How Motivational Interviewing Can Empower Your Life

When we go to our, say for example, we go to our doctor or to our, even to our naturopath or whatever, and we already have the belief around, you know, this is, this person is meant to be the best, you know, he or she, um, has been recommended as the, the specialist, um, but I'm finding that they're just not listening to me, I'm just not getting my message across, um, And they also feel that, you know, because this person is the best, I should just be sticking it out. What is that all about when it comes to this whole idea of motivational interviewing and, and change? Hello and welcome to Beyond Diagnosis, a podcast to raise your awareness, decisions, and voice for alternative practices so you can take back control of your health. I'm Rita De Michele, your host, a mindset and empowerment coach, and the founder of the Onus platform. Join me each week so you can create the health of your dreams. Are you struggling to change your habits even when it's for your health? Whether you're managing a chronic illness or aiming to prevent future issues, Finding the motivation can feel paralyzing. In this episode, Jen Ashold, a certified lifestyle medicine coach, will help us understand the benefits of motivational interviewing and provide strategies to help you embrace a healthier, more empowered life. Hi Jen, welcome to the show again.

Thank you, I very much appreciate you asking me to come back.

Oh, it's good. I love you, your information. You're always full of great wisdom on helping people move forward and the language to use, their thinking. So going down that track, let's start with what is motivational interviewing and why does it matter to someone, especially the client?

Yeah, it actually is a clinician tool But in my opinion, I think that all humans should be required to take a basic course on motivational interviewing, especially parents and teachers. But I digress there a little bit. Motivational interviewing has been around, oh boy, I think since 1980, give or take. And it's kind of fun because it actually started in the barbershop, in a barbershop in Norway with no intent to go anywhere. And now it's exploded. It's worldwide. We have all sorts of amazing research on it. And so what it is, is it is a client-centered— and we can shift that out to you-centered— style of communication. And what it's doing is we're really paying attention to the language of change. The words we use, we are feeding ourselves and those around us information on, are we more likely to change, or are we more likely to stay where we are? And so we're really exploring either our client or, in this case, our own reasons and motivations to change, as opposed to just, you know, you must do this, you must do that. And it's really boosting our own personal commitment and motivation to ourselves when we are doing the work of figuring out the what and the why of the change we want to make. So that's a brief overview of what MI— we affectionately call it MI—

is. It is definitely a different approach, isn't it, Jen? Like, most people are used to someone telling them what to do or how to do it, as opposed to finding— and I think if the word is correct here— that intrinsic motivation. So the motivation that comes from within ourselves to do it. And that is so— people find that so much harder than some— an external voice. Sort of like pushing you along to change. So is it just communication, or, or does it actually work?

I love that question. Um, it is communication, and I think there is a lot of skepticism around it because it is a communication style. But the reality is there are over 200 Studies on motivational interviewing, and what it shows us in a one-sentence summary is that it is more beneficial 80% of the time than traditional advice giving. Now, for any of your listeners who are parents, or any of us that have been to a doctor or a medical provider— that's all of us— how do you feel? Like, think for 5 or 10 seconds. How do you feel? When your doctor says, you must fill in the blank, you have to lower your blood pressure, you have to lose 30 pounds, or as a child, you know, you have to do your homework before 7:00 PM.

Mm-hmm.

We don't like to be told what to do, but as humans, we do like to tell people what to do. So we have to find, that's a pretty big disconnect, right? We are happy to give advice, But we certainly don't want to receive it. So how do we make it more harmonious? And actually, it enhances the motivation of everyone involved. When I have a conversation with my kids, because I use this with my kids a lot, it is a much more pleasant conversation when I integrate motivational interviewing techniques, when we get to— they get to some resolution, than if I am just mandating whatever the particular topic is.

