What is Motivational Interviewing?
The most convincing argument for change is the one you make to yourself.
Most of us became animal health professionals because we wanted to use our knowledge and skills to make a meaningful difference for animals. It doesn’t take many years in practice to realise that the animal part is often the easy part. The bigger challenge is working with the people who care for them, especially when we want them to change the way they’re currently providing care.
The Fixer Problem
Through our education, we are trained to be problem solvers and information providers. We gather evidence from the history and physical exam to formulate hypotheses. We tell the owner what we think is wrong with their animal and why it’s important for them to fix it. We then use our clinical knowledge and skills to recommend the management plan we think will lead to the best outcomes in the circumstances. This pattern of providing direct advice often carries over into our personal lives as well.
We’re just trying to be helpful in the best way we know how and yet it often seems to backfire. The morbidly obese labrador retriever we put on a diet last month comes back 3kg heavier than before. The friend we coached through using a time management app last week showed up 10 minutes late for our coffee date (again!). We get frustrated and burned out because it feels like we’re wasting all that effort on people who just don’t care enough to change.
The problem we’re actually running into is something called psychological reactance. This is the automatic urge to push back when we feel our freedom or autonomy is being threatened. When someone tells us what to do, particularly in a pushy or directive way, we often resist or do the opposite just to reassert control. The stronger our sense of autonomy, the stronger the reaction. It’s why a teenager who was already planning to do the dishes suddenly refuses the moment a parent asks them to. And it’s why telling clients what they need to do often produces exactly the opposite of the intended result.
“Veterinary medicine is the branch of medicine focused on working with people to facilitate the prevention, management, diagnosis, and treatment of disease, disorder, and injury in non-human animals.”
Where MI came from
Motivational Interviewing (MI) was developed by William Miller and Stephen Rollnick, initially in the context of addiction counselling in the early 1980s. They noticed that certain ways of talking with clients about change seemed to work better than others and used that observation to develop a structured approach to having conversations in clinical settings. The core insight was simple but powerful. People are more likely to change when you help them find their own reasons to, not when you tell them what to do.
What MI is
MI is a way of mindfully using empathic listening skills including open-ended questions, affirmations, reflections, and summaries (OARS) to engage with people who are on the fence about making a change and help them explore what they want to do, why they want to do it, and how they are going to do it. It is still okay to provide the client with information, but it’s done in a way that respects their knowledge and autonomy by first asking what they already know about their options, asking permission to share additional ideas, and then checking back in once you have given the information to see what additional thoughts or questions they might have.
The final destination of the conversation might end up being the same whether you use MI or direct advice-giving, but there is big difference in how the journey feels and how likely the client is to actually follow through. MI is what shared decision-making actually looks like in practice.
What MI isn’t
Many people mistakenly think that MI is a form of manipulation, which is why it is always practiced within the spirit of MI, captured in the four principles of PACE: Partnership, Acceptance, Compassion, and Empowerment.
- Partnership means working with the client rather than directing them, treating the conversation as a collaboration between two people with different but complementary knowledge.
- Acceptance means approaching the client without judgment, taking genuine interest in their prior experiences and understanding their unique perspective.
- Compassion means keeping the client's best interests at the centre of the conversation rather than your own preferred outcome.
- Empowerment recognises that motivation for change cannot be imposed from outside but must come from within the client, drawn from their own values, strengths, and circumstances.
If you are using MI skills to deliberately steer someone towards your preferred outcome, whether because you believe it is best for the animal or for less ethical reasons, it is no longer MI. It is manipulation. The spirit of MI is what keeps the approach honest.
Reflections in Action
Complete the following 2 min exercise to get a feel for how reflections work in practice to give a conversation directionality without being directive or maniuplative.
Start
Read the following statement:
“I’ve been wanting to get to the gym more regularly because it gives me so much more energy, but I’ve just been so tired and busy after work lately that I haven’t managed to get there.”
Now read these two responses and notice what direction each one would make you want to keep talking.
Reflection 1: “So you’ve really been wanting to make it to the gym more often, but lately work has been leaving you too exhausted to follow through.”
Reflection 2: “So work has been really draining lately and, even so, you’re still thinking about getting to the gym because of how good it makes you feel.”
Notice the difference? Both reflections use exactly the same words the person said, just in a different order. Yet that simple shift changes the entire direction of the conversation. End with the barrier and you invite the person to keep talking about why change is hard. End with the benefits and you invite them to keep talking about why it matters to them.
That’s the power of a double-sided reflection. No new information, no persuasion, no advice. Just the person’s own words, reflected back in an order that opens the door to change rather than closing it.
When do you actually need MI?
While the basic OARS empathic listening skills and the ask-offer-ask framework for providing information are useful in almost every clinical consultation, not every conversation with a client requires the full MI approach. For example, a client who brings in a horse with a laceration and is completely on board with the recommended treatment does not need a full behaviour change conversation.
The full MI approach becomes most valuable where the client has significant ambivalence about a decision, which often shows up as someone weighing the pros and cons of different options. These are usually complex decisions like changing a milking routine to reduce mastitis cases, deciding what level of treatment to pursue for a dog recently diagnosed with cancer, or working out when it’s the right time to euthanise an animal. These are the conversations where MI makes the most difference.
Animal health professionals also have a professional obligation to advocate for animals that cannot speak for themselves. There will be situations where animal welfare concerns mean you need to push towards a particular outcome even when it conflicts with what the client wants. That falls outside the boundaries of MI, but the conversation can still be conducted using MI skills in a way that is respectful and transparent with the client about why.
How long does it take to learn MI?
It’s a bit like asking how long it would take you to learn how to play Beethoven’s Moonlight Sonata on the piano. A lot depends on your current skill level, natural aptitude for music, and how much time you spend practicing. Some people will get there quickly and some will need more coaching and deliberate practice, but everyone can learn. One thing we do know is that becoming proficient in MI is not something that happens overnight for anyone.
Our communication patterns are often so deeply ingrained that it takes a lot of conscious effort and practice to do things differently. The Motivational Interviewing Network of Trainers (MINT) recommends a minimum of 16 hours just to begin learning MI, but it is clear from research that this is nowhere near enough to reach full competency. Brief one-off training can produce short-term changes in confidence, but rarely changes what actually happens in practice unless there is ongoing feedback, whether from someone directly observing your consultations or from recordings, so you can notice when you slip back into old patterns. A large part of the process is also developing new “sound bites” for responding to common things that clients say in different contexts, so they become automatic rather than something you have to think hard about in the moment.
Is it worth the effort?
That’s probably a question only you can answer, but here are a few things worth sitting with. Think about the consultations that leave you feeling drained, the ones where you know what needs to change, you’ve explained it clearly, and nothing moves. How often does that happen in a week? Now think about what it would feel like if those conversations went differently. Not perfectly, but differently. If clients left with a plan they had actually made themselves rather than one you had handed them.
The research across dozens of studies in human health settings consistently shows that MI improves outcomes for clients and reduces burnout for practitioners. The veterinary evidence base is smaller but the findings point in the same direction. And the conversational skills you develop for your professional practice have a way of trickling into personal life too, changing how you show up in conversations with friends and family who are struggling to make changes of their own.
Of all the skills you can develop through professional development, this might just be the one that makes the biggest difference to your ability to do your best for the animals (and people) in your care.
