Motivational interviewing (MI) is a communication style health coaches and personal trainers can employ to guide their clients towards effective and sustainable behavior change. Motivational interviewing is not about telling or directing; it’s a process of motivating, encouraging, supporting, and assisting a client as he or she journeys toward a new lifestyle.
This is in contrast to more direct approaches of communication in which a professional tells a client what to do and how to do it. Fitness professionals use this type of communication style in directing group fitness classes or in exercise instruction with clients. There are times when a direct approach is valuable, but when we are working with clients on change efforts, guiding is the most effective method.
Core Tenets of MI
Well-known psychologists William Miller and Stephen Rollnick developed MI with the intention of creating a method of communication that was client-centered versus professional-directed. The basic foundation of MI is encouragement and empowerment.
In order for clients (or any individual) to make a change, he or she must have a sense of empowerment (confidence and self-efficacy) and feel encouraged as he or she moves toward the intended goal. Therefore, MI uses the OARS approach to evoke change.
O = open-ended questioning
A = affirmation
R = reflective listening
S = summarizing
The Open-ended Question
Using open-ended questions versus those of the “yes or no” variety allows a client (and the fitness professional) to dig deeper into a client’s needs and desires and the reasons behind his or her goal.
For example, a client comes to you with a common desire – to lose X amount of weight by Y date. As a way of using the MI strategy, you could say “I understand you wish to lose X weight by Y time. Can you share with me what losing this identified weight means to you?”
Another example might be a client telling you that she feels she is unable to exercise consistently because she is too tired. You could respond by saying “What do you feel are the root causes of your fatigue?”
Humans inherently want to seek affirmation as a way of building confidence. A trainer can affirm a client’s statements by using “you” instead of “I”.
For example, instead of stating “I am happy you did X” you can say “You did a great job of identifying triggers for stress and finding ways to manage those triggers in a positive way.” Affirming statements encourage the client to keep going and help to reframe a negative mindset to a positive one.
We often hear clients say something such as “I missed my workout this morning. I failed.” We can turn this thought process around by saying “You remembered to take your walks throughout the day. Remember when you first started and taking intermittent walks to break up the day seemed impossible?” This moves the “deficit” mentality to the “strengths” mentality.
Here, the professional can clarify what the meaning behind what a client says. Reflective comments encourage the client to think longer about something he or she said during the conversation. A client may say “My work environment does not support my goals.”
You might reflect by saying “It will be a challenge to find the support you need in your professional setting.” The client can agree, disagree, or expand upon the earlier statement.
Reflective listening is a way of challenging a client’s thinking. It is not a method to refute or dismiss a client’s thoughts or feelings. It’s a time to foster a deeper level of thinking.
At this time, the professional summarizes what he or she heard the client say throughout the conversation. This is done at the end of the MI session. For example, “let me summarize what you shared with me so far. I hear you feel…and…etc. Does this sound accurate?”
MI takes time to learn and implement with clients. Miller and Rollnick suggest the following four questions to use with clients who may be ambivalent to change.
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 and why?
Engage in the MI process by affirming, reflecting and summarizing the answers the client provides and then follow-up by asking “What do you think you’ll do to move forward?”.
If you are new to MI, remember to approach all conversations with your clients in a non-judgmental way. As soon as a client feels that they are being judged, they will leave and change may not become possible. Each conversation you have with a client is an opportunity to learn and grow together as the journey of change progresses.
Miller, W. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rded.). New York: John Wiley & Sons.