Feature References 1.
2.
UNICEF. Committing to child survival: A promise renewed. September 2012. Available online at: http://www.unicef.org/ videoaudio/PDFs/APR_Progress_ Report_2012_final.pdf (Last accessed 16th March 2015). Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE et al. Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends
3.
since 2000. The Lancet 2012; 379(9832): 2151–61. World Health Organization (WHO). WHOCHERG methods and data sources for child causes of death 2000–2011. Global Health Estimates technical paper WHO/HIS/HSI/ GHE/2013.2. Geneva: WHO. Available online at: www.who.int/healthinfo/statistics/ ChildCOD_method.pdf (Last accessed 16th March 2015).
4.
5.
YouTube. Help a Child Reach 5. Available online at: www.youtube.com\helpachildreach5 (Last accessed 16th March 2015). Nicholson JA, Naeeni M, Hoptroff M, Matheson JR, Roberts AJ, Taylor D et al. An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Tropical Medicine & International Health 2014; 19: 284–92.
What would your future self say? Using motivational interviewing to affect behaviour change Based on a workshop delivered to RSPH members in February 2015 by Neal Gething, Registered Psychologist at Empowerment Training Consultancy, this article explores the technique of motivational interviewing and how it can be used to change behaviour. We cannot change anything until we accept it. Condemnation does not liberate, it oppresses. Carl Jung Before you start reading, think of a behaviour that you would like to change. If you can, write it down and describe it, so you can easily come back to it as you are reading through this article. An important part of motivational interviewing is to be able to first apply the technique to yourself: once you’ve found the trick to changing your own behaviours, you can then use this knowledge to help transform others. Motivation, in simple terms, is the desire to change something. Motivational interviewing is a personcentred counselling approach that focuses on collaboratively eliciting, and subsequently strengthening, an individual’s motivation to change.1 Rather than focusing on the negative battle, the technique encourages the individual to focus on what they are good at, who they are now – their needs, desires and goals – and the person they will turn into – their future
self. Ultimately, motivational interviewing is about change, and the three principles that underlie all change: everything is a state of mind; state of mind is habit; and habits can change. We all learn things by habit, for example, how we sign our name and which arm our watch is on. Motivational interviewing focuses on finding these habits and discovering what it is that blocks you from getting up and doing what you know is right, that is, from changing your behaviour.
Change is the responsibility of the individual, and it is important to remember that you cannot force behaviour change in others: in order to change a behaviour, you need to own your own problem. The role of the motivational interviewer is to be a supportive companion who focuses on bringing the conversation back to change, and on listening to the person rather than the problem. The first step is discovering who the client is (the present self) and facilitating them in looking at who The key here is they are when their problem owns them, developing a beginning to engage the The Essence of discrepancy Motivational with who/where habit mind. The key here Interviewing an individual is is developing a discrepancy with who/ Pause here and think about now compared where an individual is how compassionate you are to who/where towards yourself – what do they want to be now compared to who/ where they want to be, you say to yourself when you which brings you to the think about the behaviour you second step – discovering who the client are going to change? What motivates wants to be (desired future self). Here, it is you? important to focus on keeping statements ‘It’s not your fault, but it is your positive: on ‘be this’ rather than ‘don’t be problem.’ that’. This is an important stage in giving
118 Perspectives in Public Health l May 2015 Vol 135 No 3 Downloaded from rsh.sagepub.com at EMORY UNIV on August 4, 2015
Feature the mind the right information for change to happen and recognising the barriers that might get in the way of your future self: ‘How dare you ask me to change, you don’t know what I’ve been through.’ Spending time on feelings of ambivalence is necessary here as it is common for uncertainty to cause fluctuation through a range of emotions, including fear, anger, grief, guilt, shame and helplessness, leading to internal power struggles. Avoid letting this power become the focus of the discussion as it can cause individuals to fight back – this can lead to arguments, which should be avoided. It is important to remain focused on discovering and understanding the desired future self: through maximising the desire for change, the perceived ability to change and the actual ability to change will increase.
What would your future self say? Every time the problem is mentioned, ask the individual this question: establishing
and focusing on the future self and driving towards it are the key to motivational interviewing. Collaborative and changefocused empathy is important here: displaying compassion and affirming an individual’s struggle. Any behaviour that relates to the future self should be focused on and expanded: for example, if the future self is judging the current self, this needs to remain the focus until the relationship becomes a positive one: ‘How do I accommodate the behaviour into my future self?’ The final step is goal setting: securing a commitment to change. Goal setting within motivational interviewing is slightly different – it is about cultivating change based on the values that have been drawn out from investigating your present self and your desired future self – rather than setting goals just to tick boxes. Goal setting to secure change includes the following: the changes I plan to make are, the reasons I want to make these changes are, future actions are, I will know I am changing when and I will know when I’m regressing when.
Conclusion Motivational interviewing is a key behaviour change technique used by psychotherapists, occupational health doctors and general practitioners (GPs) in their day-to-day work with clients. As this article has explored, the technique makes use of shortterm, solution-focused strategies to help individuals overcome behaviours and actions that may be impeding their health and wellbeing. This is achieved through the key principles: understanding what motivates you by focusing on the self and your values rather than on the problem, identifying the barriers to change and identifying how these barriers can be overcome by setting up a dialogue between the present self and the future self. Thinking back to the behaviour that you identified at the start, what would your future self say?
Alison Firth RSPH Editorial Officer
Reference 1.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change, 3rd edn. New York: The Guildford Press, 2012.
May 2015 Vol 135 No 3 l Perspectives in Public Health 119 Downloaded from rsh.sagepub.com at EMORY UNIV on August 4, 2015
2.
