Hi guys, and welcome to today’s session. My name is Gilles Brideau and I’m a psychotherapist, hypnotist, and coach that works and lives in Sudbury, Ontario, Canada.
Today I thought I’d do a quick video on what makes people change. The presentation is just a snippet of actually a full workshop that I do on motivational interviewing. I thought I’d just take a little bit of the key elements of what motivational interviewing is all about and how you can incorporate these elements to start to promote change.
Now, today will just be on the guiding principle and what MI is really about. In future videos, I’m going to go a little bit more into the specifics on how motivational interviewing actually works. The way I thought to start this presentation is just having you have a little bit of thoughts or food for thoughts.
The first one is that you would think having had a heart attack would be enough to persuade a person to quit smoking, change their diet, exercise, or take their medication. Also, you would think that hangovers, damaged relationships, crashes, memory blackouts would be enough to convince a person to stop drinking, say. You would also think that the very real threats of blindness, amputation, other complications from diabetes would be enough to motivate weight loss and glycemic control. Lastly, you would think that the time spent in the dehumanizing privations of prison would dissuade people from re-offending.
Yet, often it’s not enough. Some of the key things to think about when you’re thinking about all these behaviors is that logic would indicate that of course you should stop smoking, or of course you should go on a diet, or of course you should have your diabetes under control, or of course you shouldn’t re-offend. Yet, a lot of times it’s not enough. One of the reasons that a lot of these arguments are based in logic. Logic really doesn’t often go far in terms of changing people’s behaviors because we fail to take into account one of the biggest predictors or factors in changing behaviors, and that’s the emotional drivers.
One of the universal laws is called Saunders’ Law of Change, and that is that people only change when the pain of change is less than the pain of staying the same. In other words, the best predictor of tomorrow’s behavior is actually what you did yesterday. Change is hard simply because we get into patterns and then it takes a while in order to make changes in their life. So how do we make things a little different?
Know that the natural response for anyone who’s challenged about a behavior of which they are ambivalent or so-so about, is to argue a counter-position. This is exciting because this is really what it means. If you said to a person, “You really need to quit smoking,” or, “You really need to quit drinking,” or whatever behavior they really want, they will argue a counter-position forever. I’ve talked to family members in addictions or smoking or whatever, and that’s what they typically have said to me is that it’s been exhaustive because they always come up with a counterargument. “You should really quit smoking.” “Well, I don’t want to quit smoking.” “But it’s bad for you.” “Well, so is pollution.” “Don’t you want to be alive for your kids?” “We’re all going to die one day.” It’s a circular argument that goes round and round and round and round until one or both just leaves in a huff.
Know that the confrontation edge or to get into a person’s face and really challenge them really is not effective in terms of promoting change. A lot of times it really feels like you’re having a tug of war with a person. It’s this back and forth and, “Do what I’m telling you!” “No, I don’t want to.” Especially when you’re dealing with children. “Please do what I want.” “No, I don’t want to.” It really feels like this back and forth, “Do it my way,” “I don’t want to do it your way,” that kind of stuff.
What motivational interviewing really proposes is that instead, we dance. If you think about the process of dance, it’s really an engagement between two people to cooperate and having a person lead, having a person follow. Now one of the key elements, sometimes the thought is, if I follow, it means that I’m coming from a position of weakness. It’s actually not quite that way. I usually coach people that it takes great strength and confidence to allow yourself to be strong enough to follow. Having taken Latin ballroom dancing myself, I know that the strongest position is not the male position. We just offer the step. The woman has to be strong enough and trusting enough in herself and in me that she will allow herself to be lead. It’s a unique platform.
Now, of course I’ve seen people dance phenomenally, like the ones that are on stage, Fred Astaire and Ginger Rogers, but the key elements of MI is you don’t get to that level of dance without a lot of practice. It’s the same thing with motivational interviewing. It really does take a lot of practice because it gets us out of our regular mindset of just continually ask questions and try to impose our advice and our wills on other people. Now this is not often, or not always I should say, done in a negative way. Sometimes it’s the people that we love and we really want the best for them, but sometimes what comes across as advice-giving or confrontation.
What are some of the guiding principles of MI? People are generally better persuaded by reasons which they themselves discover rather than those that come from the minds of others. In other words, I do much better if I come up with my answers than if you come up with them. Sometimes people talk about that as an aha moment, where a person goes, “You know what? I need to change this behavior.” Our job is to get to a way where they’re confronting themselves.
