Motivational Interviewing or NLP?

This post is dedicated to Adele – physiotherapist, manager and all round excellent person!

Motivational Interviewing

Motivational Interviewing was first developed by Miller and Rollnick (who have written the definitive book on the subject) to work with drug addicts, smokers and alcoholics, but it is now used a whole range of settings, including health.

Physiotherapists might use this approach to motivate a patient to stick to a daily exercise programme, whilst Careers Advisers might use the approach with unemployed clients, to motivate them to look for work or stick to a training programme.

To get your head around this approach, you need to start by thinking about ambivalence.  If you find it hard to motivate yourself to do something, it is usually because you are in some way ambivalent – in some ways you want to do it, in other ways you don’t.  For example, in some ways you might want a promotion (more money, more challenge, more high-profile) but in other ways you might not (fear of failure, more stress, not sure you if have the skills).  The scales can tip from side to side, and Motivational Interviewing works with the client to help them uncover what is on each side of the scales, and then tip the balance towards the desired action (if there is one).

There are two components to motivation – believing that something is important, and feeling confident that if you did the thing, you would succeed.  If either of these beliefs is weak, motivation will be weak as well, so the interviewer works to increase these two beliefs.

One of the common traps in trying to motivate someone is giving advice – telling them what you think they should do.  Often when people tell you what to do, they articulate what is on one side of the scales (all the reasons to act), and you respond by articulating the other side of the scales (all the reasons not to act), which has the effect of weakening your motivation to act.  For example, if my mother comes round and tells me I must decorate the bathroom, I respond by saying I haven’t got time and anyway I don’t spend much time in the bathroom so what does it matter?  She’s been telling me to decorate it for years, and I still haven’t done it!

So in motivational interviewing, you start in the opposite place – you explore with the person why they don’t want to act, and by really listening and understanding their responses, you free them up to articulate the other side of the scales – why they should act, which strengthens motivation.

So a physiotherapist might explore with a patient all the reasons why she finds it difficult to stick to her exercises – not enough time, not sure if she is doing them right, not seeing any results, forgetting – and then only after this has been explored well, would the physiotherapist use questions to elicit more positive statements from the patient about the benefits of doing the exercises.  The point is very much that the reasons for sticking to the exercises must come from the client, not the physio.

There are many specific questions and techniques that are used in MI, but the basics are fairly simple:

  • Open Questions
  • Affirmation
  • Reflective listening
  • Summaries

These are all basic counselling skills, used in many professions.  As with client-centred counselling, you need a lot of respect and empathy for the individual you are working with, and you need to believe that they have the potential to change.  The key thing that is different fro client-centred couneslling is that the interviewer uses techniques to help the client build motivation to act in a certain direction – to give up smoking, to exercise regularly, to engage with a  training programme.

There is a lot of academic research supporting the efficacy of this approach, and it seems to be most effective when the interviewer genuinely does have empathy and respect for the client/patient.

My experience of motivational interviewing is that it is really effective in working with reluctant or disengaged clients.  It is a great approach to working with clients who have been “sent” for an interview, and don’t want to be there.  I’ve also used techniques from motivational interviewing on friends and family, with some success! It’s also useful in a management situation, when you are perhaps hoping to motivate someone to make the best of their potential – perhaps do some extra training, take on a new project or role,  take control of changes in the workplace, or develop new skills.

It doesn’t fit so well, however, with managing performance in the workplace.  If you are in the position of having to set targets and ensure they are met, you are providing an external “stick” and you can’t then be neutral enough to do motivational interviewing.

So What About NLP?

NLP ~(Neuro-Linguistic Programming) is widely used in business and management, life coaching, sports coaching and communication skills training.  The jury is still out on how effective it is – some people swear by it and others think it is a bit of a con.  There are loads of books, trainers and websites on NLP, explaining how to use NLP techniques to get the most out of life, set and achieve goals, improve your relationships and anything else you care to mention!  NLP consultants often come into organisations to improve communication skills, increase sales or improve motivation.

NLP was developed by Bandler and Grinder, and is a set of practical techniques to improve your skills in managing your thought patterns, communications and behaviour.  Where Motivational Interviewing delves around in the negative, NLP relentlessly concentrates on the positive.

So the physiotherapist above might work with her patient and ask her to visualise how her life would be in five years if it was as good as it could possibly be.  The patient might imagine herself as healthy and fit, back in work and enjoying her family.  She would be asked to make this vision as clear as possible – what can she see, what do others say about her, how is she dressed, what colours are in the picture?  She could perhaps add some music to this mental picture.  Then she would be asked to keep this picture in her mind every day, so that subconsciously she makes choices which lead her towards it.

The physio might also help the patient to identify negative thought patterns (e.g. There’s no point in doing the exercises because I’ll never get better) and replace them with more positive “self-talk” – If I do the exercise every day, I will be getting a tiny bit better every day and in the end I will notice it.
NLP is often used in Career Guidance to improve confidence in managing new situations, job interviews, presentations.  It can also be used to help clients set ambitious goals and think into the long-term about how they want their life to be.  There are techniques than can be used to help clients control negative emotions – anger, anxiety, shyness – and to improve relationship and communication skills. 

NLP techniques are great to use with clients/patients/colleagues who want to take part in the activities.  They can be adapted well to group sessions as well.  They are also good for mentoring relationships – perhaps in the workplace or in education.  I’m not completely convinced about the whole NLP package, but there are definitely tools in there that are very useful, and I’ve made small changes in my life as a result of doing NLP activities, so some of it at least has worked for me!

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3 responses to this post.

  1. Posted by Sam on February 13, 2013 at 3:15 pm

    do nlp langugae patterns work in interviews or will the interviewer think i’m wierd? I just download eda couple of NLP/interview books (the 73 rules for infleuncing the interview and get that job with nlp) but im concerned about using the techniques with someone (the interviewer) who will just think im crazy???

    Reply

  2. Hi Sam,

    I wouldn’t practice any techniques that you are not totally confident and familiar with in the middle of a job interview. If you try applying new techniques, chances are that you won’t be thinking about the questions and the people sitting in front of you! However, NLP can be good for job interview preparation. Monitor your self-talk, and if you catch yourself being negative (I’m bound to mess it up) replace that with a more positive statement (I’m going to do my best and show how I can help them). Some relaxation techniques might help as well. It might help to visualise yourself doing a really good interview, and make this a really vivid image that you can recall while you are waiting to be called in. Good luck, hope it goes well for you!

    Reply

  3. Posted by Sandy on June 27, 2016 at 4:07 pm

    Agree with you careeradvisonatlarge, One of the challenges of both ideas (NLP/MI) to improve communication is that they work well if you have understood and practiced them with like minded individuals. However, starting to use them in practice without such practice is likely to be awkward and not work as well. If they are subtly used, I have found each to be constructive in assisting my clients to change. While NLP was born out of a more business context, early studies of Erickson & Satir quickly brought in the therapy/human services context.

    Reply

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