Motivational interviewing (MI) originated in Norway in the early 1980s by psychotherapists who began to use this principle to treat patients with drinking difficulties. He suggested one “could use empathetic listening to minimize resistance and increase motivation for change” 1. The methodology was further developed, revised and expanded 2, 3 by William Miller and fellow clinical psychologist Stephen Rollnick to elicit change behavior using intrinsic motivation to overcome resistance and ambivalence.
MI has gained greater popularity with it’s expansion from treatment of addiction by psychologists to healthcare providers working to elicit change health-related behaviors such as smoking cessation, exercise and healthy eating habits. This is where I first encountered MI. The outpatient physical therapy clinic where I was working offered a continuing education class for physical and occupational therapists to learn MI principles, conversation and listening (especially listening) skills to elicit change behavior in our patients. Most of our patients are motivated to perform their home exercise program and implement lifestyle modifications, if necessary, to help in pain management and improving function. However, as in the classroom, there always seems to be 1 or 2 patients on your schedule where it feels like pulling teeth to get them involved and motivated to participate.
During the 2-day MI course, we practiced reflective and empathetic listening skills and learned how to drive a conversation so the patient is the one doing most of the talking. I worked to expand these new skills with my patients in the PT clinic. It was harder than I anticipated to withhold my opinion on how I thought various obstacles could be overcome or ways my patients could make time in their day to do their home exercise program. However, what emerged was a patient-driven conversation where they devised ways to make behavioral changes and I felt like I was doing less work. Woah.
I split my time between treating patients as a PT in an outpatient PT clinic and being a PhD student. For many reasons I love this split in my roles, but one of the best parts is experiencing how what I learn in one environment influences my actions in the other. In my role as a lab instructor, discussion leader and eventually sole instructor on campus, one of my biggest challenges was knowing how far to go to reach out to the seemingly disengaged or apathetic students. I felt responsible for their learning, I wanted them to get the most out of the short time we spent together in the classroom and I wanted them to have a positive experience. At the same time, I recognized that I cannot make a student learn. It was unclear to me how far I should be reaching, how often should I pull them into the conversation and really, how to manage the less well-engaged students.
I made use of the many wonderful people and resources available to me to better understand how others dealt with similar experiences and feelings. I also started to think about how I handle the patients in the PT clinic that are there “because my doctor sent me”, at least on the surface don’t seem to want to be there and take few actions to help themselves resolve their pain. And then the thought, “why not use MI strategies in the classroom”, came to me. While MI is continually evolving over time with its ongoing expansion into more disciplines, to me, MI is a style of listening (really listening) and questioning to facilitate change behaviors by working with the other person to identify their intrinsic motivation. And many of the keywords used to describe MI are words that have also been used to describe high-quality pedagogical techniques such as collaboration, empathy, autonomy and promoting self-efficacy.
After a few reflective listening conversations, what followed was not a miracle transformation of student behavior. However, I gained a much better understanding of the student’s situation from her perspective, with many layers of complexity built in, and was able to give that student what she needed at that moment in time – which did not involve getting an A in that class. We were now on the same page. I felt so much better about the situation and I lost the guilt and stress over not being able to improve participation in the seemingly unengaged student in the back of the class. This student seemed to also feel more comfortable in class and with me. She did not pass that class, but it was what she needed to do at that time. She took the class again over the summer, when her personal life allowed her to succeed in the classroom, with a high level of engagement throughout the term. It was a huge win for both of us – she was eventually successful in the classroom and I felt good about meeting her where she was on that path to success.
I certainly am not the only one who has thought to transfer MI strategies from the healthcare setting to the classroom. In fact, Harvey Wells and Anna Jones have recently published a couple papers on the theoretical basis4 and practical application5 of using MI in higher education classrooms. They argue that using MI in higher education classrooms can lead to student-teacher collaboration, facilitate building self-efficacious behaviors in students and establish a student-driven pathway to change4. After all, isn’t learning a non-linear process of change? Why not couple that process with a set of useful techniques educators can use to see the change they want to see in students?
To be sure, there are challenges associated with taking a method or style of communication from one discipline and adapting it to another. Certainly, empathetic and reflective listening practices can easily lead to a greater emotional involvement, yet as Wells & Jones4 have described, “education is not (nor should be) therapy”. Using MI strategies should not be viewed as a mechanism to “treat” a student, but rather as a tool to foster change within a student and help educators to understand where they need to meet the student, so they can walk along the same path instead of pushing against each other.
While empirical evidence is needed to determine the effectiveness of using MI in higher education, given my own use of and success with MI, I can foresee MI practices becoming more prevalent in higher education as a mechanism to identify student-driven goals with a pathway for educators and students to collaboratively meet those goals. I encourage you to do a little reading on MI practices. At a minimum it will make you a better listener.
1) Rollnick, S. and Allison, J. (2004). Motivational Interviewing. In The Essential Handbook of Treatment and Prevention of Alcohol Problems. (105-116). Chapter 7: West Sussex, England: John Wiley & Sons, Ltd.
2) Miller, W.R. and Rollnick, S. (1991). Motivational interviewing: Preparing people for change. New York, NY: Guilford Press.
3) Miller, W.R. and Rollnick, S. (2013). Motivational Interviewing: Helping people change, 3rd edition. New York, NY: Guilford Press.
4) Wells, H. and Jones, A. (2018). Learning to change: the rationale for the use of motivational interviewing in higher education, Innovations in Education and Teaching International, 55:1, 111-118.
5) Wells, H., Jones, A. and Jones, S.C. (2014). Teaching reluctant students: using the principles and techniques of motivational interviewing to foster better student-teacher interactions, Innovations in Education and Teaching International, 51:2, 175-184.
||Katie Kolwaski completed her BS and DPT from the University of Wisconsin – Madison. After practicing as a full-time PT for 4 years, she decided to pursue further education at the University of Oregon. In 2017, she finished a MS degree in Muscle Physiology and then transitioned into the Neurophysiology lab for her PhD, studying the impact of mental fatigue on neuromuscular function in older adults and the potential role of physical activity in modulating that relationship. Katie has since moved to the University of Western Ontario in the great white north in order to finish her PhD. She continues to treat patients as a PT and teach students within the Physio school in London, ON as a TA.