available online

Understanding motivational interviewing – a short three page guide. Available online

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Graham Harris
Graham Harris
1 year ago

Thanks Denise and John – a very interesting topic.

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