Solving Your Clients' Problems With Motivational Interviewing
Are you more motivated when working on one of your own ideas at work that could benefit the company or when your boss tells you to carry out a task? You’ll probably agree with me that you’d be more motivated by your own ideas and decisions. Don’t you think your clients feel the same way when it comes to their fitness goals? There is a powerful technique to help people make positive health changes by reframing how they see their goals. These motivational interviewing techniques can provide a simple and effective way for people to make big life changes.
What is Motivational Interviewing?
Motivational interviewing is a collaborative, goal-orientated style of communication with particular attention to the language of change. It is designed to strengthen personal motivation and commitment to a specific goal. You bring and explore the person’s own reasons for change within an atmosphere of acceptance and compassion.
To put it bluntly, it’s a soft way of asking your clients to take a hard look at themselves and set their own goals to change behavior that is not beneficial to them.
Furthermore, It’s a way to eliminate the frustration for personal trainers and nutritionists that see their client not sticking to the plan, or ‘falling off the wagon’ after a short period of time.
Motivational interviewing addresses the different stages of achieving change and evolved from the field of addiction treatment. But it can be applied in the health and fitness industry to impact behavioral change in nutrition and exercise. After all, in fitness it is frustrating as well to see someone not sticking to the plan, or ‘falling off the wagon’ after a week.
The goal of motivational interviewing is to get individuals to resolve their ambivalence about changing their behavior, without evoking resistance to change.The client sets their own goals with your help, and you guide them through 4 main stages with the use of open ended questions that are specific to each stage.
Before we can get to a practical application of motivational interviewing, there’s one term that needs further introduction: ambivalence.
People often experience guilt or embarrassment over the reasons they have to sustain their current behavior.
What is Ambivalence and How Do You Solve It?
Ambivalence is when a client has mixed feelings or views about making a change.
They may argue for reasons not to change. Ambivalence is normal. When they talk about making the change, they may include “but” statements, such as “I want to exercise, but don’t have the time,” or “I want to add more vegetables to my diet, but the rest of my family won’t eat them”.
On the one hand a person’s current behaviour brings them some rewards, but on the other hand, a change in behaviour is also appealing but very hard. Thus, there is this constant back and forth about making any changes. Motivational Interviewing attempts to tip the balance of this ambivalence into the direction of change.
Let’s look at the example of a person thinking about a change in their diet. Basically, a person is asked to write down all the reasons for change and all the reasons to stay the same. It is done in an honest way so that all the reasons to stay the same are realistically expressed.
The motivation comes from seeing both sides of the story and seeing what the barriers to change might be. As they realize the reasons for their current behavior, they can also see why it has been so difficult to change. This realization removes some of the pressure, as unhealthy behaviors are often accompanied by feelings of guilt. It also helps people be more realistic when they are in the midst of change and it becomes difficult.
OARS is a skill-based model of interaction adapted from a client-centered approach used in Motivational Interviewing. OARS stands for: Open-ended questions, Affirmations, Reflections and Summarizing statements.
Using OARS will help to establish an atmosphere of acceptance and trust and aid the client in exploring their hopes and fears. They are not used in any order and can be used throughout a whole consulting session.
Advice for Coaches
Research indicates that people are more likely to stick to their goals if they set them themselves. Thus, your job is to help them discover their goals, as well as to help them complete their own list of reasons for change and all the (true) reasons to stay the same in an impartial manner.
Firstly, you want to avoid jumping right into the reasons for the change. Coaches rarely ask clients about the benefits of not exercising or not making healthy changes.
People often experience guilt or embarrassment over the reasons they have to sustain their current behavior.
So as a coach, your job should be to completely explore the difficulties that a person will have in making a change and this includes why not changing is also appealing to them.
One question you could ask is, “What barriers could get in the way of you making that change?” The more realistic you are with people about the difficulties they might face, the more they will trust your ability to work with them.
Putting OARS Into Practice
1. Discovering ambivalence
Coach: “You said you wanted to try the new Bootcamp class at the gym for a long time. What do you think is keeping you from going?”
Client: “I don’t know, I’m probably just afraid to try something new. It will take me awhile to get the hang of it, and I have to figure out if its worth the risk of embarrassment .”
Here you have to choose carefully what you will say next. You need to highlight ambivalence in a curious and non-judgmental way.
Coach: “You’re concerned others may make certain judgments about you doing Bootcamp classes.”
2. Hearing and highlighting keywords that indicate a will to change
Coach: “And yet you keep putting a Bootcamp class on your to-do list.”
Client: “Well, I want to be healthy, for one. Plus, my friends talk about boot camp classes all the time, so I would like to be able to join in their conversations. I’ve also been very stressed lately and I know I could use a way to de-stress.”
The best way to proceed at this stage is to use Reflective Listening: Mirroring the individual’s comments by repeating back what they said. Download our free OARS resource for more information about Reflective Listening.
Coach: “You value your health and recognize that managing stress is important in order to keep healthy. Bootcamp has been a personal goal for a long time now and you are hesitant to get started. You sound pretty confident that if you got over some of your fears of surviving the first class, Bootcamp would benefit you in a lot of ways. What do you think you will do?”
Client: “Yeah, I know that if I do one or two classes I’d be fine. I think that if I make sure to go to class with one of my friends it should be fine with the other people in the room.”
Note that it’s extremely important that you let the client realize the answer to their problem by themselves. In real life it may not be as simple as the example above. In that case, keep using reflective listening and open-ended questions until they reach a conclusion by themselves.
