Inside Mental Health Podcast: What is Motivational Interviewing?

Episode Description

Motivational interviewing is a common phrase these days, but what is it? Is it only for counselors, or can anyone use it? And if anyone can use it, how? Today’s guest has trained thousands of people in motivational interviewing techniques. Join us as she explains how motivational interviewing is really just a simple set of conversational practices that can help you at home and at work.

Guest Bio

Dr. Liz Barnett received her master’s of social work from Boston University and her PhD from the University of Southern California’s Department of Preventive Medicine. She has been a member of the Motivational Interviewing Network of Trainers since 2005 and has since trained and coached thousands of people in the health and mental health arenas.

She has published multiple peer-reviewed journal articles on the application of MI with adolescent substance users, co-authored two book chapters, produced specialized training videos, and developed the MI Companion™, which offers online practice modules. Her online practice platform has been adopted into academic programs in nursing and social work. Learn more at www.DrLizBarnett.com.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hey, everyone, and welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast, I’m your host, Gabe Howard, and I want to quickly thank our sponsor, Better Help. You can get a week free by visiting BetterHelp.com/PsychCentral. Calling into the show today, we have Dr. Liz Barnett. Dr. Barnett received her master’s of social work from Boston University and her PhD from the University of Southern California’s Department of Preventative Medicine. She has been a member of the Motivational Interviewing Network of Trainers since 2005 and has since trained and coached thousands of people in the health and mental health arena. Dr. Barnett, welcome to the show.

Dr. Liz Barnett: Well, thank you, thank you for having me.

Gabe Howard: As a podcaster and a moderator, I have interviewed hundreds of people and I’ve been interviewed more times than I can count, whether it’s for podcasts, blogs or even just a job interview. Now, I realize that I’m aging myself here, but back in my day, it was just called interviewing and there was only the single type, essentially someone asking someone else questions and one person was expected to answer. Then all this research started coming out that the way that we ask questions was influencing the answers. And in fact, motivational interviewing was invented to solve some of these issues or discrepancies or problems now, Dr. Barnett, before we discuss what motivational interviewing seeks to accomplish, can you quickly explain to our listeners exactly what motivational interviewing is?

Dr. Liz Barnett: So motivational interviewing is both a way of being with people, of seeking to understand their perspective, of being a very skilled listener, and then it’s got its more technical side, which is sort of what you were alluding to, is about really being thoughtful and intentional, about the kinds of questions that we’re asking in order to get people to come up with their own ideas, explore their own motivations. Really giving people an opportunity to do those things, because as it turns out, people don’t always take those opportunities for themselves.

Gabe Howard: One of the things that I think about very, very simply is if you walk up to a child and you say what’s going on? You’re going to get a very different answer than if you walk up to a child and say, what did you do? And I think that parents sort of naturally learn this along the way. Does this apply to adults?

Dr. Liz Barnett: Absolutely. The question you ask influences the response, and one of the things that I think of most when I’m thinking about motivational interviewing is this concept we call change talk. Any language in the direction of change. But what is often happening is we ask questions that get the exact opposite of that right? We ask questions that elicit reasons not to do something instead of reasons to do it. So, for instance, if I ask you, you know, why didn’t you do something? You’re going to tell me all the reasons that you couldn’t get it done. It didn’t happen. It wasn’t the right time. Things came up. But you’re going to give me and we call that the status quo. Versus if I asked you, hey, you know, last week you said you wanted to take care of this thing. I’m wondering how did that go? And what would be some of the good things about doing it? From that question, you start to hear the good things, right? Many times it’s going against our instinct to kind of find out about the barriers to just being there, to explore reasons to do something.

Gabe Howard: Let’s do like a real-world example, let’s say that you were going to interview me. Can you give me an example of there’s a question that you want the answer to, and maybe word the question how most people would normally ask the question and then give us the example of how they should ask it, utilizing motivational interviewing.

Dr. Liz Barnett: Before I do it, can I get you to give me either a behavior that you personally want to change

Gabe Howard: Yeah,

Dr. Liz Barnett: Like that would be helpful.