Wow, what an eye-opener that is. That is so true. How many people just— I mean, you know it in your family dynamic. And like, this is a podcast about health, and you did bring up about, you know, a clinician, a doctor, it doesn't matter who, whether it's an alternative one or, you know, traditional. People come away from those sessions, their appointments, going, oh, they've told me to do this. Or, I now have to do that, or I have to take these supplements, I hate it, or I don't want to be on pharmaceuticals. And, you know, there's all this resistance. But like you're saying, if we frame it or say it differently, that encourages and brings up the motivation within someone, it's a completely different scenario.

Completely. Absolutely. We are our own best expert. So intuitively, inherently, we already know what our path is, but we got to get out of our own way. We are really good at getting in our own way. And one of our previous episodes, we talked about the mental fitness where when we have these negative emotions, whatever they are— guilt, shame, anger, control— that limits us from tapping into our true best potential. Where we already have the answers. And it sounds a little la-la. It's really not if we really start to get curious. And when you see it in action, whether you're on the clinician side or the client side, it's really fun and fascinating to watch it unfold.

Yeah, it's definitely not out there. It just sounds like common sense. It sounds really logical, but it's hard to do.

Thank you for saying it sounds logical and like common sense. We— Brené Brown, one of my favorite people in the whole wide world, she says as humans we are driven for connection.

Yes.

And so if we're driven for connection, why aren't we coming towards each other with curiosity and listening rather than these, you know, mandates of you must, you have to, I know everything? So thank you for saying that because I agree.

Yeah, absolutely, absolutely.

And you have here—

you, you said there's a phrase called gold into the garbage. That is— that now, that sparked my curiosity. What does that mean?

Yeah, I think as soon as I give you an example, you might be able to define it yourself. So I'll do that. Um, let's just say that you have a new pair of glasses And you go to meet your friend for coffee and your friend says, oh my gosh, Rita, your glasses are so adorable. I really like them. And you say, oh, so you didn't like my other glasses? They made me look ugly? That is an example of taking gold and turning it into garbage. Do you have a guess of what it is?

Is that neg— is it the negative self-talk, though, the negative, um, headspace that we have that will—

We're negating. Like, it's— for a lot of people, it's really hard to receive compliments and accolades. And so we take that, and it's uncomfortable for whatever reason— that's a very different conversation— but then we just push it away. And so it's very hard for people, but to learn that skill We're actually creating a shift in our neuroplasticity, in our neuro wiring, so that we can— when we can receive compliments, then we can get more creative, and then we can actually take better charge of our own health. So it's very different. Hey, Rita, those glasses are so cute on you. Oh, thank you. I love my optometrist. He's so good at finding the right shape and color for me.

Yes.

How different does that seem?

It's a real change, a real reframe, isn't it? Yes.

To see—

to— I mean, like you said, it's a huge conversation behind that, you know, around the ability to accept my self-worth, you know, all the rest of it. That's another conversation. But it's so true. You hear it all the time. And I even hear it in my family, even with myself in the past. You know, someone will give you a compliment and you go, oh no, it's not. It's not me. I can't be like that. Or, you know, someone says, oh, you're very attractive. Oh no, no, no, no, I've got, you know, a pimple here. Or— it's amazing how quickly we're conditioned to diminish ourselves, right?

And what if we look at it from the perspective of the person who gave the compliment? Oh, right. So if I compliment your glasses And you reject that, that doesn't make me feel very good. That doesn't make me want to continue to support and compliment you because you're going to reject it. So now this simple little interaction about your glasses has potentially impacted our relationship and our ability to connect.

Yeah, that's, that's another way of looking at it that you don't think. That's a really— I love that point. It's always, you know, looking, how is it affecting somebody else? How is my comment affecting that person? You know, it's— yeah, it's really taking a bigger awareness about what we're doing and what we're saying and what we're believing. And we can also apply this to, you know—

Yeah, so that is a mix of different things. In our society in the US, I don't know about in Australia. However, we have kind of put— we have put doctors on a pedestal. And so we are often entering the conversation and there's a one-up, one-down already. And so we tend to believe that they know best when really what we already mentioned is that we already And we already are our own best expert. And so I am really curious with my clients when they say this, and I'm like, hey, how'd that appointment go? And they're like, well, you know, he didn't really listen to me, and he told me I had to do this, and I do that. And I'm like, so what, what keeps you going back to that physician? You know? And then we have, we have to get more curious because we're hiring them. We're paying them.

