First, the most important sentence: the harder you push someone to change, the more they will defend “not changing”; letting them state their own reasons for wanting to change is how change actually happens. This conversational method is called “motivational interviewing.” Healthcare professionals use it to talk to patients about quitting smoking, exercising, and controlling blood sugar, but it works just as well for persuading your parents to exercise or your partner to see a doctor.

This post is an extension of Do 80-Year-Olds Still Need to Exercise?, written for those of you who have tried to persuade a family member a hundred times, only to end up in a fight every time.

Why persuading them backfires

Imagine someone constantly telling you, “You just need to sleep early, this isn’t working.” What’s your first reaction? Probably, “No I don’t, I have my own schedule.” When people are being persuaded, they automatically defend their current selves. If you’ve given all the reasons “to change,” they only have the reasons “not to change” left to say. And as they talk, they convince themselves even more that they don’t need to change.

So the direction needs to be reversed: lecture less, let them talk more, and catch that tiny fraction of “wanting to change” in their words.

A different approach: three concrete steps

  • Validate first, get curious second. Don’t point out the problem the moment you open your mouth. Genuinely validate what they’re already doing: “You walk to get groceries every day, no wonder your legs are still pretty strong.” Then use open questions to get them to talk more: “Is there anywhere you want to go or anything you want to do recently?”
  • Reflect their words back to them. Whatever they say, repeat it back in your own words: “So you’re worried you might get hurt if you move around?” This makes them feel heard and willing to keep talking. Catching their feelings isn’t the same as agreeing with their conclusions, but arguing will only slam the door shut.
  • Amplify the “want” signal when you hear it. When they say “I do want to move a bit” or “I can’t keep going on like this,” that is the most precious moment. Follow up by asking: “Oh? How so?” Let them flesh out the reasons themselves. The reasons they come up with are more powerful than you telling them a hundred times.

A very useful question: the ruler

Ask them: “On a scale of 0 to 10, how important is it to you to be able to walk to your granddaughter’s wedding?” If they say 4, ask, “Why is it a 4, and not a 0?” They’ll naturally talk about why they care. Never ask the reverse, “Why isn’t it a 10?” That will just force them to come up with a bunch of excuses for why they can’t do it. The direction is exactly the opposite.

A sample conversation

Scenario: An elder in their 80s feels walking every day is enough and doesn’t want to “exercise specifically.”

Elder: I’m in my 80s, what’s there to exercise for? Walking out the door a few times a day is plenty.

Family member: You walk a few times every day, no wonder you’re so spry. (Validate first) By the way, your granddaughter is getting married next year, didn’t you say you wanted to walk her down the aisle?

Elder: Well of course I have to do that.

Family member: You’ll have to stand for quite a while that day. Do you think your current leg strength will hold up for the whole day? (Leave the decision up to them)

Elder: …Now that you mention it, maybe I do need to train my legs a bit more.

Notice that the final sentence, “need to train my legs a bit more,” was said by them. Starting the conversation from here on how to train, versus starting from “you just need to go exercise,” are two entirely different conversations.

Finally: they have the right to say no

Even if you use all the right methods, the other person might still not want to change. Adults with the capacity to judge inherently have the right to decide their own lifestyle, including not exercising. We can continue to care and look for chances to talk again, but we can’t force or trick them. If you preserve the relationship, you preserve the chance to speak up next time.

If you want to know “whether they’re actually willing to change right now and what approach to take,” you can read this alongside the five stages of behavior change.

Further reading: Do 80-Year-Olds Still Need to Exercise? full article

To summarize in one sentence: the core of motivational interviewing isn’t “persuading the other person to change,” but “eliciting the person’s own reasons for wanting to change.” The harder you push, the more they will defend the status quo; conversely, let them state their own reasons for wanting to change, and change will happen. This is the conversational strategy for dealing with older adults who don’t want to exercise, as discussed in the post Do 80-Year-Olds Still Need to Exercise?.

Below, we’ll break down an interview into six steps.

Step 1: Cultivating the right attitude

Skills divorced from attitude turn into manipulation, so we must talk about attitude first. The attitude of motivational interviewing has four elements: partnership, acceptance, compassion, and empowerment.

  • Partnership: Collaborating with the person. It’s like dancing together, not a tug-of-war.
  • Acceptance: Catching their thoughts without judgment. Note that acceptance does not equal agreement; you can catch their feelings without endorsing their choices.
  • Compassion: Genuinely starting from what is best for the person.
  • Empowerment: Believing the person already possesses the capabilities and resources needed to change. Your role isn’t to “give them what they lack,” but to validate and help them leverage the abilities they already have, while respecting their right to autonomous choice.

Empowerment is an “attitude.” “Eliciting” in Step 3 below is the concrete skill to practice this attitude.

Source: Miller & Rollnick, Motivational Interviewing: Helping People Change and Grow, 4th ed. (2023) Ch.1.

Step 2: The four tasks of an interview

With the right attitude, an interview sequentially (though you can loop back) moves through four tasks, with each task answering a question:

  1. Engaging: Can we talk together? First, make them willing to talk to you.
  2. Focusing: What are we talking about? Identify the shared goal for this session.
  3. Evoking: Why do you want to change? Elicit their own reasons.
  4. Planning: How will you do it? Have them take the lead in setting concrete steps.

The key is the order: trying to focus without first building rapport feels like an interrogation; trying to plan without eliciting motivation feels like coercion. Most failed patient education skips the first two steps and rushes straight to step four to write checklists and set schedules. And one sentence is worth remembering: a plan they haven’t nodded to isn’t a plan.

