An Introduction to Motivational Interviewing

by Natalie Digate Muth, MD, MPH, RD on Oct 12, 2015

Motivational interviewing is a communication approach where a coach helps a client work through ambivalence toward behavioral change. It is highly effective for people who are ambivalent about change.

Motivational interviewing was first described more than 40 years ago, when it was used and studied as a tool to help alcoholics quit drinking. Since then, its efficacy with regard to a wide range of behavior changes has been proven through hundreds of scientific research studies (reviewed in Miller & Rollnick 2012). Without a doubt, this communication approach helps people who are ambivalent move toward change. Fitness professionals who gain some degree of proficiency in motivational interviewing will see immediate value.

It generally proceeds through four phases:

Engaging. The coach and client develop a strong, open relationship.

Focusing. The client and coach establish and/or explore the focus of the relationship. In many cases the focus will be apparent; however, if it isn’t, coaches may use “agenda mapping,” during which they explore several possible areas of focus and the client chooses one.

Evoking. The coach asks questions and provides reflections to help the client verbalize reasons for change through “change talk.” The coach helps the client to increase his motivation for change by reflecting on change talk, which typically comes up in the form of “DARN” statements: desire, ability, reasons or need to change.

Planning. The client and coach develop an action plan for behavioral change. Not every session will proceed through all four phases. In fact, the people who benefit most from motivational interviewing—those ambivalent about change-— will take awhile to get to the planning phase.

Miller & Rollnick (2013) recommend the following when you are first learning motivational interviewing.

  1. Why do you want to make this change?
  2. How might you go about making this change?
  3. What are the three best reasons for you to do it?
  4. How important is it for you to make this change?
    After each question, reflect on the client’s responses and summarize them, before asking:
  5. So what do you think you’ll do?

There are many opportunities to gain motivational interviewing skills, though the most effective is through ongoing practice and feedback. The Motivational Interviewing Network of Trainers (MINT), at www.motivationalinterviewing.org, offers workshops, some of which founders William R. Miller and Stephen Rollnick lead. The American Council on Exercise offers a Behavior Change Specialty certification. Wellcoaches® offers motivational interviewing in its coach training curriculum. Miller and Rollnick’s book Motivational Interviewing: Helping People Change (2012) provides a thorough introduction, along with prompts to support skill development.

To read more about how motivate clients to change their habitual behaviors, please see "The Secrets to Behavior Change: Principles and Practice" in the online IDEA Library or in the June 2015 print issue of IDEA Fitness Journal. If you cannot access the full article and would like to, please contact the IDEA Inspired Service Team at (800) 999-4332, ext. 7.

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Reference

Miller, W., & Rollnick, S. 2012. Motivational Interviewing: Helping People Change. New York: Guilford.

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About the Author

Natalie Digate Muth, MD, MPH, RD

Natalie Digate Muth, MD, MPH, RD IDEA Author/Presenter

Natalie Digate Muth, MD, MPH, RD is a board-certified pediatrician, registered dietitian, and ACE Health Coach. She is committed to providing evidence-based nutrition and fitness information to health professionals and consumers alike in a way that is logical, practical and directly applicable to readers’ lives. She has authored over 100 publications and book chapters, all which are based on the latest scientific evidence and presented in a manner that is easy-to-understand and apply. She is Director of Healthcare Solutions for the American Council on Exercise (ACE) having written the nutrition chapters for each of ACE’s textbooks, the ACE Fitness Nutrition Manual and Specialty Certification, and recorded several Webinars and online courses. Furthermore, as a spokesperson for ACE, the largest fitness certifying and advocacy organization in the country, she informs broadcast and print media outlets throughout the U.S. on pertinent nutrition and fitness issues. She is author '"Eat Your Vegetables!" and other mistakes parents make: Redefining How to Raise Healthy Eaters'. She presented a similar topic at IDEA World 2009; the video is available for purchase through IDEA. Certifications: ACE, ACSM and NSCA