Yes.

And, you know, if we're not getting what we need, then that's not very helpful. And when you have these unpleasant negative impacts in the appointment, what's your motivation going to be to follow through? And how is that going to impact your health? Is it going to impact it on an emotional level? It could even impact it on a physical level or a physiological level. So I really work with my clients to choose and work with clinicians who listen to them and validate them. And some of your listeners may not know, my specialty is chronic pain. And when my clients have doctors or any clinician that tells them that their pain isn't real or that their pain is all in their head, I say, I would encourage you to politely stand up. And leave and never go back to that clinician because that is not a good relationship. Because we know that the relationship with your clinician has a huge bearing on how well you do. And that is how motivational interviewing can be so important when it is a conversation as opposed to directives.

Absolutely. And can you give an example there before I move on? For our listeners and viewers to, to really understand and embed this knowledge, if they are in, in an appointment and they feel they're not being listened to, what are some of the, the questions that they could actually ask their clinician, or some of the things that they could say to their clinician to let them know, in, you know, uh, that they're not being heard?

So the success for this is going to actually be in the weeks before that appointment. Usually when they're going to an appointment, unless it's a brand new clinician, let's assume this is a clinician you've seen before, you already know that this is how they treat you. So you already have these negative experiences. And so it's really hard in that moment, right? You're already there because whatever the medical thing is, whatever questions you have, and then on top of it, you you're not going to get treated with respect or have your needs and concerns actually listened to. So that's going to be hard to do in the moment. However, this is what I do with my clients too. Beforehand, what are the questions that are most important for you to get addressed? Keeping in mind they have a schedule, right? So you don't want to go in there and spend 7 or 8 minutes telling your whole story. But hey, these are my key symptoms. These are my top questions, and have them ready. And that's going to help you be more direct and concise, and the doc will likely appreciate that as well. So if the doc then shifts into, you know, not listening or giving directives and mandates, you can just— it's hard to do, but politely, hey, can we get back to— these are my most important questions. I know you have a tight schedule, and I hear you that you want me to take a cholesterol medication, Can we talk about that another time? Because today, what's most important to me is I want to figure out how to get more exercise. And so those are a couple of ways that we can kind of nudge ourselves into creating that conversation. Because if they're not going to initiate motivational interviewing, why can't we? Because we're the most important in that room at that time.

Absolutely. 100% agree. And also, I think— For people going in with that list, having that piece of paper in their hand and being able to read off it instead of thinking and having everything in your mind, which at the time you feel flustered, you feel, you know, um, that you're not empowered. Having a list, I feel, would really empower someone just to be able to check it off, speak confidently, because it is— can be intimidating for people.

Yeah.

You know, it's the What do I know compared to the doctor scenario?

Right.

So what I also am really interested in is, is it people's resistance to change or changing their practitioner, doctor, whoever? Do they confuse that with loyalty?

Do they confuse resistance to change with loyalty? I don't know if they confuse it. I think that those who are strongly loyal, they are unable to see the top priorities for themselves. I have a child who is an exceptionally loyal human being. And again, back to mental fitness, our greatest areas of struggle, whether it's we control things or we're hypervigilant, they actually represent our greatest strengths that have gone a little overboard. So loyalty can go overboard. And the one example with my son is he was in a car when he was a teenager with a friend who was on a crazy squirrely road driving 90 miles an hour. And I'm like, why didn't you tell him to stop? Thank God he got pulled over by the police. I'm like, why didn't you tell him to stop? He's like, I'm not gonna rat him out. And I was like, Your life was in danger. You were on a curvy road going 90 miles an hour. Your life was in danger. And he's like, I don't care. And I was like, wow. And that was my first thought on how loyalty can actually become a weakness.

