Episode 107 | Nov 21, 2024

The Art of Motivational Interviewing, With Cecilia Lanier and Patty Bean

What makes an effective coaching conversation? Dr. Sandi welcomes two experienced health and life coaches, Cecilia Lanier and Patty Bean, to discuss how motivational interviewing (MI) can transform coaching sessions by fostering genuine connection and empowering clients to create lasting change. They explore the essence of MI, its practical benefits, and why it remains the gold standard in the coaching world.

“People have within them their own resources, their genius, their motivation. So, motivational interviewing is a way to have a conversation with people to bring that out and foster growth and lasting change.”

Cecilia Lanier

Cecilia, a National Board-Certified Health and Wellness Coach and an educator with over 25 years of experience, discovered her passion for coaching through personal transformation and her love of supporting fellow teachers. Motivational interviewing became a central tool in her approach, inspiring her to co-author the book Motivational Interviewing in Life and Health Coaching alongside Patty and fellow FMCA graduate Stacey Arnold. Patty, an Internal Family Systems-informed coach and licensed massage therapist, has a rich background as a Master Wayfinder Life Coach and Functional Medicine Certified Health Coach. Her dedication to mindfulness practices like QiGong and meditation informs her work as both a coach and an educator. Together, Cecilia and Patty delve into MI’s foundational principles, highlighting its value across various coaching settings.

In their conversation with Dr. Sandi, Cecilia and Patty detail how MI operates on a belief system that emphasizes compassion, acceptance, partnership, and empowerment. They share insights into how deep listening and reflective techniques can help clients navigate ambivalence and inspire confidence. They also discuss the challenges practitioners face when trying to influence clients and how MI’s client-centered approach resolves these issues, making behavior change both more likely and more meaningful. As they outline strategies from their book, they underscore the importance of consistency in MI practices and the transformative potential of fostering trust and autonomy in every client interaction.

Health coaches will appreciate this deep dive into the spirit and skills of motivational interviewing. As the coaching landscape evolves, particularly with the rise of AI health coaches, the human touch remains irreplaceable. This episode reinforces the critical role of authentic relationships in coaching and offers a framework for integrating MI to elevate client outcomes. Whether preparing for certification exams or seeking to refine coaching techniques, the conversation provides practical applications that can benefit both novice and experienced coaches.

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Dr. Sandi: Motivational interviewing. You may have heard the term. It’s commonly shortened to just MI. It’s a classic technique that has been integral to certain types of counseling, as well as now moving into the world of coaching, whether it’s life coaching, executive coaching, health and wellness coaching. And it is a process that has to do with effective communication, and it can be used by practitioners. It can be used… If you want to just improve your communication skills, it has to do with deep listening, building rapport. And these are concepts that we talk about in today’s podcast because I have two guests who I have the pleasure of knowing very, very well because they are part of our FMCA community. They just wrote a book, and they are Cecilia Lanier and Patty Bean. The third author of the book is Stacey Arnold, and the three of them wrote a book about motivational interviewing that will soon become a classic for health coaches as well as for life coaches. It is called “Motivational Interviewing in Life and Health Coaching.”

So, I would like to share with you a little bit about these two women and their connection to FMCA. So, Cecilia is a national board-certified health and wellness coach, and she’s a life coach trainee with ICF, the International Coaching Federation. She coaches in private practice and serves as a course facilitator in the coach training program of her alma mater, FMCA, Functional Medicine Coaching Academy, the school I founded. Cecilia earned her master’s degree in educational leadership and administration at the University of Alabama in Birmingham, as well as the National Board for Professional Teaching Standards Certification. She has 25 years of experience as an educator and found her deepest passion in coaching fellow teachers during the final years of her teaching career. A personal transformation inspired her to use coaching to support others in their journey toward change and growth. This inspired her to support others, and she is citing motivational interviewing as the primary influence in her work. Cecilia is the lead author of the book we’re going to be discussing, “Motivational Interviewing in Life and Health Coaching.”

Patty Bean is a Nebraska-based, Internal Family Systems-informed coach, and a licensed massage therapist in private practice. She’s certified as a Master Wayfinder Life Coach, a Professional Certified Coach of the International Coaching Federation, a National Board-Certified Health and Wellness Coach, and a Functional Medicine Certified Health Coach. She has worked as a course facilitator at the Functional Medicine Coaching Academy (FMCA). In addition to her coaching work, she also teaches online QiGong, meditation, and yoga classes.

So, without further ado, let’s dig into motivational interviewing with these two dynamic women. So, welcome, Cecilia and Patty.

Cecilia: Thank you.

Patty: Thank you.

