Mental Health: Motivational Interviewing


Have you been struggling with doing something that you know is good for you? Creating change is hard enough in normal times, but even more so now. Motivation is at the heart of so many of our behaviors and Motivational Interviewing can help us move away from feeling stuck or uncertain and toward making healthy changes. Here’s Home Base’s Dr. Patrick Downes to explain in today’s #HBHealthAtHome mental health segment.

Motivational interviewing is a psychotherapy approach that helps people move away from feeling stuck or uncertain, and toward finding motivation and making positive change.

Let’s talk about exercise. There’s so much evidence to show that exercise is good for us, but many of us have a hard time getting motivated to do it. Let’s start by looking at something called a decisional balance. Essentially, it’s a fancy pro-con list. You start first by looking at the disadvantages of staying the same. In this case, it would be not exercising. And ask yourself, what is the current situation costing you? You might not like how you feel, there might be health consequences, you might not be able to do activities with your friends. Then ask yourself, what are the benefits of the current situation right now? What are the advantages of not exercising? Perhaps you love the couch, you can stay in your comfort zone, you don’t have to go find a gym or equipment. Again, you love the couch. You really want to stick to the couch.

Then ask yourself, what would be some of the disadvantages of making a change, of starting to exercise? What challenges will be involved in making that change? For one, change is hard for all of us. You’d have to find some time in your schedule. And you might even be really sore. You know that there are going to be some growing pains to starting to exercise. And then what can you gain by making the change? What are the advantages of starting to exercise? Hopefully, you start to feel better, it’s good for your longterm health, and you can join your friends for those activities that you’ve been missing out on.

The Importance Ruler

On a scale of one to 10, how important is it for you to start exercising? Pick a number on that ruler, 10 being extremely important, one is not at all important. And once you’ve given yourself a number, ask yourself, why isn’t it a lower number? So if you said six, say, well, why not a five? Doing this will help you articulate why this behavior change is so important to you. Knowing and reminding yourself of why something is important will help you when you feel stuck or unmotivated.

The Confidence Ruler

Then we moved to the confidence ruler. Again, on a scale of one to 10, how confident are you that you could start exercising? One is not at all confident, 10 being extremely confident. Again, once you’ve assigned yourself a number, ask what would it take to get one number higher? How could you think about going from, say, a four to a five? And that will help you realize what are some obstacles potentially in the way of you starting to exercise. If we can identify the obstacles, then we can start problem-solving to overcome them.

States of Motivation

Then we start to look at the states of motivation. Depending on how you answered those questions, what numbers you assigned yourself on the importance ruler and the confidence ruler, that will give us a sense of where you’re at in terms of your readiness for change. If you had a low number on both and you have little interest in changing, or not even sure that you could change. If your importance is high but your confidence is low, you want to change, but you’re just not sure you’re able to. If your confidence is high and your importance is low, you believe you could change, but you’re just not that interested right now. And if you rate yourself with high numbers on both scales, that shows that you want to change and you believe you have the ability to do so.

The Readiness Ruler

Then we move to the readiness ruler. Again, on a scale of one to 10, how ready are you to start exercising? Once you assign yourself a number, ask why isn’t it a lower number? And what would it take to get one number higher? Again, this will help you identify potential barriers to your readiness for change and show that you’re ready to move in the direction of your goal.

Change is really hard, but hopefully motivational interviewing can help you get at some of the obstacles that might be in the way of you making a positive change, a healthy change, in your life. This can be used for things such as we did today, exercising, to nutrition, to taking the medication that’s been prescribed to you, even to attending therapy. Really getting at why something is important and how confident you are that you can make that positive change in your life.

If you have additional questions about motivational interviewing or would like to speak to someone at Home Base, please visit or call our clinic at 617-724-5202.

About the Author: Dr. Downes is a post-doc clinical psychology fellow working with veterans and their family members. He has a doctorate in clinical psychology from William James College and a bachelor’s in Human Development and Philosophy from Boston College. He completed pre-doctoral training at Tufts Medical Center and Boston University Student Health Services. Dr. Downes has a particular interest in how people and communities care for each other after traumatic events, as well as how to enhance collaboration between military and civilian healthcare. Dr. Downes is a native of Cambridge, MA where he lives with his wife, an MGH oncology nurse, and their black lab. He is involved in several non-profit organizations related to veterans, health care, special education, and people with physical disabilities.