Motivational Interviewing
In my time as a trainer with Housing First University (HFU), I’ve found that an unexpected side effect of offering instruction and support to groups from across the nation has been that it helps me improve my own practice. One of my favorite training subjects is Motivational Interviewing (MI). A cluster of techniques for engaging authentically with people in a way that supports them to make positive changes in their lives, MI is a well-researched approach that gets the job done.
In days of yore, skeptical villagers might have asked the traveling salesman about an offered miracle cure, “But would you give it to your own loved ones?” When it comes to MI, I would. I teach MI to a wide variety of practitioners and I use it in my own therapy practice to support Pathways to Housing PA participants. I believe in it so much that I’m inclined to demonstrate its effectiveness here and now by taking this opportunity to apply it to my own mind. Stand back people, I’m about to motivationally interview myself.
Let’s say, just for the sake of providing a test case, that I’m evaluating the wisdom of my daily 2pm pilgrimage to the snack machine for a Snickers bar (#2pSnix). I feel like it gives me a boost of energy that lasts until approximately 4:45pm, but which I also know is just the result of burning highly processed corn syrup and typically leads to feelings of lethargy and regret by around 4:46pm. To put it simply, I could take ‘em or leave ‘em. Ambivalence—derived from the Latin elements ambi- (“both, on both sides”) and valentia- (“strength”) and classically represented by the emoji ¯\_(ツ)_/¯ is a key MI concept describing a person’s level of interest in making change or taking action. While few decisions are made with 100% certainty, supporting people in clarifying their feelings about their options is a critical tool in inspiring motivation. Gauging ambivalence is thus a useful first step in getting “a lay of the land” in order to work toward change.
In assessing my own feelings of ambivalence around #2pSnix, I’ve found myself leaning more toward the “keep snacking” side of things. I tend to feel pretty sluggish in the afternoon, and the walk to the machine alone is something of a boost. The Snickers is almost inconsequential, which does not mean I’m planning to stop eating them. On the other hand (note the language of ambivalence there!), I recognize that this is not healthy, I know that Mars, Inc. does not have my best interests in mind when they produce my #2pSnix, and I could use that money for bigger and better things. In practicing MI, we work to identify and resolve participant ambivalence, highlighting their own language regarding the possibility of change and encouraging them to keep talking about those feelings of “strengths on both sides.”
Another helpful MI tool toward this end is the Readiness Ruler, which measures both Importance and Confidence on a 0-10 scale. The Readiness Ruler is useful not only for assessment, but as a tool for increasing people’s sense of the importance of making a change as well as their confidence that change is possible. How ready am I for change? Let me start with the Confidence side. Can I stop engaging in #2pSnix? I’ve done it before, and I feel pretty sure I can do it again—I’m at a 9. What could move you from a 9 to a 10, I might ask myself. I round up an old journal from my year of living sugar-free (TLDR: it was hell) and quickly find myself at Confidence level 10.
As for the Importance side of the Readiness Ruler, however, I’d have to give myself a 6. Snickers bars are, as you likely know, delicious. As I continue debating the pros and cons of continuing with my #2pSnix habit, I note that peer support might help increase my sense of the importance of making this change. By contacting a friend group from those sugar-free days, I find the inspiration I needed and I’m fully invested: a nice round 10.
Finally, I’m prepared to engage one of the MI toolkit’s most effective and subtle techniques: managing change talk and sustain talk. MI practitioners should tune in closely to these two modes of speech. Sustain talk is comprised of statements that reflect a desire to maintain the status quo, while change talk elicits the sense that another way of being is possible, preferable, or even inevitable. Change talk is encouraged, explored, and reflected back to the client, while sustain talk is de-emphasized and allowed to fall away into the background.
You know, instead of #2pSnix, I could take a walk over to the park to work on my urban bird identification skills, I suggest to myself. The sugar-dependent section of my brain attempts to redirect me with a visualization of biting into that nougat topped in caramel and peanuts, all swaddled in a creamy chocolate overcoat. What I hear you saying, I say to me, is that you identify both the joys of the immediate sugar rush as well as the longer-term negative feelings that arise. Back and forth goes the dance of self-negotiation, with heartfelt expositions about the soothing effects of cocoa butter and soy lecithin quickly scuttled and replaced by reminders of the benefits of cardio without added palm oil. It sounds like you know exactly what you want to do!
Eventually, change talk wins. #2pSnix is no more, and a new habit of #2pWalx is born.
Now if I can just motivate myself to call those nice people back about my car’s extended warranty.