UNICEF. Committing to child survival: A promise renewed. September 2012. Available online at: http://www.unicef.org/ videoaudio/PDFs/APR_Progress_ Report_2012_final.pdf (Last accessed 16th March 2015). Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE et al. Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends
3.
since 2000. The Lancet 2012; 379(9832): 2151–61. World Health Organization (WHO). WHOCHERG methods and data sources for child causes of death 2000–2011. Global Health Estimates technical paper WHO/HIS/HSI/ GHE/2013.2. Geneva: WHO. Available online at: www.who.int/healthinfo/statistics/ ChildCOD_method.pdf (Last accessed 16th March 2015).
4.
5.
YouTube. Help a Child Reach 5. Available online at: www.youtube.com\helpachildreach5 (Last accessed 16th March 2015). Nicholson JA, Naeeni M, Hoptroff M, Matheson JR, Roberts AJ, Taylor D et al. An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Tropical Medicine & International Health 2014; 19: 284–92.
What would your future self say? Using motivational interviewing to affect behaviour change Based on a workshop delivered to RSPH members in February 2015 by Neal Gething, Registered Psychologist at Empowerment Training Consultancy, this article explores the technique of motivational interviewing and how it can be used to change behaviour. We cannot change anything until we accept it. Condemnation does not liberate, it oppresses. Carl Jung Before you start reading, think of a behaviour that you would like to change. If you can, write it down and describe it, so you can easily come back to it as you are reading through this article. An important part of motivational interviewing is to be able to first apply the technique to yourself: once you’ve found the trick to changing your own behaviours, you can then use this knowledge to help transform others. Motivation, in simple terms, is the desire to change something. Motivational interviewing is a personcentred counselling approach that focuses on collaboratively eliciting, and subsequently strengthening, an individual’s motivation to change.1 Rather than focusing on the negative battle, the technique encourages the individual to focus on what they are good at, who they are now – their needs, desires and goals – and the person they will turn into – their future
self. Ultimately, motivational interviewing is about change, and the three principles that underlie all change: everything is a state of mind; state of mind is habit; and habits can change. We all learn things by habit, for example, how we sign our name and which arm our watch is on. Motivational interviewing focuses on finding these habits and discovering what it is that blocks you from getting up and doing what you know is right, that is, from changing your behaviour.
Change is the responsibility of the individual, and it is important to remember that you cannot force behaviour change in others: in order to change a behaviour, you need to own your own problem. The role of the motivational interviewer is to be a supportive companion who focuses on bringing the conversation back to change, and on listening to the person rather than the problem. The first step is discovering who the client is (the present self) and facilitating them in looking at who The key here is they are when their problem owns them, developing a beginning to engage the The Essence of discrepancy Motivational with who/where habit mind. The key here Interviewing an individual is is developing a discrepancy with who/ Pause here and think about now compared where an individual is how compassionate you are to who/where towards yourself – what do they want to be now compared to who/ where they want to be, you say to yourself when you which brings you to the think about the behaviour you second step – discovering who the client are going to change? What motivates wants to be (desired future self). Here, it is you? important to focus on keeping statements ‘It’s not your fault, but it is your positive: on ‘be this’ rather than ‘don’t be problem.’ that’. This is an important stage in giving
118 Perspectives in Public Health l May 2015 Vol 135 No 3 Downloaded from rsh.sagepub.com at EMORY UNIV on August 4, 2015
Feature the mind the right information for change to happen and recognising the barriers that might get in the way of your future self: ‘How dare you ask me to change, you don’t know what I’ve been through.’ Spending time on feelings of ambivalence is necessary here as it is common for uncertainty to cause fluctuation through a range of emotions, including fear, anger, grief, guilt, shame and helplessness, leading to internal power struggles. Avoid letting this power become the focus of the discussion as it can cause individuals to fight back – this can lead to arguments, which should be avoided. It is important to remain focused on discovering and understanding the desired future self: through maximising the desire for change, the perceived ability to change and the actual ability to change will increase.
What would your future self say? Every time the problem is mentioned, ask the individual this question: establishing
and focusing on the future self and driving towards it are the key to motivational interviewing. Collaborative and changefocused empathy is important here: displaying compassion and affirming an individual’s struggle. Any behaviour that relates to the future self should be focused on and expanded: for example, if the future self is judging the current self, this needs to remain the focus until the relationship becomes a positive one: ‘How do I accommodate the behaviour into my future self?’ The final step is goal setting: securing a commitment to change. Goal setting within motivational interviewing is slightly different – it is about cultivating change based on the values that have been drawn out from investigating your present self and your desired future self – rather than setting goals just to tick boxes. Goal setting to secure change includes the following: the changes I plan to make are, the reasons I want to make these changes are, future actions are, I will know I am changing when and I will know when I’m regressing when.
Conclusion Motivational interviewing is a key behaviour change technique used by psychotherapists, occupational health doctors and general practitioners (GPs) in their day-to-day work with clients. As this article has explored, the technique makes use of shortterm, solution-focused strategies to help individuals overcome behaviours and actions that may be impeding their health and wellbeing. This is achieved through the key principles: understanding what motivates you by focusing on the self and your values rather than on the problem, identifying the barriers to change and identifying how these barriers can be overcome by setting up a dialogue between the present self and the future self. Thinking back to the behaviour that you identified at the start, what would your future self say?
Alison Firth RSPH Editorial Officer
Reference 1.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change, 3rd edn. New York: The Guildford Press, 2012.
May 2015 Vol 135 No 3 l Perspectives in Public Health 119 Downloaded from rsh.sagepub.com at EMORY UNIV on August 4, 2015