Dr. Sandi: I’m excited to get into the topic of motivational interviewing. So, for those who might not be familiar, can you perhaps Cecilia begin by talking about what is motivational interviewing? How is it used?

Cecilia: Sure. The term motivational interviewing comes from the world of counseling, and it was founded as a method by Bill Miller back in the ’80s and Stephen Rollnick, and they developed it. And it’s a method for helping people change. It’s a conversational method that focuses on a few important components of how we think about people that’s inspired a lot by positive psychology and Carl Rogers. And that is that people have within them their own resources, their genius, their motivation. So, motivational interviewing is a way to have a conversation with people to bring that out and foster growth and lasting change.

Dr. Sandi: Beautiful. And it is really, really effective. There have been books before about motivational interviewing guidebooks. So, what inspired you to write this book?

Cecilia: Well, I’ll start first and tell you that one of the inspirations is sitting in this room, and that would be Patty Bean, because I was in her cohort at FMCA, and Patty and the curriculum referred to the coach approach. And she might have mentioned the book one or two times. And as I read the book and did a book study with colleagues there outside of our LTS class, we had a lot of fun researching a lot of different resources that were available, and we looked into the book. And I kept noticing, “Hey, this seems a lot like coaching.” As a matter of fact, if it wasn’t for counselors, it could be written for coaches. And I had a few other people wonder if I was correct or not. And I shared that with Patty, and Patty said, “Yeah, maybe it is.” I said, “I think it really is the foundation for coaching. It’s very parallel.” So, I went about to prove the point that motivational interviewing, its concepts, its skills, its belief system, and its strategies are really quite aligned with our coaching paradigm. Matter of fact, I see it as a foundation.

Dr. Sandi: Absolutely. Well, I agree with you. Just I wanted to point out for those who might not be familiar, LTS are our live training sessions at FMCA, and this is where people learn coaching approach strategies like motivational interviewing. Patty, who specifically would this book be written for?

Patty: I believe this book is written for people who are considering being in a coach training program. Especially Chapter 1, it helps them understand and have a foundational knowledge of the coach approach because it’s different than most medical models in that it’s not the expert approach. And I’m really proud of the definition that we came up with on the coach approach that’s in the book. So, it’s for people who are considering becoming a coach, but it’s also for people who are in a coach training program and want to deepen their understanding of motivational interviewing and how to help our clients more effectively change to have that conversation. It is also for people who have graduated from a coach training program and they’re preparing for one of the exams, whether that’s the ICF exam or the NBHWC exam. So, it can be exam prep to have that deeper understanding of the principles of MI. And finally, for people who have been coaching for a while and they are making some progress with clients and yet they know that there’s probably some skills that they could work on to improve their method of coaching to help the clients create that lasting change. So, that’s who I see it would be written for.

Dr. Sandi: Let me hold up the cover of this book, and it is in life and health coaching. So, I’m assuming that this would be not just for health coaches but for life coaches, executive coaches, anybody who is interested in what the process is like. What struck me when I looked at the book is that you take people into the coaching session. It’s a script. It’s written in script form where you can see what the coach would say, how the client responds, and so forth. And I think that’s very important to actually see what it actually is. You’re taking the mystery out of it. So, how would you say, Cecilia… What particular skill or approach would be most helpful in health coaching, how that relates to motivational interviewing?

Cecilia: Well, health coaching in particular has a little bit of a caveat with regard to the coach approach, because the coach approach first assumes that we are not the expert in the client’s life. However, we have information. We have a body of knowledge. We have skills that can help them. So, as we take an approach that the client is the expert in their own lives, it’s important to also handle information with care, that in a way that we maintain the client’s autonomy, which is an important factor for change, as we know. So, one of the most important skills is… Actually it’s a mind and a heart set. Motivational interviewing calls it the spirit, and we have cleverly rearranged the components of spirit to the acronym CAPE. So, that involves our attitudes of compassion, attitudes and our behavior of compassion, acceptance, partnership, and empowerment. So, that mindset embodies a coach and how we approach people. So, it’s not exactly a skill, but it’s a way of thinking, a way of being with people that’s very respectful. But when we get into the actual skills, the most important skill is listening well, and we call it accurate, which comes from Carl Rogers, actually reflective listening. And the reflective part takes it out of just a purely sit back and listen, kind of, approach from Carl Rogers. It’s not totally that, but reflective listening is designed to reflect what the client is saying, perhaps under the story, perhaps their feelings in a way to elicit them to say more, because we know that the more a person talks about change, the more likely it is that they will change. So, that’s the bedrock, the basic skills.

