MOTIVATIONAL INTERVIEWING & BEHAVIOUR CHANGE
Successful weight management programmes require three key components
DO YOU PROVIDE THEM ALL?
Nutrition education and support
Activity and/or exercise advice
Behavioural/Lifestyle change and habit formation
If ONE component is missing then the chances of achieving long-term, permanent weight-loss are very low.
If a client is not in the correct stage of change they will ultimately not succeed in a weight-loss programme. Working with a client who is unsure or carries self-doubt is a difficult task, but there are researched, effective and simple techniques to build your clients self-efficacy, confidence and knowledge, making your job and their success come far easier.
There are two components to the new course.
- E-Learning covering all the latest theory and psychological models in behaviour change. This also includes sections on how to use psychometric testing with clients. How to score and interpret these tests and also how to use them as a client retention tool.
- The taught one-day workshop covers motivational interviewing and communication and its application for behaviour change. I will teach all workshops and they will include a large practical element to enable you to refine these skills.
The NEW one-day motivational interviewing (MI) workshop (2 above) will teach you how to enhance your client engagement and also enable you to assist clients with other lifestyle behavioural changes such as those required for exercise adherence, smoking cessation. This important counselling skill (MI) has been incorporated into the behaviour change workshop to enable trainers to guide clients who are ambivalent about lifestyle change (sitting on the fence) and help them take the next step. You also receive a free text book: MI in Nutrition and Fitness.
Using MI based skills, trainers can build client self-confidence and also improve their businesses client retention. For a full description of MI see appendix one at the foot of this page.
Using the techniques taught in the behaviour change workshop the weight-loss system developed in my research (LEAN Man System) achieved an 86% success rate both in the UK and New Zealand (NZ). This programme has since been adopted by the Manawatu Public Health region (NZ) for use in the community. The MI skills most recently incorporated in this workshop may well increase this already impressive success rate, only time will tell.
The one-day workshop is delivered by Dr Gary Mendoza. The day runs from 09:00 to 18:00 and it will be very interactive and practical with all content explained and demonstrated. Students will learn and practice the basic techniques of motivational interviewing. The workshop includes a lot of ‘real play’ which offers participants the opportunity to work on their own problems (Be these business or personal) throughout the day. On completion of the workshop students will have a possess a toolbox of techniques they can apply to initiate change and run a successful weight-loss programme. All techniques are based on evidence-based research. The course text book that accompanies the workshop is also fully referenced. Due to the very interactive nature of the workshop student numbers will be limited to allow the required interaction and practice.
Who should attend the One-day workshop?
- Personal trainers wanting to improve their weight-loss and communication skills
- Registered Nutritionist’s involved in delivering weight loss programmes
- Dietitians running weight loss programmes
- Practice nurses running weight-loss programmes in GP surgeries
- Individuals interested in weight loss and where they are personally in the change cycle
What is Motivational Interviewing?
Motivational interviewing (MI) is a way of being with a client, not just a set of techniques for doing counselling (Miller and Rollnick. 1991). A laypersons definition would be ‘MI is a collaborative conversation style for strengthening a person’s own motivation and commitment to change’.
To understand what MI is it is helpful to understand MI spirit. The following diagram taken from the basic MI training workshop sums this up very well.
Figure 1. The MI Spirit (diagram from basic MI training workshop)
It is very much person centred and very much about accepting that an individual has complete autonomy of their choices and actions. MI is not some magic technique that your practice on an individual. It is also not a method for manipulating an individual to make changes. MI recognises that the person who knows you best is you. Through a conversational style the counsellor/trainer draws on this knowledge and reflects it back to the client.
Listening is a key skill to master in MI and is often referred to as active listening. It is this ability to listen and recognise different aspects of a person’s language that sets a person skilled in MI apart from others.
MI is very much client centered and the aspect that separates an MI conversation apart from your everyday conversation is that it has direction. Using the basic skills of OARS (see definition below) the conversation is guided in a useful direction.
The basic skills of MI are built around O.A.R.S :
- Open questions
Using these skills, the counsellor/trainer moves in a general direction through the foundational steps of MI. These steps are as follows:
Figure 2. The Foundational processes of MI (diagram from basic MI training workshop)
Using the idea of weight loss, you can see how this might work. It is not too much an assumption to make that the population have a general idea about what healthy eating entails. It would also be reasonable to assume that the majority of the population understand the importance of exercise/activity in terms of health and weight loss.
If these assumptions are accurate then why do we have an obesity epidemic? One answer may be that although people know what they should do they choose not to. Many people can see the advantages of eating healthier and being more active and could no doubt tell you what they are. On the other hand they can equally see as many reasons why they can’t eat healthily and exercise more. In MI terms this is called ‘ambivalence’. In other words, the pros and cons of change are pretty much in balance.
The treatment improvement protocol from rockville1 describes MI as follows and takes account of ambivalence within this:
“Motivational interviewing is a counselling style based on the following assumptions:
- Ambivalence about substance use (and change) is normal and constitutes an important motivational obstacle in recovery.
- Ambivalence can be resolved by working with your client’s intrinsic motivations and values.
- The alliance between you and your client is a collaborative partnership to which you each bring important expertise.
- An empathic, supportive, yet directive, counselling style provides conditions under which change can occur. (Direct argument and aggressive confrontation may tend to increase client defensiveness and reduce the likelihood of behavioural change.)”
With MI you very much work with the client and their knowledge. As an expert in a field there is temptation to think that you know all the answers and all you need to do is tell your client what to do. This form of information giving is known as ‘directing’ in MI. Equally if you just sit and listen to a client the conversation is likely to go around in circles and this is known as ‘following’.
What you are aiming for is the middle ground between these two extremes and this is called ‘guiding’. As the MI counsellor you are gently guiding the client in a direction that will be beneficial to resolving their issue and you are using their knowledge and understanding to come up with solutions.
You are listening for the clients “change talk”. This is language that is used that can see the positives for changing. The flip-side of this language is “sustain talk”. When we are ambivalent about a change the sustain talk and change talk tend to balance out. In MI the counsellor/trainer reflects the change talk back to the client. Research shows that hearing your own words (change talk) repeated back to you can be a powerful stimulus to ultimately making a change; this is at the heart of MI.
That is not to say that you cannot offer advice and information within MI. You can and it needs to be MI consistent. You may have noticed that I said “offer advice” and not “give advice”. By offering advice/information I am being MI consistent because I fully respect the client’s right to ignore it. As part of the basic training in MI you learn how to offer advice in an MI consistent manner.
I am not a huge fan of anything that has cultish undertones but one thing I do appreciate is that in order to become proficient at delivering MI you need to become more MI consistent in your daily life. That means accepting everyone for who they are and listening to them properly without judgement but with curiosity. To my mind that is no bad thing and we all could benefit from that.
I think it is appropriate that the final words on MI should come from the co-founders of motivational interviewing, Professors Stephen Rollnick and William Miller2:
“Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”
- Treatment Improvement Protocol (TIP) Series, No. 35. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (http://www.ncbi.nlm.nih.gov/books/NBK64964/)
- Motivational Interviewing: Helping People Change. William R Miller, PhD, Stephen Rollnick, PhD. Guilford Press, Sep 2012.