Motivational Interviewing Techniques_Final
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>> Do you like to take a hands-on approach
when working with your clients?
If you're a fan of exercises and worksheets
or if you're just looking for something new
to try with your clients
then you are going to love this lecture.
My favorite thing about motivational interviewing
is a number of simple but powerful techniques
offered by this approach.
Many of these exercises are great
in the context of coaching,
and can be easily incorporated into your work with clients.
In this lecture, I'll share with you five of my favorites.
Scaling questions, the decisional balance,
the Columbo approach, the therapeutic paradox,
and affirmations.
First, scaling questions.
Scaling questions ask you to measure your opinion
or the way you feel about something
by choosing a numeric value
from a range of numbers to represent your answer.
Like, if someone asked you,
"On a scale of 1 to 10, how much do you like ice cream?"
Typically, with scaling questions,
the lowest number represents the least likelihood
or complete disagreement,
while the highest number represents
the most likelihood or complete agreement.
Scaling questions are really useful
for helping your clients assess their degree of importance,
level of confidence,
and willingness around an issue or idea.
This type of question can help clients
work through their ambivalence by clarifying their values
and weighing them against one another
and their readiness to change.
Asking a sequence of scaling questions
that elicits how a client rates the importance of a change
followed by a rating of their confidence
and willingness to change can help highlight the discrepancy
of where they are and where they want to be.
This opens up the door for clients
to take an honest look at their barriers to change
before they materialize in disrupt progress.
Scaling questions are closed questions,
but when paired with a simple why or open ended question,
they can help your client to really think about
where they stand on an issue
or how they feel about something.
For example, you can ask questions like,
"On a scale of 1 to 10,
how important is it for you to do this?"
Take a moment to pause and let them answer,
and then ask them why.
And then you could ask,
"How confident are you that you could make this change
right now on a scale of 1 to 10?
What would it take to go from a six to an eight?
On a scale of 1 to 10, how willing are you
to do all of the things that need to be done
to get you to your goal?
What would need to happen for that number to be higher?"
The readiness to change ruler is a handy tool
that utilizes scaling questions to assess a client's level
of readiness to make a change.
To help you incorporate scaling questions
into your practice, we've included
the readiness to change ruler in this module
which you can use with your clients.
Along with this handout
is a list of powerful scaling questions you can ask
while using the ruler to help track
your client's level of confidence and willing to change
throughout your work together.
Pause the lecture here to check it out and then come back
to learn about the four remaining techniques.
Hi again.
The second technique is the decisional balance.
This is a great and easy-to-use tool
to help your clients weigh the pros and cons
of making a change,
particularly for our clients who have visual, reading,
or writing learning styles.
We've included a blank worksheet in this module
for you to use with your client, so be sure to check it out.
Your clients are likely thinking about all the reasons
why they want to make a change
and all of the things that are holding them back.
They come to us as coaches with this information
floating around in their heads,
overwhelming and confusing them.
This often prevents them from thinking clearly
and rationally about their goals, and so they're stuck,
which is why they are seeking you out.
So with the decisional balance worksheet,
you're asking your clients to evaluate
their current behaviors or habits
while at the same time looking at what is
and isn't serving them through their actions.
The goal is to lead them to their own conclusion
that they're deriving some kind of benefit
from their current problem behavior,
and that there will, therefore, be some kind of cost
or sacrifice involved
if they do decide to make their desired change.
To do this, simply walk them through the worksheet
by asking them to think about
and jot down in the appropriate boxes
the benefits to changing,
the costs of changing,
the benefits of staying the same,
and the costs of staying the same.
So let's take a look at an example.
Let's say your client Sarah is thinking about
eliminating her consumption of alcohol.
She's been thinking about why she wants to do it,
but also her reservations,
and she's feeling confused, overwhelmed,
and unsure about what to do.
You suggest that she complete
the decisional balance worksheet with you
to help her map out her thoughts more clearly
and look at the costs and benefits involved
in making this change.
You hand her the worksheet and guide her through it.