Gabe Howard: Yeah, I think that’s a really good idea, let’s start with something that’s very relatable and let’s say that I am concerned about my friend’s eating habits. I am now over 40 and I can no longer live on a diet of pizza and French fries. I have learned this, but, you know, I have a buddy that doesn’t have a wife as supportive as mine. He’s still living on French fries and pizza and I want to talk to him about it. So I would imagine that my approach would be, because I haven’t taken motivational interviewing, would be to say, dude, you’re fat and you’re going to die of a heart attack. I imagine that that is the extreme wrong way. But realistically, I think what I would say is you eat too much and you’re grossly overweight and you’re going to die. That is probably how I would genuinely handle that problem. But I suspect that motivational interviewing can teach me to do better.

Dr. Liz Barnett: Yeah, so right, that would not be the motivational interviewing approach. So one simple way to sort of approach those kind of conversations. One thing I like to encourage people to do when they want to have a conversation is to set a time frame for it. So if this is somewhat of an uncomfortable conversation, making some sort of agreement that like, hey, I was wondering if we could just talk about this for just five or ten minutes tops, I promise. Just setting that time frame can create a willingness of somebody to participate in perhaps a difficult conversation, especially conversations that you’ve had in the past. Asking somebody for just a small amount of time can be a really good way to bring up the difficult topic. But then to get into the exact topic that you want to talk about, I might ask a question like I’m curious from your perspective, what would be some of the good things about making a change to your eating habits. In just in that sentence, I’m expressing curiosity. Like I’m not trying to get you to do anything. I’m just curious. I want to hear your perspective. I know what everybody else says, but I want to hear your perspective. There’s that respect that comes along with it. And then the actual question itself was, from your perspective, what would be the reasons to make a change? So just in that one simple question, inviting them to go wherever they take it from their reasons. And that’s one useful question that you can use that will put you in a very different space than starting off with telling, suggesting, bringing up issues, confronting somebody about a problem.

Gabe Howard: So what is the hallmark of motivational interviewing? If I was taking one of your training classes to learn how to become a motivational interviewer, what is lesson one?

Dr. Liz Barnett: Lesson one is stop telling people what to do right? It’s very hard to do. It’s really about acknowledging in ourselves how much we do that and then trying to put the brakes on it. I like to ask this question kind of about how strong is that impulse in you to try to fix other people’s problems or give people solutions? Where a ten is I know what you should do before you’re done talking. And one is, oh, I never try to solve other people’s problems because I’ve got my own problems. So I always ask people, you know, where would you put yourself on that scale? And for many people, they’re pretty high on that scales, like a seven or higher. And I say, well, that’s the first thing to do. That’s the first thing to focus on, is getting that instinct under control. I also like to say, if you don’t know how strong that impulse is in you, just ask a friend. They definitely know. It’s pretty hard to keep that stuff secret.

Gabe Howard: I, I really, really like that. If you’re not sure if you have that personality trait, ask your friend, they’ll tell you. And everybody needs the friend that will tell you.

Dr. Liz Barnett: Exactly, exactly, and you probably, I mean, I’m sure you know who your friends are, who do it right? People tend to be very sensitive to it when they’re receiving it and maybe not as sensitive when we’re doing it. There’s an idea that it needs to be done or we’re justified in doing it or, you know, it has to be this way. But when it’s done to us, many of us are pretty sensitive to it and don’t like it at all.

Gabe Howard: So let’s talk about the specific problem that motivational interviewing looks to address. Can you explain that to the listeners how they would use it and why they should use it?

Dr. Liz Barnett: So, motivational interviewing is intended to address ambivalence. Ambivalence is this idea that it doesn’t matter what behavior or action we’re talking about, that we have conflicting feelings about it. We feel two ways about something. It could be getting up earlier in the morning. On the one hand, I want to, on the other hand, I don’t. Motivational interviewing is meant to help people sort that out for themselves. In some ways, it’s to weigh the pros and the cons. But I don’t want to oversimplify it too much. But I would say that is the problem that it kind of fundamentally addresses. And then once that balance has started to get tipped in the direction of taking action, that’s when you start to see behavior change and that’s when you start to see action happen.

Gabe Howard: What symptoms or challenges will someone experience if they need motivational interviewing or is it just motivational interviewing is something that you can use on every single person always?

Dr. Liz Barnett: If you feel stuck, motivational interviewing could help. If you know someone who’s stuck motivational interviewing could help. Knowing the principles enables virtually anyone to ask better questions of a friend or of a sibling or a spouse or a child or a parent. Anyone can ask better questions. You know you want motivational interviewing when somebody is really stuck in a behavior and making a change in that behavior would make a change in their life or their lifestyle or their health.

