The 3 F's of Motivational Interviewing: A Smarter Framework for Clinicians

When writing Advancing Motivational Interviewing: An Experiential Skills Guide for Mental Health Providers with my colleague and pal, Ali Hall, I found myself wondering more about what it means to build resources that continue to address the complexity of work we do in ways that are useful and not too complex. When asked why we wrote the book, we typically share the inspiration for each of the chapters and how we wrote them came from the challenges new Motivational Interviewing (MI) learners have when they start to apply what they learn in real life practice. I often imagine a comprehensive MI training offers a map for how to do MI, but practitioners new to MI start to realize when they are out there with their map that it is not always so clear how to navigate the up and down terrain of a typical health care system and the needs of individual travelers who themselves need support and knowledge to move toward their own valued change and growth.

Inspired by this challenge, Advancing Motivational Interviewing offers a toolkit for a complicated journey tucked into thirteen chapters organized around themes and practice. What I also noticed is that when the writing stops, we keep thinking about the themes and how to use them. Our community also continues to respond and engage with the material, and they tell us how they understand what we wrote and how they are changing their practice. Indeed, the reason we called the book Advancing Motivational Interviewing instead of Advanced Motivational Interviewing is that the learning and the process of practice, mastery, and implementation is always evolving; we are never finished with learning and growth, and the process of moving toward learning and growth enables us to engage in the best practice of continuous practice improvement.

In this spirit of ongoing learning, I created another shorthand for organizing the dozen skills and attitude approaches featured in the book. Although there is some conceptual overlap, practitioners can develop or advance their MI practice through considerations of the 3 F’s: being flexible, finding focus, and engaging in facilitation.

The Three F’s help us assess our own practice when we are able to ask, “When Providing Motivational Interviewing, how can I move toward….?”

1. Being flexible in my thoughts, feelings, and behaviors as I approach the work
2. Finding focus in our conversations about change and growth
3. Engaging in facilitation of a person’s growth and change process, vs. trying to control someone’s change and growth via persuasion

Each chapter of Advancing Motivational Interviewing contains a little or a lot of the 3 Fs, and here are some examples.

When training in MI, I encourage providers to be the most psychologically flexible person in the room. We are flexible so those learning, changing, and growing do not have to limit their options and change their approaches to meet our needs; we are the ones shifting to meet their needs, so they have the psychological safety and support to take risks and explore options.

In Advancing Motivational interviewing, flexibility comes up in our ability to avoid the onerous and fatiguing parade of questions that occurs when we fall into the assessment trap, or otherwise inflexibly following an intake process to collect information. Instead of routinely collecting information that isn’t even necessarily useful to our practice, we can focus instead on building a relationship with the client (Chow, 2018). This chapter offers ways to think differently about the idea of assessment and consider where and how we might flexibly adjust our approach in these first sessions, so we have a more open and thoughtful relationship building-process. Increased flexibility in the first sessions might include breaking down the assessment into do-able parts, pausing to reflect, or making links between themes. Creatively approaching how to complete a static assessment form can add small but meaningful humanness to an otherwise overwhelming process.

Finding focus in a conversation is always an important task in MI and many of our best intentions get unwound as we lose our way through challenging conversations. In the chapter What’s the Problem, we explore who is the customer in the room and how do we get on the same page. If we are on different tracks regarding what the most important issue is for the person seeking help, we end up talking around each other and often getting into a common wrestling match as each party, often frustrated and annoyed, tries to get the other person to understand them. Such misunderstanding the problem is all too common because we can come into the conversation with a preconceived idea of what needs to be done and the obvious steps to the desired outcome. But what if the person we are supporting has a different idea of what the problem is in the first place and doesn’t agree with the proposed steps to the outcome and doesn’t want same the outcomes we want? In this chapter, practicing humility, listening carefully, and engaging in advocacy are all important practitioner behaviors that both hone autonomy and build empowerment. Having the right focus from the client’s perspective creates an entirely new direction for the conversation and path forward, helping to provide direction and hope in a process that might have otherwise seemed impossible.

Facilitating growth is the opposite of trying to control the agenda. The former is something we can do. The latter only seems possible, but almost always leads to frustration or avoidance in the relationship. In the chapter I Was Only Trying to Help, we explore the control agenda and bring forth the good intentions that can lead to bad outcomes. In this chapter, we consider ways to step back and empower others by letting them have their moment and resisting our own temptation to jump in with a solution or an idea. We help practitioners see their role as not primarily providing advice or “psycho education”, but instead to listen and observe in order to facilitate a client's conversation that reveals their brilliance as they start to come up with their own ideas for change and growth. Facilitation instead of fixing is a win-win situation: the client wins increased confidence and motivation, and the provider wins decreased stress and frustration.

These are just three examples of how the tools of Advancing Motivational Interviewing fit into the broader concepts of being flexible, focusing, and engaging in facilitation. We look forward to the discoveries you make when thinking about how all the concepts in the Advancing Motivational interviewing toolbox helps you achieve the 3Fs.

Chow, D. (2018). The First Kiss: Undoing the intake model and igniting engagement from the first session in psychotherapy. DarylChow.com.