You ask her,
"How will you benefit physically and emotionally
from giving up alcohol?"
She writes down that she'll save money,
improve her relationship,
have more productive mornings,
sleep better, and take in less calories.
Then you say,
"Okay, now let's think about the cost of quitting drinking.
How will that affect you?"
She writes down that her social life might change,
going out with friends to bars might become boring,
her friends might perceive her as boring,
and she may find herself feeling socially awkward
or left out of social situations
where everyone else is drinking.
Next you ask Sarah,
"So let's say, you decide to keep alcohol in your lifestyle.
What will you get out of this?"
She writes down that
she'll still have fun on the weekends,
and get to enjoy going to parties and bars with her friends.
She'll feel included and like she's part of the group.
Lastly, you ask her to think about
the cost of continuing with this lifestyle.
She writes down hangovers,
the financial cost of drinking, tired mornings,
drunk arguments with her boyfriend,
and feeling unhealthy and bloated after drinking.
Now all of this information
is clearly laid out on the table.
You're in a place
to ask some really great high-mileage questions,
and Sarah has all of her thoughts about making this change
right at her fingertips in an easily digestible way.
You can ask her,
"Which of these outcomes feels most powerful to you?
What are some ways
you could navigate a social life without alcohol?"
You might want to do some role playing here
so she could try it on for size
and help her generate some alternatives
such as joining a Meetup group
instead of going out to the bar.
You could even use scaling questions
to assess her readiness to change.
You could ask,
"On a scale of 1 to 10, how ready do you feel at this moment
to make those sacrifices you defined
as the costs of giving up drinking?"
The decisional balance is a way for your clients
to see all sides of a given situation
in a clear and concise way
that's not cluttered by shoulds and maybes.
By thinking through what they've gained as well as lose
as a result of a behavior change they want to make,
they can really consider what it is that they want,
and what exactly they'll do,
what will life be like if they continue down this path.
You can guide them to take a look at how changing
will create a better future for them, and ask them,
"Which future are you committed to creating?"
This exercise is also useful for helping your clients
discover their subconscious beliefs and bigger wants.
Does your client Sarah wan to give up alcohol
or does she want to keep her friends?
When posed that way,
most people are going to choose the latter.
So your job as a coach is to then look at
how you can help her give up alcohol
and maintain an active social life.
In the end, this exercise
should result in a higher level of commitment
because your client has evaluated and taken ownership
of the commitments they'd have to make
if they were to decide that the benefits of changing
outweighed the cost of staying the same.
Next is the Columbo approach.
This is a technique used to highlight the discrepancies
in your client's statements or actions.
The name was coined after the lead character
in the 1970's television show Columbo
who was a master of this skill.
The Columbo approach
is a way of gently challenging your client
by getting them to see that they're contradicting themselves
without passing judgment.
Think of this approach
as the on-the-one-hand-on-the-other-hand technique.
What you're doing here
is summarizing what your client's doing
and presenting the information in such a way
that it naturally points out
that they're thinking of behaving in a conflicting manner.
The goal is for them to recognize this for themselves
without having to be straight up called out
on what they're saying or doing
which can run the risk of sparking defensiveness.
Here's an example,
your client Bill wants to eat healthier,
yet despite his desire to change,
he keeps finding himself at the drive-through.
You say, "On the one hand, you want to eat healthy
because you're at risk for another heart attack
and you want to be around for the birth
of your first grandchild.
On the other hand, you're telling me
that you had McDonald's for dinner last night.
What's going on here?"
Here's another example of the Columbo Approach.
"So help me understand.
I hear you saying
you want to lose 15 pounds for your wedding,
yet on the other hand,
you're unwilling to cutback on your soda consumption
which, we've discovered,
is adding about 1,000 empty calories to your diet
every single week.
I'm wondering how you'd be able to reach
your weight-loss goal in time for your wedding
if you're going to continue down this path.
What's the disconnect?"
