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Motivational Interviewing - Effective Approach to Coaching

The Institute of Coaching's April Webinar featured coach Michael Pantalon with a presentation on 'Motivational Interviewing," a client-centered approach to coaching that follows a conversational path.  It seeks to strengthen a person's internal motivation for change, thereby ensuring an authentic and sustainable change plan well after coaching is done.  The approach also offers laypeople guidance on how to assist family and friends to make authentic and self-derived decisions.



Michael PantalonMichael Pantalon presented the Institute of Coaching's April webinar (4/16/14) on "Motivational Interviewing" for coaches.  It has particular applicability to Health and Wellness Coaching.  While primarily of interest to coaching professionals, the approach has many useful principles that can be applied to supporting friends and family in their decision-making processes.


Lay person's definition of motivational coaching: 


"A collaborative conversation to strengthen a person's own motivation for change."

In other words, two individuals working together enable the individual seeking change to become more self-motivated toward achieving the change.

Motivational interviewing evolved as a response to the traditional approaches used in the early 1970s in the field of alcohol addiction counseling.  At that time many states had a requirement that alcohol addiction counselors themselves had to be in recovery. As a result the process the counselor had followed to achieve recovery became the method to be taught to clients.  It was often harsh and dictatorial with the counselor making demands since s/he "knew better."

Over the last 40 years, a more client centered approach to counseling / coaching has been evolving.  It recognizes that motivation for change cannot be instituted from above but must come from within.  The challenge is how to evoke from a client an authentic desire for change that reflects the client's inner values and not external ones.


Ambivalence about Change

Motivational interviewing is particularly useful when people express ambivalence about change.
  • They know they need to make a change and say so. That's why they're in counseling.
  • At the same time they're very comfortable with what they're doing.  They don't think of themselves as whatever label is applied to their behavior, for example, "alcoholic."
In early approaches to addiction counseling, the clinician often entered the conversation with a negative view. They regarded their clients as immature, defensive, even pathological in their thinking styles which caused the clinician to treat the client in a way that led to a self fulfilling prophecy.

Coaches or counselors who use motivational interviewing make the assumption they know nothing (very little) about the client. Defined by an unknown set of beliefs, experiences, attitudes, hopes and aspirations, the client is someone expressing at least a small desire for change, and that is where the conversation begins.  Some motivational factor, be it negative or positive, has established a driving force.

Often the client, caught up in ambivalence about their desire for, and fear of change, is like someone who has fallen into a well and wants desperately to get out, yet fears being criticized for falling into the well - a catch 22 of unacceptable choices.

Motivational interviewing may begin with attending to a client's resistance to change.  Coaches often refer to this as "sustain talk" vs "change talk."    At the same time the coach or counselor uses highly tuned aural skills to identify client language and choices that point to viable options while paying close attention to not suggesting either praise or their own preferences.


Four Processes of Motivational Interviewing

Motivational interviewing consists of four processes, not necessarily executed in linear order, repeated as often as appropriate and possibly overlapping as the client moves forward in understanding.

Engage

The initial phase is always to engage the client through conversation. This is the stage when both parties get to know each other.  Because conversation is a relational process, both the client and the clinician must be engaged. Both parties can enter the conversation with bias and as a result become disengaged. The role of the clinician is to ensure he or she enters the conversation with the ability to guide the client to a context of change.

Guide

Guidance helps the client see the options they have expressed to understand why they are important.  It is also designed to allow the client to develop an increased sense of inner motivation. Initially, conversations are broad and client centered. As the client begins to share, the coach's role is to focus it in the direction of change while not allowing it to become chaotic or meander way off course.  Eventually, the coach seeks to negotiate an agenda, or if the client is not yet ready, identify a potential agenda for future conversations. 

It should be noted that motivational interviewing does not focus on a specific aspect of client behavior which is by its very nature becomes judgmental.  Rather this approach uses conversation to increase the client's understanding of their own motivation and confidence that they have the ability to accomplish the change they are seeking.

