Motivational Interviewing for Leaders
Change from the outside in seldom sticks. However, that does not seem to curtail our temptations to paint others with our desires, expectations, and hopes. There is a better way, and with practice it may even neutralize the ineffective inclinations to "change others."
If you work in health care, you are probably familiar with the intervention called Motivational Interviewing (MI). However, no matter what sector of our economy you represent, if you are leading change, Big Change or small change, this is a form of dialogue you should learn to use.
I will provide a brief overview of MI and then characterize how it might be used by those of us who are leading change. As you will observe, the practice of MI is really quite simple, deceptively simple. Not so difficult to grasp conceptually, it requires regular application to attain mastery.
What you will also notice, is that its elegant simplicity consists in merely avoiding the difficulties we create for ourselves. That's right, it's really not that others are being difficult or oppositional on purpose. Rather, we inadvertently activate their resistance through our actions.
Motivational Interviewing and Change
There are some fundamental assumptions that we make when using MI. They are assumptions about human nature at the individual level and at the interpersonal level. Let me share a few, and then I will briefly elaborate the MI model.
These assumptions are all associated with a person-centered view of human nature, interpersonal relations, and normal (healthy) development. Therefore, they should accord with any model that aims to be patient-centered, customer-centered, client-centered - any approach to human relations that aims to put the experience of those we serve at the center of consciousness.
Human beings have within themselves a natural striving to grow, learn, develop, and thrive, what Albert Schweitzer called "the doctor within."
Human development is best nurtured by fostering enlightened autonomy, i.e. a balanced appreciation of our independence and our interdependencieis.
Persons define themselves and sustain healthy development in and through relationships, helping relationships that encourage self-discovery.
Those who seek to be of help to others will usually be most effective when taking a nondirective approach, less telling and more active listening.
No matter how confused or distressed we are, we can usually, with the help of others, find a calm, clear direction within that will guide us.
Every human being wants to matter, wants to exercise their potency to set and achieve goals that are personally meaningful to them.
Human beings strive to adapatively realize their potential until they encounter threatening forces, at which time they "circle the wagons."
All sustainable motivation is based on what we value intrinsically; extrinsic values are useful, but usually not enough to sustain change.
When we work against the self-directing nature (autonomy) of healthy human nature, we pose a threat and arouse defenses.
When others exhibit defenses in response to our directive style, there is great risk of escalating a spiral of resistance, thereby blocking change.
Motivational Interviewing has been defined by Miller and Rollnick (2009)as "A collaborative, person-centered form of guiding to elicit and strengthen motivation for change." MI is a conversational style of intervention. It has been shown to be highly effective, even with difficult personal changes most of us are quite familiar with, i.e., diet, exercise, and various health behaviors.
It is often contrasted wtih a more confrontational style of engagement: "Do you realize the problems you are creating for yourself? If you do, then you should recognize that this behavior must change!" From a source of authority (one's supervisor) this may evoke fear, and fear can motivate, but not for long.
MI, by contrast, has been shown to have robust and enduring effects when incorporated from the beginning and throughout a change process. So how does it work? What is the process and what are the skills one needs to implement the process?
There are four principles that underly and guide the practice of MI conversations:
Expressing and sustaining empathy for the person's situation. This is not merely sympathy; it validates the person's subjective experience without endorsing it. It shows that you "get it."
Help them surface the discrepancy between the change they want and the actions they are taking. This highlights feelings of ambivalence and also explores their desire, reasons, and abilities to change.
Roll with resistance. Don't push, don't offer information or advice prematurely or without "permission." Acknowledge the reality of resistance. There is no benefit in denying or ignoring it.
Support self-efficacy by helping them consider what might work best for them. The experience of change is different for all of us, so what is it that will work best for you?
You might say, "we don't have time for all this kid-glove treatment. We expect people to get with the program." On one level, that is an understandable attitude, but it is not a very pragmatic one in the end. The truth is that you can jump-start the issues of change or wait for them to bite you later.
Basically, there are three vital qualities of the conversation that one is aiming to realize:
Collaboration: establishing a non-authoritarian working alliance.
Evocation: eliciting what matters to the person, making no assumptions.
Autonomy support: affirming choice, responsibility, and increasing the options.