Gabe Howard: When you ask a question, you have a desired response that you want. I think most of us tend to know the answers to the questions that we’re asking in some form or have a desire that we want. For example, if we’re interviewing somebody for a job, we want them to be qualified. We want them to be a good candidate. And the danger is as if we word the question in a way that influences that answer, we’re not able to tease out who the best candidate is because they’re utilizing our words to form their answer, which sort of creates this feedback loop. And I don’t think people understand that they’re doing it right?

Dr. Liz Barnett: Questions certainly are sort of in the middle of motivational interviewing, though, I think it’s almost a little too narrowly focused. If we pull back a little bit on motivational interviewing, you are absolutely trying to create a space where somebody feels free to explore a topic. Now, the kinds of behavior change that people are usually working on, these tend to be pretty sensitive topics, right? People have been telling you you need to make a change. Your doctor says you need to make a change. Your spouse says you need to make a change. So these tend to be kind of sensitive topics or things that people are often defensive about. So our first job is to create a space where that judgment is gone. Doing that can free up so much possibility and potential to happen. That’s really hard to do. But before you start focusing on what kind of question to ask, really creating that nonjudgmental space is the first step. Once you have a nonjudgmental space, then it’s kind of what you’re talking about. What do you fill it with? How do you ask questions that are nonjudgmental? And open questions are much better at that than sort of a closed yes or no question. So getting people to ask bigger open questions that allow people to explore and then the next part of motivational interviewing after asking better questions is really to become a skilled listener, because what you respond to in their answer will really dictate what happens next in that conversation. Part of doing motivational interviewing or kind of learning about motivational interviewing is becoming more selective in what you respond to. Again, there’s a real tendency for people to respond to that status quo talk, you know, the resistance, the barriers, the reasons they can’t do something. And often they almost ignore or miss opportunities to respond to the positive stuff. It’s like we’re really hypersensitive to the negative and we kind of ignore the positive.

Gabe Howard: We’ll be right back after a word from our sponsors.

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Gabe Howard: We’re back with Dr. Liz Barnett, discussing motivational interviewing. Let’s talk about who can benefit from learning motivational interviewing skills. Is this something that everybody can benefit from or does it have a very narrow space in where it belongs?

Dr. Liz Barnett: I err, personally, I err on the side of that, everyone can use it. We should all be mindful about the questions we ask and what we respond to. And then, of course, there’s how you respond. All that judgment that we want to really be mindful about. I definitely err on the side of anyone can use motivational interviewing. The basic skills of it are so important. A lot of motivational interviewing, many people have heard of active listening and that is at the heart of motivational interviewing, doing reflective listening. When you hear something, instead of telling somebody what you think about what they just said, taking a moment to make sure you actually understood what they were saying. But anyone can use the basic foundations of motivational interviewing and it can improve communication at home with friends and certainly on the job.

Gabe Howard: Dr. Barnett, what are the main ingredients of motivational interviewing, what does it all boil down to?

Dr. Liz Barnett: I would say it’s a spirit, a belief about people that motivation is in there and as a helper, it’s our job to help bring it out. It is a set of skills, being able to do reflective listening, to be a skilled listener, asking good open questions. So it’s a set of skills and there is a process to it. But the process, it’s not actually something you have to focus on and learn, but it can help to guide, to guide a conversation. So I would say those are the three elements, a spirit, the skills and then the process.

Gabe Howard: In doing research for this show, I just looked up the definition of motivational interviewing and I got a very clinical definition and it was motivational interviewing is a counseling approach developed in part by clinical psychologists. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. I want my listeners to know that is absolutely correct. That is what motivational interviewing is. But it sounds like it’s not something that I, Gabe Howard, can do. I’m not a counselor. It also sounds a little manipulative. Right? You’re trying to elicit behavior. It sounds scary and it sounds like something only for doctors. And I know for a fact that you don’t agree with either one of those statements.

