The 4 Stages Of Motivational Interviewing

Last week we introduced a behaviour change technique that we sometimes use when clients just aren’t budging with their exercise (or other lifestyle-change) program.

This week, we lay out the 4 phases that one would move through when using Motivational Interviewing.

The 4 Stages Of Motivational Interviewing

When using motivational interviewing, we follow the flow of these 4 stages, ultimately finishing when a plan for change is put in place.

The 4 stages are:

1. Engaging

2. Focusing

3. Evoking

4. Planning

Phase 1 (Engaging) is exactly what the name suggests – it’s about getting them engaged with the behaviour they need to change. This involves asking Open-ended questions about their relationship with the behaviour, positively Affirming the changes that they have made already, Reflecting back what they have told you, and Summarising the conversation (think ‘OARS’). The conversation may flow back and forth between the different components of Phase 1, before moving to Phase 2 (focusing). 

Phase 2, Focusing, involves letting the client decide on the goal or change that they would like to focus on. The most important thing here is that it is client led – rather than focusing on our own agenda! This strips away any power imbalances between ourselves and the client. We want to be on their level, rather than posing ourselves as a figure of authority. At this point in the conversation (as much as we want to give them all the solutions and advice we have!), we need to hold back. Remember, it’s about guiding them to the answers. Just like learning maths – you can’t teach algebra by simply giving the answers, people need to work it out themselves to understand the process.

Once the client has identified an area that they would like to work on, we move to Phase 3 – Evoking. This phase is all about strengthening the clients’ motivations to make the change. Those open-ended questions come in helpful again here. 

“What would it mean to you if you were to be active every day?” “What changes do you think you would see if you were able to get your health back under control?”

This allows us to understand the client’s motivation for change, and gently unpick the reasons that they are resisting change. Here is also where we want to emphasise and affirm ‘change talk’ – those subtle cues in wording that say “I can and I will”, versus “I can’t and there’s nothing I can do to change it”.

 Once they have identified an area they wish to change, and they have connected with their reasons for making the change, we move into the forth and final stage – Planning. 

 Here, we work together with them to create goals for change. Once again, we must hold back on the ‘expert-talk’, we are not here to solve their problems for them.  We can nudge them along by offering suggestions, with their permission, that we think may help (“Do you mind if I suggest something that I think will help you with XYZ?”) but they need to be the ones developing their own action plan.

In Summary 

Motivational interviewing is a fantastic tool when experiencing challenges with eliciting behaviour change. The nature of it, being almost entirely client-led, can require a lot of discipline on our part! Instead of giving all the answers and solutions, we must teach them how to find the solutions themselves. 

It’s a great conversational tool because it puts the power for change into the client’s hands – it gives them agency and control, and develops their intrinsic motivation to make a change. 

So the next time you try to convince your partner or family member to cut down on their sugar consumption / screen time / alcohol, why not try to integrate some aspects of motivational interviewing? We think you will be pleasantly surprised with the results! 

References:

1. https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf

Author: Yolanda van Vugt

Editor: Tessa Nielsen

Clinical Exercise Physiologist and Content Creator at Specialised Health

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