Evoke

The clinician uses aural skills to identify words and language that either support or are in conflict with change, that reflect either an open or closed door.  The motivational interviewing process helps evoke the client's vision of change at a time and pace that makes sense. At its heart, this technique is respectful while eliciting change talk rather than sustain talk. All of this is done compatibly with client aspirations.  Under no circumstances is the clinician to make recommendations or suggest choices that effectively take away the client's autonomy.

Plan

The final process is planning - the bridge to leads to change.  The client and coach work out a change plan, one the client can commit to.


Challenges of Motivational Interviewing


Most people do not know how to listen or what to listen for.  Learning how to listen within the context of motivational interviewing takes time to develop. 

Using a language which ensures client autonomy is harder than you might think.  We often use expressions such as "that's great" or other forms of support. Parents do this all the time. Motivational interviewing needs to be predominantly devoid of such comments.  People look for external support but all this does is maintain dependency.  When the counseling session ends, to whom will the client turn to continue their psychological support? Motivational interviewing seeks to elicit motivation from within that sustains itself well beyond the close of external support systems.

Motivational interviewing pays special attention to the use of language. The opening process of engagement easily devolves into disengagement if something the counselor said feels confrontational or critical. One of the most important words to be cautious of is the three letter word "why." Depending on what you are asking why about, it may automatically convey judgment.

When the word "why" begins an appropriate question, it will have strength. So asking: "Why did you eat the entire chocolate cake" is a disastrous question.  Asking the client to explain a positive ranking, "Why did you …" is helpful in eliciting client understanding.


Collaborative Conversation Partners & YOU

The motivational interviewing approach to counseling and coaching has matured and changed over the last 40 years.  As the webinar speaker, Dr. Pantalon, stated,  following the somewhat rigid documented procedure, taught for certification purposes, may not be as effective as a more simplified form tempered by intuition.  This is especially true in coaching as compared with psychoanalysis.

More than this, the essential components of motivational interviewing are useful in many a layperson context, be it helping friends or family in their decision-making processes or helping someone understand what is holding them back.  What stands out about this approach is the following:
  1. Client-centered (client-directed)
  2. Partner with the ability to listen and not be judgmental
  3. Partner who can identify language conveying what is important
  4. Partner who can guide a client through "sustain talk" - ambivalence
  5. The collaborative pair has the ability to develop trust
Taking the motivational interviewing home to family and friends usually doesn't work because the people know each other too well and they have unavoidable expectations.  No matter how you try to suppress them, they manage to express themselves.

However, where to start in learning motivational interviewing is not during the critical decision-making time periods but rather today in ordinary conversation.  Listen to yourself and be sensitive to any statement that suggests judgment - positive as well as negative. 

Instead of responding quickly, take time to listen carefully to the other person's story.  Ask non-invasive questions - open-ended and consistent with the tone of the conversation.  You will be surprised at how different the conversation becomes.  Have fun.


More Information

Michael Pantalon Website (webinar speaker)
http://www.michaelpantalon.com/
Motivational Interviewing Website
http://www.motivationalinterview.org
Institute of Coaching
http://www.instituteofcoaching.org



Institute of CoachingThe Institute of Coaching is a non-profit organization dedicated to enhancing the integrity and credibility of the field of coaching.  By advancing coaching research, education, and practice, the Institute supports professional coaches and others who use coaching skills in their personal and professional lives.

Coaching is a change process that mobilizes strengths and realizes the potential of individuals and organizations. The practice of coaching embodies a unique skill set designed to optimize the performance of a person or organization in diverse arenas including leadership, healthcare, and public service. 

The Institute is housed at McLean Hospital, the largest psychiatric teaching affiliate of Harvard Medical School and the world's premier psychiatric hospital, known for its world-class clinicians and innovative research and treatment of psychiatric illness and improvement of mental health.


Posted: April 17, 2014     Nancy J Conrad


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