Dr. Sandi: And they’re so powerful because I talked to a lot of practitioners, medical doctors, and often they’re frustrated because they’ll say, “Well, I tell people they need to exercise. They need to lose weight. They need to eat better, for example. They need to take care of the stress that’s in their life. And I can’t get them to do it.” And they’re coming at it from the expert approach. You can get somebody to do something. And I find that when they learn these skills, people are following through now. They’re actually able to take charge of their health, change their lifestyle. And as you said, that active listening. And so that’s what we do, we train people to listen. And what I find so remarkable, and I’d love for you to comment on this, Patty, and you’ve probably seen this as a course facilitator, that people come into a coaching program, ours in particular, and they think, “Oh, they just want to learn the coaching skills, or they just want to learn about functional medicine.” And they come out and they say, “I was personally transformed. I’m such a better communicator with my friends, with my family.” So, I’d love for you to comment on that.

Patty: Absolutely. It is so true that when we build our own skills that we will use in coaching, we also become better humans, whether that’s at work, in our family, or wherever it may be. So, those coaching skills translate across our life. And that’s what’s so beautiful, as a former course facilitator, is watching that transformation of students into more confident beings. It’s quite a privilege.

Dr. Sandi: Absolutely. So, Cecilia, what would you say would be some of those primary benefits of MI consistent coaching? And I think the key word here is consistent to have this style or this approach and be consistent.

Cecilia: Well, Sandi, you have been highlighting the research behind this. So, I’d say, and there’s a lot more coming and there’s a lot in our book, but the main benefit is that MI consistent coaching is effective. It actually works. And we’re beginning to see the research pile up and pile up. As a matter of fact, in my upcoming cohort, there are two medical doctors who are going to learn the coaching technique in FMCA’s functional medicine approach so that they can use this coaching approach in their practice because they see it is so effective. So, anyway, the first benefit is that it works. I mean, we can give you subjective data and there’s some in the book, but I think we’ll rely on the validation coming from the studies that are numerous, as you have pointed out. And thank you. And the second benefit really is to the coach. I have said this for a long time is that I really want to coach and do it with ease and joy. I don’t want to have this as a job. I want to enjoy what I do and to watch people grow and take ownership of their life and be a part of that. It’s very exciting. If you are not working within the MI framework of empowering clients and allowing them to discover and articulate their own genius, their own way, you have a tendency to work too hard as a coach. And this just takes you back into the place of actually being a guide for the changer because it empowers the individual to find their deeper why, connect their goals to their larger vision of their life, which is very motivating, and very inspiring, and it results in long-lasting change.

Dr. Sandi: That is so beautifully said. And that’s what we’re after, right? Long-lasting change because so many people may initiate change and they start like gangbusters, but they don’t follow through. And that’s where the coach comes in. And that’s where the coach using MI can be so, so effective. And you’re absolutely correct. It works. It’s effective. And I have seen study after study coming out for a whole variety of conditions. So, we might think, well, it’s for stopping smoking, which is part of its origins or weight loss or lots of studies on reversing or halting the progression or changing biomarkers associated with type 2 diabetes. But I’ve also seen studies used with cancer, helping people improve their quality of life. People with cognitive decline, there’s studies on health coaching as being helpful. People with COPD, for example, with Parkinson’s, shortened hospital stays for those getting some surgery. So, that research is growing.

One of the things that I found, and I’ve been writing about this for an upcoming book, we’ve lost so much in our medical system’s current approach to care, particularly primary care. In my day, we called it bedside manner. And it’s been shown that a doctor making eye contact, who understands you, who listens to you, they’re going to be much more effective, but doctors aren’t trained in that anymore. They’ve lost that and for many outside reasons. They’re only given a limited amount of time to be with each of their patients. They have to do a lot of record-keeping during the appointment. So, patients may walk out of that feeling like, “I wasn’t heard. I didn’t get a chance to even describe what’s bothering me.” And that’s where I believe the coach comes in. So, how can motivational interviewing really the process that brings back bedside manner? Because it’s about change, helping them change, but can it also be about this very, very profound heart-centered encounter between two human beings?

Patty: It’s about a belief. It’s about how we show up and do our work as coaches, knowing that we believe that the client can make the changes they seek. And when we have that belief, the data shows that we can help them create that change. That sets the stage. And we do mention that several times in the book with the research that backs that up, that it’s the relationship between the helper and the client that creates the success. So, you are right on target.