Dr. Liz Barnett: Motivational interviewing is, we say directive, meaning that there is a bias towards behavior change, so if you went to a substance abuse counselor, they would have a bias towards change. But in order to actually be doing motivational interviewing, you really have to have a nonjudgmental stance. I like to say, have an agenda, but hold it lightly. So you have a direction, right? You want people to have increased health, whether that be diet and exercise or that be around substances or any other thing, financial security, saving more money, doesn’t matter. So you have an agenda, you have a direction, but you fundamentally believe in the right and ability for people to make choices themselves. Where you also fundamentally believe when you’re doing motivational interviewing is that people will choose health. So this was actually a Carl Rogers idea that people would move in the direction of health given supportive environments. And if you think about a lot of people’s lives, you know, environments really aren’t always so supportive. Even ones that try to be are often quite judgmental. And we’re trying to create that environment where somebody can choose health. And while we do have a, you know, our fingers are crossed, we hope you’ll make that choice, at the end of the day is ultimately up to the individual. That’s why it is not manipulation, because at the end of the day, this is all up to people.

Gabe Howard: But here’s the good news. Well, that was a very clinical definition. I read this thing called the Five Principles of Motivational Interviewing, and I’m not going to read all five, but one of them was support, self-efficacy and optimism. That’s something that I think we want for the people that we’re talking to. Right? If the way that we’re addressing people is making them defensive, or is, of course, making them pessimistic, we’re clearly doing something wrong in our communication.

Dr. Liz Barnett: I would certainly agree with what you just said, right? To be able to do those things for somebody else, like support self efficacy and optimism. Absolutely right. Motivational interviewing should be doing those things. Absolutely.

Gabe Howard: And the other one that I really liked in the five was avoid an argument and direct confrontation. And again, if the way that we’re asking questions to our peers or the people that we serve or the people that we work with is causing an argument or is leading into a direct confrontation, we’re probably not communicating well. I can honestly say in every single disagreement I’ve ever had with my wife, the initial confrontation, the fight, as it were, is not where the resolution happened. It was after we calmed down, went to separate corners and then started talking to each other much more gently and really considering each other’s point of view. That’s when resolution happens in relationships. I imagine that this applies out in other types of relationships as well. Or again, am I oversimplifying?

Dr. Liz Barnett: No, I mean, that principle of avoid argument is central. It’s a simple way to sort of assess whether or not you’re on the right path. For instance, if you find somebody is starting to get defensive or arguing back, I always in my training, I will always focus on sort of what did you say that prompted that response, right? So that we ultimately, we get to take some responsibility for those responses in our daily lives. We like to blame other people for things in counseling. Often, it used to be, certainly not in motivational interviewing. You think of a client as being resistant to change. But really, if you are hearing that sort of counter argument, the first thing you should do is think about what did I just say that precipitated that response?

Gabe Howard: I really, really like that. Are there any last words or last concepts or just last points that you want to make for our listeners so that they can understand this concept and gain more information?

Dr. Liz Barnett: For gaining more information, I would encourage people to, you’re welcome to check out my website. So while most of my work is with professionals and training, I love to think about how these skills can be used at home, sort of in our just daily communication with loved ones. Tell a quick little story. In the past couple of years, I built an online practice platform, so that was meant to supplement the training I was doing with professionals. They would be doing these practice exercises, but they would be practicing at home. And so they would be writing to me and they would be talking about I used it with my child. I used it with my mom. I used it here, I used it there. And that, from my perspective, it opened up this world to me of motivational interviewing at home. Because I think there’s so much of it that can really help in our daily lives. I’m somebody who does not like to be told what to do and can get defensive pretty quickly. And so motivational interviewing just makes sense to me. For loved ones, there’s absolutely things that you can learn and do that can make those conversations go better and even things that can surprise you. If you think of the most stubborn person in your life and you were to use some of these approaches and ideas and this mindset, you would surprise yourself at how much of a different view you could get of that person. You know, making small changes. That’s another thing I love about motivational interviewing. There are some really small changes that we can make that can make a really big difference.

Gabe Howard: And Dr. Barnett, how can folks find your website?

Dr. Liz Barnett: My website is www.DrLizBarnett.com. You know, I’ve got an email list that you could sign up for, and I’ve got plenty of stuff just on the website.

Gabe Howard: Dr. Barnett, thank you so much for being here. And all of our listeners, thank you so very much. Please follow the show. It’s absolutely free and take a moment to review the show, use your words and tell other people why they should listen as well. I’m Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a nationally recognized public speaker, and I think it would be just super sweet to come to your next event. You can grab a signed copy of my book and get free swag or learn more about me over at gabehoward.com. I’ll see everybody next Thursday on Inside Mental Health.

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