MI, or motivational interviewing, is really a method of communication rather than a set of techniques. Now one of the things that had come up the most when I offered this technique is that people would want specific things to say in specific situations. If they were dealing with their teenager, what do I say when they do this? I would ask them, let’s just do a roleplay because there’s not a specific set of techniques. It’s more of a set of guiding principles and that’s why we’re covering these now in order to make these effective. It’s really a fundamental way of being with people rather than a set of techniques that will get to the end goal.
It’s often, again, described as dancing rather than wrestling with the person. You can imagine how less exhaustive it is to dance. Again, not that that doesn’t take work, but it’s just a lot less exhaustive than the wrestling. Now, dancing of course follows a person’s essential views and opinion while wrestling moves in opposition to what the person brings. There’s always a counter move.
Why interviewing? As with all interviews, the person that is speaking takes center stage. They tell their story in their own way. Now, they’re guided by the interviewer, but it’s really them taking center stage. As the predicament or the problem is discussed on an equal and shared footing, the process of change can be enhanced or initiated to some degree. It’s, again, as they start to talk about their process, that we get the answers or we listen for gems called change talk, which I’ll explain in videos to come. That’s the key elements of what we’re looking for to promote change.
The fifth principle is that the assumption that all helpfulness starts from a position of humility, ignorance, and concerned curiosity. When I was taught this technique, it was really to take on the role of Columbo, so a little bit of head-scratching, a little bit of, “Tell me more about that.” Now Columbo was a genius because a lot of times he would just seem like the idiot that was looking for an answer, but oftentimes what happened is he got the answers from other people. This helpful material that the person will give you, my job is then to work with the material or the gems that they provide. Again, that’s change language, which we’re going to talk about at a later point.
Now the sixth principle, it’s that it’s often presumed that readiness to change is caused by a lack of insight, knowledge, skill, or concern. Oftentimes, especially in addiction talk, we used to call this denial. The person is just not knowledgeable enough to make a change. I’ve come to realize in working as a hypnotists with a lot of smokers, it’s not because they don’t know better that they continue to smoke. They know the harmful effects. In fact, every time they open a pack of cigarettes, it’s right there on the container or the pack about the harmful effects of smoking. It’s not because they don’t know better.
That’s something that we really need to move away from. We need to be ready to understand and work with factors that sustain current behavior. It’s also to recognize what we do that will help the behavior be sustained. In this case, if it’s a negative behavior, we have to be aware of that so we don’t do things that makes things worse on the person.
The seventh principle is that we need to acknowledge that behavioral change is difficult and sustain effort through many temptations. We can help accelerate the process of change, but we can also inhibit. The main key is understanding and the acceptance of this ambivalence, which is really the true dilemma between the virtues of good and bad. A lot of times, when it comes to a behavior that is causing you pain, obviously it’s seen as bad. Again, take any behavior, drinking for example. The person understands that if I continue to drink, that’s bad, but it serves a purpose. It’s to understand the full concept of both sides of the person.
Now understand our attitude in dealing with the person is also key. It’s to eliminate our own filters, and that we have to be okay with the person if they stand in a position of ambivalence, which is really hard as a helper. It’s one of the hardest things I had to overcome, because one of the reasons I got in this field was because I really wanted to help people change. What do I do if they don’t want to? That was a unique challenge.
This is from Bill Miller, who is the originator of the technique, which is, “I learn what I believe as I hear myself speak.” The goal is to have the person say to themselves, “You know what? Something’s got to change.” Whether, again, that’s smoking, drinking, whatever the behavior is, but something’s got to change. Know that arguing and resistance does not result in change. It usually leads to counter that, so it leads to more problems and more of the behavior to continue.
Also understand that ambivalence, this back and forth, is normal. It is not pathological or the person’s in denial. It is normal. We’ve all, you, me, everybody, we’ve all struggled with issues, and that ambivalence to change is normal. Now my job is to organize the interview so that, again, the person confronts themselves, tells me, “You know what? I’ve got to change something.” In essence, they should convince us that they want to change, not the other way around.
That’s some of the key pointers of what motivational interviewing is. Again, in weeks to come I’m going to continue to add to this in terms of the specific skills on how to get the interview guided and generated in this way to promote change. I’m looking forward to that and I’m hoping you’ll join me for those sessions. As usual, if you have comments, if you have questions, I’d like to do a follow-up with anybody who asks a question. I welcome your comments and questions along the way. As usual, with that, have a great day and live your life with passion.