Yes.

So I, I, I think they might be 2 different things, except the resistance to change is just shadowed over this strong, strong loyalty.

Yeah, that's a really good point. And how many people do do that? How many people don't even realize that they are hurting themselves for this loyalty? You know, like, I don't want to change my practitioner. I don't— you know, the fear of the unknown. So many times in, you know, husband, my mother before, etc., I don't want to change because I don't know the other one. How do I know that I have my needs met? So it's better— it's almost like better the devil you know than the devil you don't, if you want to use that phrase.

Which is a sad place. I do know that phrase. Yeah, but that's also the whole premise of your show, is let's put— let's look beyond whatever— is it a diagnosis, is it a symptom, whatever it is. And so many people take medications that they don't actually need. They have tests and scans that they don't need because the doctor said so. And I, I find it fascinating. My specialty is pain, and I have clients who will see the orthopedic doctor and they'll do exactly what the ortho says regarding their pain. And I'm like, okay, what's motivating you to do that? Well, you know, I just want to get it checked out. And I'm like, Okay, even though the research shows us that the more tests and scans and appointments and things that we do can actually raise the sensitivity and we have more pain, like, yeah, the doctor said so. So we really give them a lot of our power, and we need to take it back.

Absolutely, absolutely. And I would actually add to that is people's motivation Also to— like, they take a series of pharmaceuticals or even a series of supplements, and where's the motivation to actually ask, do I need to continue this? Because once you're on a pharmaceutical, they'll never take you off. They just keep adding. So where— We must, you know, find that motivation For ourselves to go, do I need to stay on this? Like, that's, I guess, a question they can put on their list. Do I require to be on all this?

Can I give your listeners a website that I absolutely love?

Absolutely.

Okay, it's called thennt.com. T-H-E-N-N-T. We'll put it in the show notes, or you'll put it in the show notes. And what NNT stands for is number needed to treat. So a super simple thing is that the closer to 0, the better a treatment is. So let's just say, actually, medications for high cholesterol. So the NNT is 300. So that means that 300 people have to take that medication for 1 person to get a benefit. Now, I know the NNT of my work with chronic pain. So the NNT for people to have a reduction in pain is 3. 1 in 3 people that we teach about pain has less pain. So your listeners and your viewers can go to the nnt.com and look up, okay, my doc wants me to be on a statin. Here's what the research shows. And they give this great, like, traffic light, right? This is a black, no way, no how. Then they have red, yellow, and green. And then you can have a conversation with your doc. And now you are empowered with knowledge in addition to also trusting their knowledge. And it's finding that balance point of what's going to be best for you. Wow.

Well, that's definitely a website that's needed to check all those pharmaceuticals.

I love that website. They have cool things on there like the Mediterranean diet, which is cool. It's a green light, by the way.

Fantastic.

Um, red or black depending on the indicator of why you're taking them. But yeah, it's, it's a pretty interesting website. Yeah.

It is. And you know, where else, Jen, can we use motivational interviewing other than healthcare? Just in our life? Because if we use it in our life generally, we're going to be so much more confident to use it Once we're in a doctor's appointment. So where else can we use it?

Well, I don't want to sound like a dork, but I'm going to. We can use motivational interviewing anywhere. It's just a connected conversation. So if you and I meet at a coffee shop and you tell me that you're struggling with— I don't know, your sister is whatever— and I sit there and say, oh, well, Rita, you should do this and you should read this book and you should look there versus, Oh, that's really hard because you talk so highly of your sister in that relationship.

Hmm.

