Supporting change through skilful conversations

There are many professionals who help people who are struggling with change.

Whether they are in educational, therapeutic, healthcare or community settings, supporting people to make life-supporting choices has long-lasting impact.

Some clients might be unaware of the options that change offers them. More likely, however, they are aware of the benefits of changing but have ambivalence (reasons to maintain the status quo while aware of the pros of change) so don’t put things into place to help positive change happen.

How can we support people who are ambivalent about change?

Motivational Interviewing (MI) is a way of working with people that has been shown to effect positive change in a broad range of settings. Its roots are firmly based in sound therapeutic practice, where practitioners build a positive alliance with their clients. They offer a non-judgemental approach, with compassion and acceptance being central to their work. This facilitates a supportive relationship.

The practitioner’s role is not to persuade people to change – persuading, giving unsolicited advice and offering information often results in clients feeling ‘done to’ or not heard, and sometimes they resist by rebutting with all the reasons it won’t work, or by withdrawing. Practitioners instead need to challenge their assumptions that the changes they wish to see their client make are the ones the client values. This may not be the case! More work is needed to understand the client’s world and the pros and cons of changing from their perspective.

Practitioners who use MI are skilled in active listening and reflecting, using considered open-ended questions and summarising relevant elements of the client’s experience. This helps shine a light on areas that can help the client consider change and overcome identified barriers. This empathic and skilful style of working allows clients to feel heard, understood, engaged and more open to talk about change. More advanced practitioners skilfully evoke more ‘change talk’ with the client’s own reasons for change, and plans for change being harnessed via this collaborative partnership. The client’s autonomy is always upheld and coercion or persuasion are never used in MI.

How did Motivational Interviewing develop?

MI was developed through clinical psychology practice by Dr Bill Miller and Dr Stephen Rollnick. It was introduced in 1981, with the two founders employing it while working with some of the toughest patients in drug and alcohol rehabilitation settings. They have continued to hone the method and their book, Motivational Interviewing: Helping People Change, is now in its third edition.

Since 1981, more than 25,000 articles have cited MI and over 200 randomised clinical trials have been published. The evidence base is strong and we now see MI being employed as a tool in supporting people in fields including psychology, psychiatry, medicine, education, criminal justice, health and wellbeing, sport and physical activity development, pharmacy and dentistry.

Applying MI in practice

Developing and practising the spirit and skills that make up effective MI practice takes time, training, feedback and coaching. Just like any complex skill, such as a learning a new language or musical instrument, MI is not something that can be learned in a short one-time workshop.

As a member of the Motivational Interviewing Network of Trainers (MINT) and advocate of incorporating MI into practice, I wish I had known about MI when I was working in health promotion earlier in my career. I think back to the consultations I had with people around lifestyle change, and realise now that I was too quick to give advice, refer them to the guidelines and use my expertise without really considering if they were ready to hear it.

This is a common trap that many people fall into when working with clients – we forget to listen deeply enough to their experiences, thoughts and concerns. MI can be used efficiently in short conversations and if the client hears their ideas really being heard and understood, the likelihood of them acting on these ideas increases. There’s a time for information to be given, but in MI we always check with the client first to see if they are interested in hearing our thoughts, and follow up with asking them how they understand this information.

I train people in MI and also use it in my work to support students at the University, and for people who are interested in lifestyle change. It’s a way of working that is collaborative and I like that the client’s experience is truly valued and treated with respect and acceptance. When I train people, they often begin to realise they don’t listen skilfully, they jump in with advice and position themselves as the expert, or ask a barrage of questions so their conversations feel like interrogations! By trying a different approach, they recognise their own assumptions and patterns. They come back after trying out MI in their roles or at home with their families with stories of real breakthroughs with the people they work or live with.

Develop your MI proficiency

At the University of Derby, we offer a variety of opportunities for professionals to develop their proficiency in MI. These training workshops and coaching opportunities are led by members of MINT, an international organisation supporting the continuous learning and skilfulness of trainers in MI.

We also offer bespoke training for university teams or external organisations, and can work with people to have their practice coded with feedback, or mentor them if they are interested in becoming MI trainers. For any questions, please contact Dr. Fiona Holland at f.g.holland@derby.ac.uk.