Motivational Interviewing: Strategies and Techniques

Successful motivational interviewing relies on listening, asking lots of questions, and directing conversation so it stays on topic. It's also about developing a good rapport so an individual feels comfortable to give you the information you need to help them feel more motivated toward recovery.

The following provides an example of how a return to work coordinator, case manager or rehabilitation provider might approach a motivational interview with an employee or patient.   Remember, the person must trust you for the discussion to have any integrity.  Imagine someone you don't trust asking you something personal, your answers will be superficial and wary.

This is only one example.  Motivational interviewing can be used to assess and work with someone, for example, to increase their exercise, improve health eating behaviours, deal with a specific work problem.

Introduction

Hi John, it is good to see you.  Thanks for bringing in your certificate; it gives us a great chance to catch up. 

So how are things going for you right now?

Tell me about how your back is going, do you feel you are improving?
 

Assess level of motivation

Now, can we talk about getting back to work?  I'm trying to get a sense of where you are at regarding return to work. 

Can you tell me, on a scale from zero to ten where zero is not important and ten is the most important it could be, how important is it to you to get back to work in the next few weeks?
 

Assess motivating factors

When the person gives you their score, follow up with questions like, What is it that makes you choose X out of ten instead of Y out of 10?

For example, if the person chooses four as their response, you could ask what is it that has the person respond as a four instead of a one or two. 

This lets you know the motivating factors.  These could be

I'm bored at home

I miss my colleagues

The team needs me

I'm getting depressed being off work
 

Assess the barriers to return to work.

Understanding what reduces the score lets you know about the barriers, or factors that reduce the motivation.

What has you answer four out of ten, instead of say a nine or ten?

The person may respond,

I'm worried I won't be able to cope with the job

I'm concerned I'll let the team down not being able to do the job

I can't see myself being able to drive to and from work

I don't think I can get through a full day on the job

OR you might ask, What would have to change to make the importance a seven out of ten instead?

Remember to ask open-ended questions and to follow up on any positivity the person offers.

Once you have identified the motivating factors, as well as the barriers or obstacles, you have something to work with to support the person with the next steps. 
 

Build on the positive factors

A discussion to build on the factors motivating the individual might be:

The team is missing you too

We know that many people get depressed if they are away for more than a few weeks, what can we do to help you and prevent that happening?
 

Dealing with the barriers

This becomes self-evident, once the obstacles or barriers have been identified. 

How do you feel about coming back to work part time?

Would you like someone to pick you up and bring you to work?

We know you won't be your normal self for a while, but you will still be a great help to the team.
 

Tips

Be directive: There is sometimes concern that a discussion such as this takes up too much time, but it should not be performed as an open-ended discussion about anything and everything. The discussion should be kept focused and on topic to arrive at mutually agreed changes and a plan to implement them.

Don't get angry: Though there might be a temptation towards anger and frustration if a person is resisting change – which might be by arguing, interrupting or blaming – remember this is not necessarily a negative thing. Resistance shows, at least, that the person is considering the option and thinking about it, rather than completely dismissing it. In the face of resistance it is crucial not to become angry. Motivational interviewing is all about rapport, and getting angry is a sure fire way to destroy it. By appropriately addressing the reasons for resistance, the case manager can lead the person toward dissonance and subsequently into serious exploration of possibilities for change.

Find the positive: One simple technique is to ask a person what is good (positive) about a particular behaviour (eg not taking medications as prescribed) and what is bad about that same behaviour. By simply repeating back the positives and negatives put forward by the person, with examination of each in detail, discrepancy and opportunities for change will emerge.

People are ultimately responsible for implementing and sustaining behaviour changes themselves, but they can be assisted to feel more motivated, in control of their own recovery and confident. Everyone is motivated by something different; no two individuals are the same. If a case manager can successfully undertake motivational interviewing with a person, they can address the individual's needs, increasing their motivation towards a faster, stronger recovery. 

Motivational Interviewing training is available. See Motivational Interviewing