What else do you think is going on for your sister that might be, you know, contributing to this? Or, or what will help you get through this, Rita, because you can't actually change that situation that your sister is going through? So I think we can really use it anywhere. And I, I think I said really at the beginning, I think it's, you know, we should all have a little, you know, life learning course about motivational interviewing so that we can interact as humans a little better. It'd be nice a lot better, but—

It sounds like— excuse me— it sounds like that way of interviewing is more empathetic. It's more—

empathy is one of our driving pieces. Absolutely. Empathy is one of our drives. You know why else you can use this? It's fascinating when you have a customer service call and they're just stonewalling you because that's what they're trained to do. I'm like, hey, help me out here. You know, who, who is the person that can help me? I understand that you can't, you know, help me fix this problem with my cable, but who is that person? Or— Wow, sounds like you've had a really long day. You know, what, what's, what's a step that we can do to move forward? Because it seems like we're just cycling in this conversation. So we can use it with customer service reps too.

It's it. And I think that's where it's really needed. Um, so it sounds like it's more don't go in defensive. But see how you can be collaborative with this person.

Okay, you would think that I was feeding you these words. I am not. Empathy is a key component of motivational interviewing. Collaboration is a key component of motivational interviewing. And client autonomy, we've been talking about that all along, like putting the client or putting your listener in the driver's seat. And I'm also going to say curiosity. I heard a statement once, let's start with curiosity over criticism. And so many times when you're— if you're talking to me, I'm already formulating in my head what my response is going to be. I'm no longer listening. I am criticizing what you've told me and giving— planning my response versus just listening to you. Which is also why, Rita, this conversation has really gone in multiple directions already. And I think that's fun, and I hope that you appreciate it.

No, absolutely, because I really want the listener to understand in this— in the— yes, it is a health podcast in the context of health, but how you can actually apply this. The more you apply it in different scenarios like we've been talking about, um, the more you will become confident in embedding this way of, um, speaking with people. So the interviewing is like speaking with people.

Yeah.

So, you know, so one of, one of the things, uh, it would have been good for someone to actually, especially in a healthcare scenario, clarify their goals. Like, why are you there? Like, you have your questions, but why are you there? What do you want to actually achieve from this appointment? And making that, and then having your list of questions, would that be something they could do?

That is a fabulous idea. I think there's a little piece of reality that we have to entertain here, is that unfortunately the medical system as it stands, docs have a really limited amount of time. Now, the opposite side to that coin is that they have done research finding that when physicians use motivational interviewing, they actually get to the point of motivation and willingness to change more quickly than with the traditional advice giving. So there's this— again, there's this place of you want to have your goals and you want them discussed with your provider. And when is that— when can you most strategically do that? When it's a new diagnosis, maybe not then because you're processing it. But then next session, OK, so I have this diagnosis of cancer. My goal is to beat it without chemo. What is our best way to get down that path? And so I think we have to find this place of respecting that the system as it is limits their time. And perhaps is there another professional or clinician who could help them really hone in on their goals and their options? And then how efficient will their sessions be when they do go to the doc? Hey doc, bam, bam, bam, I'm ready, let's go.

Exactly, exactly. Or if I can put this in, if they are then looking, which this podcast is mainly about, know, functional alternative integrative practitioners. If you are not being listened to, you have your list of questions, and like you say, walk out the room. Am I being— then maybe question to yourself, am I being ambivalent around finding someone else who could possibly help me? Like, am I being ambivalent to go to an alternative Practitioner because I have a preconceived idea of what they're like.

How are you using the word ambivalence right now? I want to make sure I'm understanding your question.

That they, um, how do I want to use ambivalent? They're not, they're not, um, caring enough, or they think, oh no, I'm not going to do that. No, no, you know, it's not, um, important enough for me to find someone else.

So the question is, if they're not being treated the way they want to be by their provider, they're not mo— yet they're not motivated enough to find a new provider.

Exactly, exactly.

And the question is, how do we get them from here to here?

Exactly.