Dr. Sandi: So, I’m going to throw out a question that Cecilia, or Patty, or both of you may want to address. We’re seeing so much about the development of AI health coaches. We’ve got Thrive Global. We’ve got OpenAI developing one. We’ve got an Apple one. There’s one from Google, Samsung. I mean, they’re all racing to get what they describe as an AI health coach. It’ll be with you. It can motivate you to change. And I’d love to hear your thoughts. Can basically a bot, a robot, a non-human do motivational interviewing with people and help them to achieve results? What are your thoughts about this?

Patty: Motivational interviewing is not something you do. So, Cecilia, go ahead.

Cecilia: Well, I love that intro, Patty. It is a way of being. And also it results in a way of behaving. In that way, it’s kind of what you do. But Patty’s point is correct, and that is… And the research shows it is a relationship in coaching that makes the difference. So, same thing you could say about education, about anything else. The relationship is absolutely non-negotiable. Now, I love what’s happening with AI. The fact that it can take notes for me and some apps are coming out. I don’t have to do that. I love the fact that we can be motivated in the short term by something on our watch. I love that. I think that’s very impactful for many, many people and also there’s a time when the goal…we lose perspective because we’re focused on the goal. And that perspective is a larger vision of someone’s life, their why, their motivations, the values, the purpose, and meaning in life. This is the beauty of a relationship that can respond in real-time to a person in a conversation and really elicit, evoke, and invite that exploration. So, I think coaching is here to stay with the tools of AI.

Dr. Sandi: Absolutely. I could not agree more. Coaching is a human encounter, and I don’t believe that that can be replaced. And everything I’ve read so far, when they talk about what they think will be the benefits of having an AI health coach on your watch or on your phone, well, they talk about the non-human health coach giving advice, which of course, as you’re saying, that’s the opposite. That’s not motivational interviewing. That is not health coaching one bit because it’s not about giving advice. So, let’s turn to some specifics that the coach can find value in digging into your book. So, Patty, what do you think… You have a section called Taking It Further. How can health coaches or if you’re still studying to be a health coach or thinking of becoming a health coach can inspire you? So, how can they use that at the end of the chapters?

Patty: Absolutely. At the end of each chapter, we included a Take It Further section. And that is designed to help reinforce the main points of that particular chapter. It can be used to further expand your understanding of the concepts that are in that particular chapter, and it could also be used by study groups, book study groups, learning cohorts to actually use those activities to help cement the learning that we shared in that particular chapter. So, motivational interviewing is not something that you can succeed at by just reading. There’s more to it than that. It takes action on your part. And the Take It Further and having that opportunity to practice the skills is incredibly important for embodying the spirit of MI.

Dr. Sandi: Absolutely. You can’t just read about it. You need to practice and go out and do it so that it becomes a part of you and it’s heart-centered. So, what you’re saying then is that a coach can get skilled at MI by practicing MI.

Patty: Right. And one of our chapters towards the end, it talks about that. It talks about the way to… On page 262, it says guided practice with feedback is the added component that can make the difference for most people. So, that’s also a way to get more skilled at the MI spirit.

Cecilia: All the things that Patty said are absolutely true, and that’s why the Take It Further section is there. As a teacher, I would like in some books to have students read the chapter and then have a ready-made path for them to go for further study without me having to come up with some questions to review or whatnot. So, it’s really good for the instructor or the guide, the trainer. Also, there are some things in the Take It Further that aren’t actually in the book that you get to go online and it’s sort of a bonus to look at some of these things. And Chapter 15 that she just read from is the way, and it’s very practical in terms of, how do I actually practice this? I mean, you can’t practice it by talking about it. The Take It Further section will get you to talk and discuss and review, but the Chapter 15 is actually, “Here’s how to do it.” And it comes from the professional learning model that I was enmeshed in as an educator, and it’s very, very practical. So, it guides the practice and the feedback even as you go to practice it.

Dr. Sandi: That makes so much sense. So, what if… To just make this real for our listeners, let’s assume that I’m coming in to you both. I’m a client and I am saying, “I want to eat better. My goal is to stop eating sugar. I think that’d be good for me, but I’m just not motivated. Every night it’s the same thing. I sit down to watch TV and a bag of Oreo cookies is there. I go into the cupboard. And before I know it, I’ve eaten half of it. So, what should I do, coach?” So, if you were doing motivational interviewing, what would be a possible response? What would be a question that you might follow that up with to get into the process?

Cecilia: I know Patty has much to say about this and I want to let her say it, but I will say first of all, if you’ll find out in the book, it depends on where you are with the client in the conversation. If you’re just beginning, it’s very important to just listen with empathy, which is an attempt to understand your client, not correct, not evoke, not move toward a destination but simply to engage in this understanding. It doesn’t have to be long, but it’s simply… I would say something like this is a struggle that you’ve been having for a long time. Simple. It’s something simple like that. But then it changes, of course, as you go toward their focus, but a lot of times people will come, they want something and they don’t want it at the same time. And this is human nature. It’s called ambivalence.