Framing this curious inquiries by opening with,
help me understand, on one hand, or what I hear you saying,
lets you present the contradiction
in a way that's not blameful, non-judgmental, and helpful.
When taking this approach,
avoid starting off with you statements such as
"You say you want to lose weight
yet you're unwilling to give up soda."
You statements sound critical
and tend to put people on the defensive.
Number four is the therapeutic paradox.
This is another technique aimed to help clients
through their ambivalence
by raising their awareness of their contradictions.
Think of the therapeutic paradox as a gentle confrontation
that's designed to call your client's bluff
when they're acting in a way
that's contradictory to their goals.
It's a helpful little trick to use with clients
who've been working with you for a while
but are making very little progress.
Use the therapeutic paradox
only after you've established a high level of rapport.
A therapeutic paradox might sound something like,
"You've been continuing to eat snacks
and dessert every night and then you say
you really want to release your excess weight.
Maybe now isn't the right time
for you to work on this goal."
As you can see the therapeutic paradox
is a little more challenging
and confrontational than the Columbo approach.
The goal is to get your client to argue
for the importance of this change.
This can be extremely powerful.
These statements are designed to catch your client off guard
and provoke them to correct you,
thereby reaffirming their value of the outcome to you
and to themselves.
Obviously, there is a risk
that your client will in fact agree with you,
and say that maybe it's not as important to them
as they originally thought it was
or that the benefits of staying the same
outweigh the cons of changing,
but this is okay too.
If your client's not really committed to their goals,
or their needs and desires have shifted,
you want to assess this and change the course of your work
as soon as possible to make the most of your time with them.
This type of statement,
if it doesn't provoke a strong rebuttal by your client,
it's designed to make them think.
If they react with silence, hold this space for them.
It's really important to sit with them in this silence
while they think over the contradiction
that they've been presented with,
and the possibility
that maybe they aren't really ready to change after all.
If time passes and they don't have a response,
usually the best way to proceed is to let it simmer.
Tell them to think about it between now
and your next session and be sure to bring it up
and explore their thoughts the next time you meet with them.
Finally, number five,
affirmations.
For our final technique,
I'll leave you with this easy way
to boost your client's confidence,
love them up, and strengthen rapport.
Affirmations in motivational interviewing
are supportive responses you can make
to positive things your client share with you
in a way that sounds both genuine and encouraging.
Affirmations are straight-forward, positive remarks
that show your clients that you support them
without sounding too over the top
which can come off really fake.
We want to convey to our clients that we support them
and we want to love them up.
But sometimes when trying to do this,
we exaggerate our response.
This actually ends up coming of insincere
because our clients pick up on the fact
that we are trying to sound supportive
instead of actually being supportive.
It also runs the risk as coming off as sarcasm.
For example, if your client says
they went jogging in extra time this week,
and you respond with, "Wow, Kenneth, that's amazing.
I'm so proud of you and your efforts.
I knew you could do it."
You could be trying to love them up and empower them,
but they might interpret this level of enthusiasm
as patronizing.
An affirmation might sound something like,
"It's so clear to me that you're committed to your goal,
and I really admire the effort you've put in this week.
I hope you're as impressed with yourself as I am."
Or "With all of the stressful situations and obstacles
you're navigating right now, I think it's amazing
that you've been able to continue to abstain
from smoking this week."
Use affirmations to positively reinforce,
and recognize your client's successes, strengths,
and efforts.
You can affirm their positives as frequently as you see fit,
which will make your clients feel valued
without running the risk of sounding too sugar-coated.
In this lecture, we've gotten over
how to use scaling questions, the decisional balance,
the Columbo approach, therapeutic paradox, and affirmations
as techniques to use with your clients
to help them work through their ambivalence,
and move them forward toward being
and staying committed to their goals.
Which one of these techniques appeals to you the most?
Pick one to try out with your clients
or a coaching partner this week,
and then let us know how it worked out
in the comment section of the Facebook group page.
Thank you so much for joining me today.
I hope you've enjoyed this lecture,
and I'll see you next time.