Motivational interviewing

Motivational interviewing (MI) is a directive, client-centered conversation that helps clients explore and resolve ambivalence about changing a behavior.^{1International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 131.} Ambivalence is holding conflicting views, such as knowing activity would lower health risk while disliking how exercise feels.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1009.} MI draws out “change talk,” the client’s own statements of a desire or reason to change; change becomes more likely once these statements have been elicited.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1009.}

Its four principles are expressing empathy, rolling with resistance, developing discrepancy and supporting self-efficacy.^{1International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 131.} Rolling with resistance means avoiding head-on arguments and resisting the “righting reflex,” the urge to jump in with advice or a solution.^{1International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 131.}

In practice

Use OARS: open-ended questions, affirmations, reflective listening and summarizing.^{3International Sports Sciences Association, Fast Track Study Guide: Intake and Ongoing Evaluation, p. 19.} Evocative questions include “What are some benefits of becoming more physically active?” and “What do you intend to do?”^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1010.}

Ask the client to rate the importance of activity and their confidence on a 0 to 10 scale, then ask what would make the number higher.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1010.},^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1011.}

Keep the conversation within your scope of practice: when a client brings up personal problems, refer them to a qualified counselor or therapist.^{6Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 677.}