As these qualities of interaction are building, we pursue "prefatory change talk." This talk focuses on discovering the person's desire for change, ability to change, reasons for change, and his/her need (urgency) to realize change (acronym DARN).
This conversation is advanced primarily through questions and "reflections" of meaning that cause the person to use her own words (examples below). She thereby express her positive goal-directed feelings about the change, but also her inhibitions and concerns.
After sufficiently affirming the postive rationale and personal potential for change, we seek to elicit "commitment language." This involves the expression of three kinds of language: "commitment" (what I could/will do), "activation" (what I am ready to do), and "taking-steps" (steps I will take). The acronym here, CAT, produces DARN CAT (sorry to cat lovers).
In this last phase, there is a commitment to take action that is based upon an honest consideration of the pros and cons. Talking it through in the presence of a supportive and encouraging other, and without pushiness, helps one arrive at something he/she believes in.
Evoking Full, Clear Expression
There are two ways to evoke a full expression of the driving and restraining forces for change within a person. First, there is the use of questions. Here are a few examples:
For what are you motivated? What change do you want most? (desire)
What are your most important reasons for changing? (reasons)
On a scale of 1-10 how important is it to you to change? (need)
In what ways are you already able to make the changes you want to make? (ability)
What steps are you willing to take? How will you do it? (commitment to act)
As a person responds to such questions, the second technique for evoking expression takes over. This is the use of "reflection." It consists in restating the essential meaning (versus the literal words) in their response. For example:
Person's words - "I know that this change is important to the hospital, but I don't think they realize how much this complicates my job. How am I supposed to get the job done while changing the way I do my job all at once?"
Reflected meaning - "You can see that this change could be very beneficial, but it can feel overwhelming, and you are not sure you know how to get there from here."
The power of reflection derives from its four-fold impact: 1) it lets the person know that you "get it;" 2) it invites the person to respond, own their feelings, thoughts, concerns; 3) it generates more change talk than open questions; and 4) it keeps the person at the center and in charge of a self-directing experience.
A final kind of communication bolsters the MI process, especially toward the end of a conversation. It is summarization. This involves capturing the highpoints of the change talk and commitment talk. It invites the person to affirm or revise their aims and leave with a coherent set of take-away insights and action plans.
As a corollary to all this effective helping, we may also observe what halts the progress of MI and the efforts of others to make change. The most common error is called "The Righting Reflex." It is that sometimes irresistable need to make things better for another person.
This "reflex" involves us telling and prescribing. It undercuts the partnering stance of collaboration and it creates resistance. When we find ourselves doing this, the best corrective is to stop and reset: "I have become aware that I have been lecturing. Not helpful and not what I want to do! Let's return to what you are thinking."
It is clear that MI is very helpful and effective when dealing with personal change. But how about using it in a work setting? Actually, much the same non-directive, person-centered dialogue is quite helpful in an organizational context.
Whether these practices are employed by organizational consultants (internal or external) or leadership and management coaches (internal or external) they prove to be powerful tools. The reason? Very much the same rational: This dialogue helps restore an internal locus of control.
I would also invoke as a helpful frame of mind, John Kotter's definition leadership: "What leaders really do is prepare organizations for change and help them cope as they struggle through it." For more, read his classic HBR article, What Leaders Really Do (1990).
What is MI if not an interpersonal tool for helping others cope as they struggle through change? Kotter's perspective is all the more relevant when we consider the challenges of transformational change, such as those in health care and those associated with sustainability. In either case, we are frequently asking people to adopt Big Changes.
A complementary tool I would suggest is a model I have called a "clinical" approach to change, which prompts the leader of change to observe behavior, recognize the needs to intervene, and then do so by engaging in dialogue. MI commends person-centered practices that ensure we use our "clinical" insights in a productive, nondirective manner (i.e. questions, reflections, summarization).
Please share your comments in the space below. If you wish to discuss your questions privately, you may reach me via phone (617.312.5305) or via email at email@example.com. Thank you.
Bill Macaux, Ph.D. MBA
Principal & Consulting Psychologist
Hall, A. Using motivational interviewing to guide your conversations. A presentation at the annual APA Conference: http://professional.captus.com/apa/mig/TOC.aspx accessed 10/6/2012.
Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not. Behavioural and
Cognitive Psychotherapy, 37, 129-‐140.