Motivational Interviewing...

Coach yourself to achieve your goals

Photo by Ian Stauffer on Unsplash

In a previous post I had talked about how medicine is full of guidelines, but they never teach doctors how to help their patients to achieve the goals set forth. Consequently, I would give patients advice based on the guidelines but when they came back for follow up I was disappointed to realize they had not made any significant changes in their behavior.

After giving it further thought, the answer seemed to be staring me in the face. There's no one answer for everybody, no cookie cutter method that will work every single time. So that led me to think about something I learned at a medical conference a few years ago called Motivational Interviewing.

First, I digress. In the "old days”, medicine was a “top down” informational style. I'm the doctor, you’re the patient, here's what you need to do, no questions asked, my way or the highway. Fortunately that style of medicine is going by the wayside and now things are more of a shared decision making process.

In keeping with that premise, Motivational Interviewing is a tool that leverages shared decision making. I have used it with my patients quite frequently. Does it work every time? No. But as you will see it is a technique that you can use yourself, and if you follow the guidelines you may actually be more successful at achieving your goals.

My introduction to motivational interviewing came by the way of Frank Domino, MD who is a physician, author, and educator. He was speaking to a large group of healthcare providers when this topic came up.

So what is Motivational Interviewing?

Motivational Interviewing is nothing more than a series of questions designed to help someone arrive at their decision about what they will do next to achieve their goals. Notice the emphasis- their decision. It is not someone telling them what to do. It is giving the person the freedom to make a plan that will work for them.

Let me explain by example. My apologies to Dr. Domino if I am not a good acolyte of this method!

Ready? Here we go.

So let’s pick a common goal that many have- beginning an exercise program. So here is how my conversation with a patient would go.

“ You mentioned you wanted to start an exercise program. On a scale of 1-10, how motivated do you think you are to do that?”

“ Well, Doc, maybe a 6 or 7.”

I always follow this up with the following , no matter what their answer was (unless it is a 10, and it is NEVER a 10 !).

“ That’s interesting. I would have thought you would have said a higher number. So what would it take to make that motivation go up one point?”

“ Well, I hate going to the gym. It’s too far from my house. So if it was closer, that would help. “

“Well, you are unlikely to move closer to the gym, so what could you do instead of going to the gym?”

“I guess I could do exercise at home.”

“Have you done that before?”

“Actually, years ago I did. I was walking several days a week and using some light weights at the house.”

“That’s interesting. How did that work for you?”

“Actually, I liked it. It gave me some flexibility from a time standpoint, and it was cheaper than my gym membership which by the way I am not using.”

“Were there any other benefits you noticed?”

“I dropped a few pounds, and I felt better about myself.”

“Are there any obstacles that would keep you from doing that now?”

“Not really. Well, I could get some weights again. And I could start walking tomorrow- you only need feet to do that!”

“If you started today, how much time could you realistically allocate to your exercise?”

“ I think I could do 30 minutes three times a week.”

“What do you say if we make an agreement- you commit to that and we do a phone follow up in a few weeks to see how it is going?”

“Perfect!”

Did you notice something in this dialogue? All the “Coach” does is ask questions. There are no directives - “you must do this, etc.” You are meeting the patient where they are at, and letting them explore the challenges they face and internally agree to something they think they can achieve. In essence, you are putting down a trail of breadcrumbs to let them arrive exactly where you wanted them to go.

So, now that I have shared this technique with you, you don’t need a doctor or a coach to walk you through this, you can do it yourself.

Sit down with a piece of paper and a pen, start with your goal, and go through the sequence of questions. Probe deeper than I have if necessary ( I gave an abbreviated version here.)

Once you arrive at a plan, commit to it. Then track it. Mark on a calendar how successful you were each day or week to do what you planned. Then, after a few weeks, sit down, look at the calendar, and see how you are progressing.

If you had challenges, what could you do to overcome them? Do you need to change the time commitment or something else in your plan to get some momentum? Remember my mantra- it’s a marathon, not a sprint; slow and steady.

Wash, rinse and repeat. Keep the process going, and don’t forget to reflect on the benefits you are seeing or feeling by achieving your goals. And write these down to so you can look back and reflect on them at periodic intervals.

Motivational Interviewing can be done by anyone in order to achieve their goals. And I know you can do it too.

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Thanks for reading!

Disclaimer- the words and opinions expressed are the author’s, and his alone, and are not those of his employer.