A Guide to Motivational Interviewing for Health Coaches

Motivational interviewing is a technique used by coaches of all kinds to create a space where clients feel safe. This technique allows for open communication and recognizes client agency in all aspects of the changes they’re looking to make in their lives. By utilizing motivational interviewing, coaches can help clients better communicate and understand any barriers to their wellness journey.

Motivational interviewing has been shown to increase positive health and treatment outcomes, quality of life, and client retention and engagement rates.

A Guide to Motivational Interviewing for Health Coach

What is Motivational Interviewing?

Motivational interviewing is a counseling method that helps people find the motivation to change their lives. Psychology Today calls it “a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.” It has evolved from a client-centered approach originated by American psychologist Carl Roger into a method to help people commit to change, no matter how complex the process is.

After further developing the technique, American psychologists William R. Miller and Stephen Rollnick concluded that “The more you try to insert information and advice into others, the more they tend to back off and resist.” They wanted to show that there was a way to help others help themselves.

Five Core Skills of Motivational Interviewing

Motivational interviewing accepts that ambivalence towards change is a normal human experience - and often a necessary step in the process of change. The technique assumes that people are simply ambivalent about change, versus negative towards or resistant to change. It’s an optimistic approach to change that primarily aims to resolve these feelings through reinforcing statements that reflect the desire to change. These statements are referred to as “change talk.”

According to Miller and Rollnick, change talk reflects the desire to change, focuses on the ability to do so, lists specific reasons for change, and expresses commitment to change. Strengthening the five core skills of motivational interviewing as a Health Coach can help make the shift from directing clients to guiding them through their journey.

In motivational interviewing, the OARS approach is used to establish a relationship and to begin – and continue – discussions about change.

Open-ended questions are questions that aren’t easily answered with a simple “yes” or “no.” Instead, they lead to thoughtful discussions and invite elaboration and deeper thinking about issues. Open-ended questions create forward momentum in the conversation and can be used to help the client explore the reason for and the possibility of making a change.

• What brings you in today?
• Where will you get the support you need?
• Tell me more about...

Affirmations are short and encouraging present-tense statements that validate and confirm a desired feeling or outcome. They work to help the client see themselves in a more positive light; but to be most effective, affirmations should be genuine and consistent. Affirmations often involve reframing concerns or behaviors as positive qualities. They should build on the client’s level of self-efficacy and reiterate the belief that they can handle their own choices in life.

• You’re trying really hard to...
• It’s not always easy to...but I’m so proud of you for...
• You’ve been very thoughtful about this decision you’ve made.

Reflective listening is considered the most crucial skill in motivational interviewing. Its two main purposes are to express empathy and to help guide clients toward the change they want to make. By utilizing active listening and reflective responses, the client may feel that their coach understands the issues from their perspective. Coaches can reflect words, emotions, and/or behaviors.

• You seem to be feeling...
• I noticed...when you said...
• Some of what I heard you say was...

Summarizing helps to move the conversation forward and ensures that coaches understand their client’s goals and preferences. Summarizing what was discussed confirms that the client understands the key elements of any plan that’s put into place. Summarizing communicates the coach’s interest in and calls attention to important parts of the discussion during the session. When coaches employ effective summarizing, clients may find that they’re actively talking about making changes.

• Let’s go over what we’ve discussed so far.
• Earlier, you mentioned...Would you like to talk more about that?
• What other questions do you have before we end today’s session?

Four Stages of Motivational Interviewing

There are four core stages to motivational interviewing. Miller and Rollnick specifically emphasize that motivational interviewing should be implemented with a spirit that is collaborative, evocative, and that honors client autonomy. The ideas that coaches draw out from their clients should belong to their clients alone – it shouldn’t be the coach transferring their ideals onto their clients.

Engaging

Building an alliance and a working relationship with the client. This can be achieved by expressing empathy towards the client and their current situation and struggles. Instead of judging, try to see things from their point of view.

Some things to consider during the Engaging stage:

• Does this feel like a collaborative partnership?
• How supportive and helpful am I being?
• Do I understand this person’s perspective and concerns?

Focusing

Coming to a shared idea about one main goal of the time coach and client will be spending together. While there might be several areas that a client feels they need to address, coaches will help them to hone in on what’s truly most important to them.

Some things to consider during the Focusing stage:

• What goals for change does this person really have?
• Are we working together with a common purpose?
• Do I have a clear sense of where we are going? Does the client?

Evoking

Bringing out the client’s own arguments for and against change, including their values, goals for the future, and ideas. This is the heart of coach-client relationships, particularly when it comes to the client’s self-efficacy and internal motivation. Coaches should listen for change talk and lean into opportunities for client-led conversations about change.

Some things to consider during the Evoking stage:

• What are this person's own reasons for change?
• Am I steering too far or too fast in a particular direction?
• Are we working towards developing internal motivation?

Planning

Getting the client to envision change and how they will go about making it. During this step, coaches support their clients by helping to develop a plan while leveraging existing resources, using their strengths, and reinforcing the client’s commitment to this change.

Some things to consider during the Planning stage:

• Do we have a clear path in place? If not, have we explored all the planning options?
• Have we removed all barriers to change?
• Does the client have outside support? Do they need any?

The Bottom Line

What motivates us differs from person to person, is unique to each situation, and changes over time. Motivational interviewing techniques help clients not only reach their goals but to grow as individuals. As a coach, providing an environment that welcomes clients with genuine openness and empathy, that enables self-discovery and acceptance, that makes them feel seen – that's when they can truly begin their journey of transformation.