That would be a lot of self-work, or you know exposure to podcasts and things where they're getting motivated to learn these things. Or you know possibly if if they know that right, if you feel in your core this this clinic this doctor is not treating me well, or this chiropractor or whatever it is, but it's hard for you to make that change. That might require a little bit of work. Is it? Coaching? Is it work you can do on your own? Is it you know because we can read books and learn, but it's not going to just be a flip of the switch, and it's diving deeper. What is it that you don't like about that provider? What does it make you feel, and how is it in line or not in line with your values? And what's the type of provider that is in line with your values? And so getting curious about some of those things can help you hopefully shift as well. And something we haven't talked about yet is another key area of motivational interviewing is something called change talk. So the words we use— usually I'm listening for them from my client, but we can listen to our own words to ourselves— indicate our level of readiness for change or motivation. So let's take a topic of, I want to find a new doctor. So if I say to you, Rita, I might find a new doctor, or I could say, Rita, I expect to find a new doctor, or I guarantee I'm going to find a new doctor. Do you see? Can you and your listeners hear how each of those 3 words, there was more and more definitive change talk going on? Now, we do the might, the maybe, the not sure. We call this sustain talk. And these are words that are indicating that people, they're not quite ready to change, or we have to get more curious and help them find within themselves the reasons to change. And then we start to see a shift in their language into change talk.

I love that. I love that. That is so good. So to be able— for someone to be able to integrate, excuse me, what you're saying on their own, they're listening to this and they want to sit at home and start integrating some of this, would you say to start with their head talk? Like, just listen to the language that they're using? Would be—

were you in my head? You were drafting that? Okay, yeah, absolutely. Because, um, we have— I don't know, the research varies— 70,000 to 90,000 thoughts per day, and 90% of them are negative, and 80% we repeat the next day. So if you're in this cycle of, that doctor treats me like junk. He's not good to me. He doesn't listen to me, or she doesn't know what to do. And I'm, I'm never going to lose 50 pounds because I don't care. Well, we are just reinforcing those neural patterns in our brain. So awareness is number one. So when you start into those cycles, you may notice it in your mind. You also might notice it in your body. You know, every time I start to think about my doctor and losing 50 pounds, I don't know, my thigh aches or my stomach hurts or whatever it is. Get a little curious about that. Or when I say no, never, not gonna— my other favorite is yeah, but. Every teenager is very skilled in the yeah, buts. Hey, could you put your jacket away? Yeah, but Mom, I'm just going to put it on in an hour. So anyway, I digress. So, yes, I agree. The awareness and the interruption is A number one. Because if we don't interrupt that pattern and replace it with something more beneficial, we're just going to stay there.

Absolutely.

And that's what the mental fitness work is, is how do we become aware, get out of that negative patterning, and most importantly, make— create new patterns.

That is— you've explained that fantastically. Thank you. And to finish off for today, Jen, can you tell our listeners and watchers what is something that they can do today to start integrating this type of motivational interviewing into their life so they can feel more confident for their next medical appointment?

I'm going to start way before the medical appointment, just like we did before. Is just listen to your conversations with your family, with your friends, with your coworkers, and listen for how often you yourself are tapping into giving advice or somebody is giving you advice. How does it feel when you receive the advice? Did you really want it? Did you really ask for it? And then once you start to become aware of how much this is happening, think, what can I replace this with? If I tend to tell my friend what to do about a situation with her kids, how can I just listen to her and, you know, even reflect back a little bit what she's going through? Ooh, that sounds hard that your kid is getting Cs and Ds in school versus, well, this is what I did and my kid has As and Bs, so this is what you should do. So I think first, what are your current patterns that we're not even aware of because they're so ingrained? And then get curious. What's one tiny little shift you can make with one person and see how it goes? It could even be your coffee barista. It could be anybody.

Absolutely. Thank you, Jen. What incredible information to help people You know, think about the language they're using. Think about the resistance to change. It has been so enlightening. And for everybody who absolutely resonates with this episode, please, Jen's details are all in the show notes. She also has an offer there for you, so do go and check that out. Thank you, Jen. It's been a pleasure.

Thank you. It's always a pleasure, Rita.

I would love to know what was the biggest insight or Aha moment you got from this interview, so you can now speak up, take action, and make informed decisions for your health. And if you like this episode, get instant access to your free ebook, Alternative Wisdom: Taking Back Control of Your Health, at life-onus.com.