Source: Miller & Rollnick 4e Ch.2, Ch.7.

Step 3: How to listen and ask

There are four fundamental skills used throughout the process: open-ended questions, affirmations, reflections, and summaries.

  • Open-ended questions: Ask questions that can’t be answered with “yes/no,” getting them to talk more.
  • Affirmations: Genuinely affirm their efforts, especially their past successful experiences with change; this nurtures their confidence.
  • Reflections: Repeat back the content and emotion you heard in your own words to check your understanding (“Do you mean…?”). This is the most core skill; it makes them feel heard and willing to keep talking.
  • Summaries: String together both sides of what they’ve said, helping them see their own ambivalence. Also used to wrap up and move to the next step.

When you reach the “evoking” step, these skills aren’t used neutrally; they are used directionally to respond to and amplify their change talk.

Source: Miller & Rollnick 4e Ch.4, Ch.6.

Step 4: Hearing the signals for change

When they start making change talk (like “I do want to move a bit” or “I can’t keep going on like this”), these are signals of change. Once you hear them, use the previous skills to reinforce them. These signals come in two layers:

  • Preparatory layer (still brewing)
    • Desire: “I want to get a bit healthier.”
    • Ability: “I can probably do this.”
    • Reasons: “If I don’t move, my knees will get stiffer.”
    • Need: “I need to stand longer for my grandson’s wedding.”
  • Mobilizing layer (getting moving)
    • Commitment: “Okay, I’ll start next week.”
    • Willing to try: “I can think about it.”
    • Taking steps: “I already went for a walk yesterday.”

Hearing the “preparatory layer” means they’re still brewing. Hearing the “mobilizing layer” means you can head toward “planning.”

Source: Miller & Rollnick 4e Ch.6, Ch.10.

Step 5: What to do when you’re stuck

When they remain stuck or keep arguing back, first distinguish which kind of stuck it is, because the solutions are opposites:

  • One kind is “they are still ambivalent.” They say “I don’t want to, I can’t do it.” This is half of normal ambivalence. The approach is to catch it using listening and reflection. Don’t argue, don’t force it, and it will loosen up on its own.
  • The other kind is “your relationship has hit a snag.” They get defensive or feel misunderstood. This isn’t an issue with “change,” it’s an issue with “you.” The approach is to step back and rebuild rapport, instead of continuing to preach the logic of changing.

Getting the target wrong will only make things stiffer: constantly repairing the relationship with someone who is “still ambivalent” is unnecessary, and constantly lecturing someone when “the relationship has hit a snag” will only make things worse.

Source: Miller & Rollnick 4e Ch.14.

Step 6: Using a ruler for a little nudge

A very useful skill is turning abstract motivation into a number you can talk about: “On a scale of 0 to 10, how important is exercise to you?”

Suppose they say “4.” The next thing to ask is, “Why is it a 4, and not a 0?” This forces them to articulate the reasons why they “already have 4 points”—these are all signals of change.

A common mistake is asking the reverse, “Why isn’t it an 8 or 10?” That will just force them to come up with a bunch of “reasons why they can’t,” sending you in the exact opposite direction. You can also ask about confidence: “How confident are you that you can do it?” If their confidence score is very low, first ask, “What could help bump that score up a bit?” before moving forward.

Source: Miller & Rollnick 4e Ch.6, Fig 6.1.

A verbatim clinical demonstration

Scenario: An elder in their 80s who walks every day but doesn’t want to “exercise specifically.” (Dialogue adapted for demonstration).

Elder: I’m in my 80s, what’s there to exercise for? Walking out the door a few times a day is plenty.

Physician: You walk a few times every day, no wonder you look so spry, not like you’re in your 80s at all. (Affirmation) Walking is really good for you. I’m curious, besides walking, is there anywhere else you want to go or anything you want to do recently? (Open-ended question)

Elder: Not really… though my granddaughter is getting married next year, I’d like to be able to stand a bit longer to see her get married.

Physician: You want to stand properly and be with your granddaughter throughout that day. (Reflection) That sounds quite important to you.

Elder: Well of course.

Physician: If we use a scale of 0 to 10, how important is it to you that “your legs can hold up for that day”? (Ruler)

Elder: A 10, obviously.

Physician: A 10. Do you feel that relying just on your current walking will be enough to hold up? Or do you want to train just a bit more? (Evoking change signals, leaving the autonomy up to them)

Elder: …Now that you mention it, maybe I do need to train my legs a bit more.

At this point, the elder themselves stated “need to train my legs a bit more”—these are their words, not shoved onto them by the physician. Only then do you have ground to discuss how to train.

Do not forget: patients have the right to refuse

The spirit of motivational interviewing respects the other person’s autonomy from the start. A person with capacity inherently has the right to refuse. Refusal doesn’t equal denying their illness, nor does it imply suicidal ideation. In a rehabilitation setting, refusal can be very subtle (like not doing home exercises). These individuals are often labeled “non-compliant,” ignoring their right to bodily autonomy. In a facility, being “non-compliant” is sometimes the only way an elder can still exercise control over their life. We can try hard to encourage and persuade, but we cannot coerce or deceive.

Source: Lewis, Geriatric Rehabilitation Manual 4e Ch.17 "The Right to Refuse".

As for how to judge which stage of change the person is in, see the five stages of behavior change.

Further reading: Do 80-Year-Olds Still Need to Exercise? full article