The historical underpinnings of Motivational Interviewing (MI) come from the treatment and support of patients with substance use disorders. MI was originally developed in part by William Miller and Steph Rollnick in the 1980’s. Since then it has been widely evidenced and used to support behaviour change throughout the healthcare, justice, education, sports and parenting fields. It can be described as a communication philosophy or methodology.
Essentially, MI is a set of principles as opposed to a set of techniques. It is not about a mechanical process, rather it is grounded in a core set of principles. These principles are based on the 4 stages of the MI process:
- Engaging: The relational foundations
- Focusing: The strategic focus
- Evoking: Exploring collaboratively ambivalence (mixed feelings or contradictory ideas)
- Planning: Developing a personal plan
In this article we will explore 2 MI approaches: Agenda mapping & recognising change talk. These approaches can complement, and support the health coach approach.
Part 1: Agenda Mapping
Agenda mapping is used within a coaching conversation at the finding focus stage. Early in the coaching process the coach helps the client to focus their topic and desired outcome.
As health coaches we see clients come with one of three states of clarity:
- A clear agenda of what they want to discuss
- No clear plan, no time to think about it
- Some idea, it may not be crystallised
Agenda mapping invites clients to look at a map, seeing the places they might travel and plan a route for the next stage of their journey (Miller & Rollnick, 2013). The process is a set of stages that generate possible options and choices.
Stage 1: Set The Scene
‘Is it ok if we spend a few minutes exploring what you want from the health coaching conversation today?’
Or if in mid session ‘would it be ok if we stop for a few moments to take stock of where we are?’
Stage 2: Explore & Identify Objective
Prioritise which of a list of possible goals they wish to address first (in this conversation).
- ‘What change do you want to talk about most?’
- ‘What feels most critical to address?’
- ‘What makes this goal more important than X, Y, Z?’
During the agenda mapping stage: It is important not to disappear into too much detail on the multiple issues that may present, more to get a high level overview and to settle in on the most important one.
Stage 3: Expected Outcomes
Define and explore together (filter) a clear goal which is understood by the coach and client. Within this, to understand the clients sub-goals: short term, medium term (milestones) which can support the client to track their progress towards the longer-term goal. The solution focused ‘scaling’ coaching tool is a great way to explore this:
Scales can effectively partition a goal into small steps. For example: A client’s goal may be ‘gaining confidence in my nutrition knowledge’ On a scale of 1-10 where are you now in terms of gaining confidence? Where do you want to be? What does that look like? How will you recognise that you are there? Where do you want to be? What does 1 more step from where you are now look/ feel like?
Tip: Ensure the co-created goal and subgoals are clearly agreed before moving on to the next stage of the conversation.
Part 2: Recognising Change Talk
This is about recognising the relationship between the words being used by the client and what it indicates in terms of their inner motivation and capacity for change.
“There is a strong relationship between clients words & clients deeds.” (Anstiss & Passmore, 2012)
Essentially it is listening for changes in words and language used by the client around goal commitment and goal mobilisation.
An effective metaphor to use when listening for change talk is to think of it like a hill (see below): It comes in two parts:
- The upside of the hill is the preparatory change talk – the client is aware of the advantages and is weighing up readiness against barriers to climb. Perceived barriers or ones that have blocked their path to success in the past.
- The downside of the hill is the mobilising change talk, they are ready and willing to go.
As a PREKURE trained health coach you will recognise the foundation of this model taken from Prochaska & DiClemente’s transtheoretical change model (TTM), 1983 (1997).
What to look out for on the uphill:
- Statements which reveal an interest and consideration but lack specific commitment i.e. ‘need to, want to, I should’
- They may express ability i.e. ‘I can, I could’
- They may express the need for change ‘I think I could do Y if I really wanted to’
- They may express the consequences of failing to do so ‘I really need to do Y or……. will happen’.
At this stage it is the role of the health coach to encourage the preparatory talk, explore the emotion and the ambivalence to change. Ambivalence to change can be viewed as reflecting on discrepancies between the clients values and behaviours. A key for the health coach here is to notice subtle changes that have already taken place that the client can’t see.
Tools such as the MI decision balance sheet are designed to explore the advantages and disadvantages of the clients’ different choices. They may support new awareness on the skills and strengths a client can elicit and which barriers have got in the way previously.
A further change recognition tool that can be linked with the hill metaphor comes from the MI philosophy that there are two types of statements in change talk: DARN & CAT. See the table below to understand their application.
Miller and Rollnick provide a succinct guide through the DARN & CAT statements to support the coaches understanding of ‘where their client is at right now’.
MI adds another layer of detail and process on what the health coach can be listening for and working towards. We know in health coaching that ‘dancing in the moment’ with our clients comes from listening closely to their spoken and unspoken communication. To move our clients from contemplation into action and on the ‘down hill’ requires commitment to building the art and craft of health coaching. Exploring MI philosophies & tools can be one such stepping stone in your success.
“If you wish to know the mind of a man, listen to his words.” — Johann Wolfgang Von Goethe
- Anstiss, T., Passmore, J. (2012). Motivational Interview Approach. Cognitive Behavioural Coaching. London: Routledge.
- Prochaska J.O., Velicer W.F. (1997). The transtheoretical model of health behaviour change. American Journal of Health Promotion.
- Tee, D., Passmore, J. (2022). Coaching Practiced. UK: John Wiley & sons Ltd.