Motivational Interviewing

Vet Dr. Nick Bell shares his thoughts on Motivational Interviewing and how this can help when guiding clients.

Coaching, mentoring, facilitating and motivational interviewing – what is the difference and what does it matter (two open questions)?

Owen (Atkinson) and I got discussing the difference between coaching and mentoring late one evening between days on the last Healthy Feet Programme workshop. You might think it’s just semantics but it’s probably important to understand the values underpinning our approaches to guiding our clients.

Sport has played a formative role in my life, and now in the early development of my kids. It’s fascinating to watch the coaches who become the surrogate parents and the new, inspiring role models to your kids. While at RVC I was fortunate to train an ex-professional tennis player and I asked him to describe how coaches had helped him and he said “I gained so much more confidence about my own abilities, but also a desire to improve. You might smash the ball well outside the court but the coach would still say ‘Wow, you struck that so well!’ and then ‘How would you like to make it better?’”. The language is positive, powerful and supporting and so important to a young person’s development. The coach is there to bring out the best in your child (or you). To watch a good coach at work is uplifting and exhilarating for all involved. I have enjoyed bringing this spirit into my work as a vet, as many farmers need hope and encouragement in a day full of challenges and problems.

Within academia the role of mentors is key. Professors direct young, hardworking academics to success in research through leadership, direction and decisiveness. In the competitive world of academia the young academic gains confidence through learning from the wisdom of the experienced Professor. The relationship of the junior academic is more subordinate, the Professor is often more directive than nurturing, but the sharing of experience and learning is a fundamental part of the successful mentoring relationship. A mentor, then, is someone who has already “walked the walk” themselves, and is willing to help others do the same.

A facilitator is “a person who helps somebody do something more easily by discussing problems…... rather than telling them what to do” (Oxford English Dictionary). I’ve excluded a small phrase on advice which I will come back to. The use of facilitation within the Healthy Feet Project was revolutionary for our research team at Bristol. Farmers were empowered and inspired to find their practical solutions through some very simple facilitation techniques delivered by some enthusiastic technicians and researchers who were not expert in the field of lameness at the start. We observed greater change and improvement in that trial than reported in any other trial before. The key to facilitation is to use open questioning techniques and actively listening. As Stephen Rollnick said to me recently “ask the open question and get out of the way [using reflective statements]!”.

In January I was fortunate to attended a 2-day workshop on Motivational Interviewing (MI) run by Stephen Rollnick. Miller and Rollnick have written a number of books on the method they developed over years of helping people with drug and alcohol dependency. People came from all over the world to be at the workshop, from many different fields of work. MI describes the method perfectly: the use of interviewing technique to motivate patients and clients. The approach was developed to support people with some of the most difficult barriers in life and therefore it is argued it can be constructively applied to anyone with a problem to overcome. Someone pointed out I should be using Moo-tivational interviewing but cows aren’t great conversationalists.

What is Motivational Interviewing?

MI is founded on principles of deep respect for the client and their choices and autonomy, values which are fundamental to my own work. The core skills are based on facilitation (Open questions, Affirmations, Reflective statements and Summaries, often abbreviated to OARS. Table 1 shows some examples) and MI goes through some recognisable stages starting with making the best possible relationship, finding a constructive subject to discuss, stimulating discussion about change and formulating a plan (Engage, Focus, Evoke and Plan).

Table 1 OARS – Open questions, Affirmations, Reflective statements and Summaries are the core facilitation skills within MI. These skills are used in the interview which is built on positive engagement (“How are you today? Thank you for organising today”), Focus (“What would you like to cover first?”), Evoke (“Which solutions have interested you most and why?”) and Plan (“How are you best to proceed? What are your next steps? – let’s jot them down”).

What is fascinating is MI is now being applied to professional sports coaching (for example, applying affirmation rather than praise) and situations previously involving cognitive behavioural therapy. Dr Alison Bard (University of Bristol) has examined the application with a series of papers and articles on the successful implementation in veterinary medicine. My conclusions are that MI provides a proven structure to our facilitated discussions – or interviews. It does not preclude advice giving, although the approach to advice is to respectfully offer the opportunity of advice before launching into giving it, unless you are being specifically asked for it (“Would it be OK if I offered some advice on this part of your problem?” – closed question).

So, going back to the initial questions: coaching, mentoring, facilitating and motivational interviewing – what is the difference and what does it matter (two open questions)? Clearly there is huge overlap between all the advisory roles, and finding the right conversation style for the context depends on you and your client and their goals. I enjoy coaching as I view my clients as talented people who can be inspired to higher levels of performance with encouragement and direction. What you call it probably doesn’t matter but do use open questions and get out of the way of their answers which they will make work for them.

Derek Armstrong, AHDB's Lead Veterinary Science Expert, said: "Motivational Interviewing and facilitated farmer learning groups have great potential for use in improving lameness management on dairy farms. Like all skills they need to be developed  and good training is as essential as for any other skill. You would not expect a novice to do a good caesarean after a one morning  introductory course on to the basics of surgery. Facilitation and Motivational Interviewing are skills which will be developed through training and practice. As the (out of context) Samuel Beckett quote goes  “Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.”

"Motivational Interviewing has been used with some success to help people with addictions which almost by definition involve support and engagement over a long period of time. Lameness may not be an addiction but shares some of the features of apparent intractability. On its own MI is not a solution and not a sticking plaster that should be expected to deliver results from a single visit or interaction on farm – but an ongoing relationship underpinned by MI over time may well deliver better mobility. I expect a “try, try, try again” approach is needed. - Try, and fail, and don't give up, and try something else."

For more information on Motivational Interviewing workshops then visit https://www.stephenrollnick.com. If there is enough interest we could arrange a workshop bespoke to Mobility Mentors, vets, consultants and trimmers so let us know what you think.