24 January 2020
Some hypnotherapy clients will be highly motivated to engage in their own healthy changes, whilst others are far less engaged. These clients may expect therapy to be done ‘to’ them, and believe that it is the role of the hypnotherapist to generate that change and ‘make’ it stick. However, we know that for lasting change, the client will need to take responsibility for themselves both within and beyond the hypnotherapy session. Motivational interviewing approaches can help the therapist to have gentle yet productive behavioural change conversations with their clients.
Modern hypnotherapy is often considered a collaborative therapy and, as a result, fits very well with the motivational interviewing concept of a ‘co-operative partnership’. Unlike a problem-centred approach, motivational interviewing can work effectively in a solution-focused way, with an individual’s personal values, goals aspirations and dreams to boost their motivation for change, whilst considering the client’s independence. This being particularly important when desiring the client to engage with self-care and homework tasks, beyond the session. Hypnotherapists who like the optimistic and humanistic approach of Rogerian therapy (Carl Rogers) will find motivational interviewing fits particularly well with their therapy approaches.
Motivational interviewing helps a client move forward from uncertainty towards connecting to the motivation to make positive decisions and to meet their goals. As motivational interviewing engages the client’s own motivation for change as well as integrating therapeutic gains, this can be particularly helpful when working with weight management, smoking cessation, addictions, anxiety and even sport performance. Indeed, motivational interviewing can be helpful in any situation where a client’s lack of motivation is a significant hurdle in their ability to change.
Some therapists take a more combative or confrontational approach, perhaps telling the client of the consequences of not changing, such as saying “If you don’t stop smoking you will die sooner”, with a view that the pressure of the negative consequences would motivate a change (an ‘away from pain’ approach). In contrast, motivational interviewing has a more ‘towards pleasure’ application, helping the client consider their own feelings (including any ambivalence to change) and allowing them to move forward from these towards their own motivations for change. Thus, rather than the therapist taking an authoritarian, directive approach, they instead support the client. By helping the client develop an internal desire for change they gain a more sustainable motivation for change and maintaining that change.
Within the motivational interviewing process, change talk will include open-ended questions, affirmative statements and reflections. The open-ended questioning approach engages the client and evokes greater consideration and more focus on what is desired by the client than the simpler closed ‘yes’ and ‘no’ type questions. This is supported by reflective listening and affirmative, positive statements, which can be employed by the therapist to develop the client’s sense of autonomy and belief in their ability to change. As such, the client can discover more reasons for change than they might have initially be aware of. A planning stage can then strengthen the client’s commitment to change and help them to achieve their ‘SMART’ goals.
There are four general principles of motivational interviewing which have a curiously oppositional acronym: RULE
Resist any urge to change the individual through direct influence
Understand the client’s reasons for change
Listen for the client’s own solutions
Empower the client to believe in their ability to change
It can be tempting for a therapist to ‘rescue’ the client, remove their distress and ‘fix’ the client’s problems, whether directly or indirectly telling or guiding them towards what the therapist considers to be the solution. Curiously, such fixing, particularly with ‘strong’ persuasion, can have a paradoxical effect in therapy where the client then resists the therapist’s persuasion or direction. This can reinforce any resistant aspects of a client’s view of the issue. For example, with a client who is looking to reduce their alcohol intake. If they are treated as ‘having a problem’ and told perhaps, “you should cut down or quit drinking”, the client may respond defensively, such as with, “I am fine, it isn’t that bad”. Another example might be the weight management client who has sore knees. When it is suggested that they might engage with some light exercise to help with their weight loss, they might respond with concern that the exercise would make their knees worse.
Within a consultation it helps for the therapist to suspend their own perceptions of what might motivate someone to change, and focus on understanding their client’s own motivations. This could be as simple as asking them what they would want to make a change and how they might do it, as opposed to telling them what or how to change. It can be surprising quite how much more information can be gathered by truly listening to the client. Indeed, good listening during a consultation is a skill! Good listening will also help the therapist avoid overloading their clients with too much information. Just because you know all the facts about a condition/solution, it isn’t always appropriate to tell all of them to the client.
Throughout this process, the therapist may employ the differing styles of ‘following’, ‘directing’ and ‘guiding’. A following style can be useful during the initial phase of the client telling their story, before moving into more of a directing style to focus the client on the options for change and then a more guiding approach to explore how the client might continue their change process beyond the therapy session. Such a transition can help avoid being overly client-focused, which can have its own challenges, particularly where a therapist lets the client lead the session and takes a passive role, following their story and potentially getting lost in the process.
In addition, within motivational interviewing there are 5 key skills to keep in mind: Expressing empathy, avoiding arguments and judgements, developing discrepancy, moving beyond resistance, whilst supporting self-efficacy.
Encouraging disclosure of the client’s issues and barriers to change by using empathy and avoiding judgement is a great place to start. For example, by saying, “I can understand why you might light up a cigarette when you are feeling stressed”. You can then move from a position of empathy to one where you are helping the client observe the difference between where they are presently headed and where they would like to be to achieve their goals. For example, helping a client discover the discrepancy between their goal, which is to be healthy, whilst indicating that they are smoking 40 cigarettes a day. The therapist will use a gentle questioning approach to help the client move beyond any resistance to change. The questioning approach helps lead the client to a natural conclusion. Where there is resistance, rather than being overly directive or manipulating the client, the therapist will develop the client’s point of view and offer alternative ways of thinking for the client to consider. This helps develop a client’s belief in their choice for and ability to change, so supporting self-efficacy.
When considering the commonly held principle that ‘the suggestions we give ourselves are the most powerful’, ultimately, by helping a client a client to discover and engage with their own solutions, a therapist will help the client to connect with ways of change that are going to be the most accurate and meaningful for that particular client. This then leads to stronger and more effectively targeted goals, leading to more focused treatment plans and greater therapeutic effectiveness. Motivational interviewing can help the hypnotherapist make any hypnotherapy session truly bespoke to their client.
We hope that this blog about motivational interviewing in hypnotherapy has been helpful. If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks