Originally developed for substance-abuse counseling, motivational interviewing is a powerful way to help any type of client to change. It relies on four processes — engaging, focusing, evoking, and planning — to identify and resolve internal conflicts and help motivate the client to change themselves. While the most obvious application of motivational interviewing is for counseling and therapy sessions, other health professionals (for instance, a dietitian) seeking to assist clients in changing behaviors can utilize this method as well.

Core Strategies for Facilitating Change

To move a client through the four processes of motivational interviewing, professionals need to leverage four core strategies:

• Open-Ended Questions: Ensuring the client is doing most of the talking, helping them to explore their own thought processes and behaviors.
• Affirmations: Recognizing key strengths to help build the client’s confidence and acknowledge their own successes.
• Reflective Listening: Paraphrasing client statements back to them to demonstrate listening and empathy as well as to clarify reasoning.
• Summarizing: Encapsulating an entire session to help a client move to the next process, encapsulating a topic to facilitate moving to a new topic, or clearly linking two topics.

How to Use These Strategies

Motivational interviewing is a client-focused process, and that requires health professionals to be aware of both their verbal and non-verbal communication to ensure that their own behavior is intentional for the most effective session possible. It’s also critical to remember that each client is different, and that the processes of motivational interviewing are not checkboxes to be achieved within each session. Instead, the core strategies should be leveraged throughout every session to help clients move through the processes at the most appropriate pace for themselves, thus achieving lasting change.

Open-Ended Questions

Unlike closed questions, open-ended questions do not have a single, straightforward answer. For instance, “How long have you been smoking?” versus “Why did you start smoking?” Closed questions do not encourage explanations or help clients to tell their story; it leads to the professional doing most of the talking, rather than helping the client to open up.

Open-ended questions help engage the client with why they’re in a session, as well as to establish the trust necessary to draw on their personal beliefs and experiences to define their own ideas and motivation for change. These types of questions also help identify underlying behaviors and beliefs that can either help or interfere with the client’s efforts to change.

Affirmations

Affirmations are a type of response that encourage the client and display empathy while building rapport. It helps the professional emphasize positive moments in the client’s experience, or to acknowledge difficulties in a positive way. However, it should never sound like outright praise. For instance, “Great job dealing with that situation,” versus “It took a lot of strength to handle that situation.”

Direct affirmations should be used regularly but sparingly. This can help focus the client on the right behaviors and emphasize their success so far. Indirect affirmations should be maintained at all times — for instance, an attentive posture that demonstrates the professional is listening is key to maintaining trust, versus one that can be interpreted as bored or disinterested.

Reflective Listening

This can be a difficult skill to master. It requires the professional to observe the client’s body language, tone, and choice of words closely in order to reflect back what the client has been saying with the professional’s perceptions added in. This is important for ensuring the client stays engaged with the right topics and to clarify the client’s own reasoning behind their current behaviors and desire for change.

This must demonstrate empathy in order to guide the client toward a proper awareness of how they’ve been thinking and acting, which in turn helps to guide them toward intentional behaviors and real plans for change. Sometimes it can be as simple as repeating their words back to them, but sometimes it needs to be more nuanced, either through amplification or reframing.

Summarizing

Summarizing is probably the most straightforward of the four strategies. It utilizes paraphrasing to transition the conversation in one of three ways: closure, transition to a new topic, or a linked transition. Closure is for ending the session, and serves to tie together everything that had been discussed, while transitions move toward new topics or new perspectives. For instance, some clients may be avid talkers that get off topic; summarizing allows the professional to acknowledge their interests or distraction while bringing the focus back to where it needs to be. Or, the professional can use summarizing to transition the client’s focus from a problem to a conversation that helps them establish ideas for changing that problem.

It’s especially important through the planning process, which requires action plans based on what’s been discussed, along with revisiting and changing plans based on the behaviors and situations that resulted from the plan. Summarizing ensures that both the professional and the client are on the same page.

For a more in-depth look at motivational interviewing and the related methods and principles, please sign up for our practice-based training class. It’s geared toward any type of professional in any setting that works with clients toward changing behavior.