Clients take into account the advice of people they respect and trust[
Partnership: You and Your Client Become a Team
After you have discovered the source of the ambivalence and have been able to identify elements that suggest the client is willing to change, you have to define exactly what needs to be changed.
The typical view of exercise and nutrition guidance is that the personal trainer or nutritionist is the expert and the client is the student. The expert will fill the client with information about the changes they need to make and the client will just sit and listen.
However, researchers have found flaws in this style of communication. Clients would prepare for the abuse, admit their faults right away, and sit there waiting for their punishment.
For the majority of people, this style of coaching can be humiliating and irritating and will result in a high no-show rate and very few follow-up appointments.
In this case, the easy answer is to say that the client was just unmotivated when they don’t show up again.But perhaps the client is not unmotivated; the real issue is the communication style that is being used.
Instead of just giving up because they show no initial motivation, consider your role in bringing that motivation out and together move towards a behavioral change.
Advice for Coaches
In a session driven by motivational interviewing you need to avoid wearing the ‘expert hat’ and instead, partner up alongside your client as a team.
At times tips may be provided but only if the client is stuck and cannot come up with the answers themselves. Before providing these tips, ask for permission to share your ideas as this increases the feeling of partnership.
‘It sounds like you are interested in packing lunch for work in order to keep track of what you eat better, would you like to brainstorm together so we can come up with meals ideas?’
By including the client in the process they’re sure to leave with a list of foods that they’ll enjoy. Plus, they might be more motivated to make the change as they play and active role in coming up with the solution.
You can ask them to keep a log of their exercise and nutrition to further increase their motivation. This process can be made very easy by implementing a fitness software and mobile fitness apps for exercise and nutrition. Using these tools also shows the client that you care about their process of change and in return, and will increase the team feeling.
At this stage, it is important to avoid the expert trap, which occurs when imperatives are used.
These are statements such as ‘You need to…’ or ‘You should…’ Using these phrases suggest that the practitioner is the expert and knows what will work.
That’s true when talking about just nutrition or exercise knowledge, but the client has a better idea of what will work with their current lifestyle.
Furthermore, bringing attention to your knowledge and expertise will decrease the feeling of partnership.
For example, instead of ‘you should keep eating more protein to increase satiety’ you can show the client your desire for partnership by saying ‘My clients have said that increasing their protein has helped them reduce hunger, what have you experienced?’
Putting Partnership Into Practice
3. Avoiding the Expert Trap
Client: ‘I know I don’t eat enough fiber. I could probably do better in that area.’
Coach (falling in the expert trap): One way I like to get more fiber in my diet is to eat legumes or mix some high fiber cereal with my yogurt.
This makes you come across as the ‘perfect eater’ and you do not assess the client’s interests with regards to this change.
Coach (expressing partnership): ‘You’d like to get more fiber in your diet. What ideas do you have for adding it to your diet? Would you be interested in one idea that is perfect for a cold day like today (e.g. lentil soup)?’
The client has been invited to come up with their own ideas. Then, permission was asked before providing the idea of lentil soup. The client won’t always come up with their own valid answers, but how you present yours is very important to keep the sense of partnership.
The Righting Reflex
Most likely, you got into this line of work because you wanted to help people live healthier and happier lives.
As experts in nutrition and fitness, it can be difficult to restrain yourself from giving unsolicited advice when your client is struggling with ambivalence.
But, unsolicited advice can also occur when the practitioner perceives that the client is misinformed and corrects him. The ultimate goal is not to be right but to help your client make meaningful changes.
This type of advice is called the righting reflex. The following are indicators that you are about to use the righting reflex:
- Why don’t you just…?
- What about trying…?
- What you need to do is…
Advice For Coaches
In the process of change, unsolicited advice can become a roadblock towards the client’s progression to change. When there is a roadblock, the client has to think about how to respond to your advice, taking the focus away from change.
Although you may have the best intentions, how you provide information and advice are as or even more important than the information itself.
People take into account the advice of people they respect and trust.
Motivational interviewing techniques helps you gain that trust and respect by treating the client, with an unconditional positive regard.
By adopting an attitude of unconditional positivity, you provide them with the support they need to take responsibility for their behaviors and accept themselves as they are.
Putting the Righting Reflex Into Practice
4. Avoiding the Righting Reflex
Coach: ‘How do you stay hydrated?’
Client: ‘I usually drink juice, it tastes good and it’s made out of fruit, so I like to drink a lot of it as it’s healthy.’
Coach (using the Righting Reflex): ‘Where did you hear that? Juice has a lot of natural sugars that are not beneficial in large quantities. Why don’t you just drink water instead?’
Here you are starting to lose the sense of partnership.
You’re exerting your control over them. This ends up making clients feel more defensive which can lead to the client being less comfortable with sharing other types of misinformation they might have. They’ll start to shut down.
Coach (avoiding the righting reflex and expressing partnership): ‘It’s important for you to make food choices that improve your health and well being. Perhaps it would be helpful to talk about sugar and where it’s found in food?’
You do not express your knowledge in an authoritative way and you ask the client if it would be helpful for them to discuss further about this topic.
This allows you to explain the misinformation and provide knowledge with expressing control over them.
It also decreases the chance of the client becoming defensive. They will be more comfortable with sharing other possible misinformation they might have acquired over time.
Key Points to Remember
- Ambivalence is normal and should be expected
- Change can happen when the client sees the gap between his/her current behavior, and goals and values
- A full understanding of and practice with all of these components of motivational interviewing is a must if you want to use it successfully!
- Additional and ongoing support, education and training is recommended