Dr. Sandi: Yeah. Yeah, and that right there was very soothing. It was like, yeah, Cecilia gets me. I’ve wanted this for a long time, but I keep failing. I just have a sweet tooth and I just keep eating without awareness and then I feel guilty and shame. And I will start over tomorrow and then tomorrow, same pattern.

Patty: Absolutely. That was my thoughts too, using engaging process and accurate empathy and saying to you as the client that acknowledging the struggle. That is hard and that is tempting. So, having that understanding and that empathy that, “I get it. I get where you are at,” and that, “I’m not here to try to get you to jump into the planning stage and create a goal that you’re not going to eat Oreos in the evening.” We’re going to hang out in that as long as we need to, to create that rapport so that you feel heard.

Dr. Sandi: Yeah, that’s so important because I might think, wow, this coach, this encounter is so different. It feels so much better. I feel like I can say to you anything. Whereas when I go to my doctor, I feel like I’m being judged. And, oh, this overweight… I’m feeling like they’re judging me for my weight or they’re judging me for my poor eating habits. Then I just end up eating more and more.

Cecilia: I don’t know who said it first. Bill quotes it, it could have been Carl Rogers, but the quote that everyone needs a good listening to goes a long way. And I have asked some clients at the end of our contract or the end of our time together what benefited you the most and what you think made the most impact. And without fail, I don’t come out and say, “I’m not judging you,” but by the way I’m behaving and interacting with them, that’s the message they get and they say, and I heard it again yesterday, “I appreciated that you didn’t judge me.” And people, when they have this feeling of acceptance, which is the second component in my spirit or the CAPE, when people feel accepted, they begin to change and to feel creative and free to change.

Dr. Sandi: Yeah. So, I would assume if I were… Again, going with this a little bit further, I might decide on my own, now that I’ve got the rapport with you, I feel safe, feel comfortable, I feel like you get me and I can say anything that, well, I’d be willing to try. Maybe I can just have a couple Oreos as a dessert with my dinner and then stop eating three hours before bedtime. Oh, I can do that or something that would be along the road to not giving up completely. Maybe I’m not ready to do that or would fail, but I’m assuming then with that motivational interviewing process, you would support me and ask the right questions so I’d be successful.

Patty: To find out what you really want.

Cecilia: And I hear this too in your voice, Oreo-loving client, that you have a sense of apprehension about succeeding and what you’re describing. And this is experience of lack of confidence from previous experience, from your own struggles of trying to do something that you can’t. And motivational interviewing maintains the spirit of empathy all the way through this session. And as you begin to tell them, “I sense,” that evoking confidence is in order.

Dr. Sandi: Yeah. And what about celebrating wins? Perhaps I come back the next session and I say, “I did it. And you know what? I didn’t even want those Oreos for dessert. I just had an apple slice instead. And then I got so involved with something else and I had pledged to you that I would not eat after dinner. And so I just want to tell you that it succeeded. I did it.” Would that, again, be part of this motivational interviewing process to celebrate wins?

Cecilia: It is totally aligned with positive psychology. And we do focus on what’s right with people and try to help them reframe their lives as well. Because, Sandi, not only do we encourage celebration of victories and that’s part of the accountability factors that is so effective, but I have clients who come and say, “I failed because I wasn’t going to eat cake and I made a cake for my grandchildren and I ate three bites.” And then as we begin to talk, what the rest of the story is she ate three bites instead of the whole piece. So, there is the victory that I can help her realize and celebrate.

Dr. Sandi: Oh, absolutely. Well, this has been a fascinating conversation. Once again, the book is “Motivational Interviewing in Life and Health Coaching.” This is a wonderful accomplishment. Motivational interviewing is hands down the way that people can create better health for themselves, help their loved ones. So, in closing, where can people find the two of you?

Patty: Our website is coachingwithmi.com. We have a coaching site. My personal website is pattybean.com. Cecilia.

Cecilia: The website she shared and we also have… You can get the book on Amazon or Guilford Press. And I have a personal website called yourallycoaching.com or, yes, Your Ally Coaching, LLC.

Dr. Sandi: Wonderful. And I do want to point out that there was a third author. She is not on the call today for the interview, but her name is Stacey Arnold. She is also an FMCA graduate. So, I am so proud of this trio who have written this amazing book. So, thank you so much for being with us today.

Cecilia: Thank you, Sandi.

Patty: It was a pleasure.