Coach Approach vs Motivational Interviewing — Key Differences

By Hélène Thériault, BScOT, MAdEd, MCC
Founder of Function First Coaching™

Overview

Keywords: Coach Approach, Coaching in healthcare, Motivational Interviewing, Cognitive Behavioural Therapy, client-centered, behavioural change

One of the most common questions I get asked when introducing healthcare professionals to the Coach Approach is:

• How is the Coach Approach different from Motivational Interviewing (MI)?
• I have MI training—should I also take training in the Coach Approach?
• When should Cognitive Behavioural Therapy (CBT), MI, and the Coach Approach be used with clients?

This white paper answers these questions, with a primary focus on distinguishing the Coach Approach from MI, as these two share the most overlap.

For a visual comparison of Cognitive Behavioural Therapy (CBT), Motivational Interviewing (MI), and the Coach Approach, please refer to the PowerPoint presentation slide available at: www.functionfirstcoaching.com/resources.

What is similar?

First and foremost, both Motivational Interviewing (MI) and the Coach Approach use communication as their methodology, facilitating behaviour change through a semi-structured dialogue between the client/patient and the clinician.

Both require the development of complex skills that are honed through considerable practice over time (Miller & Rollnick, 2023; Cook, Greene, & Maxwell, 2024). A key shared skill is accurate empathy—which goes beyond simply reflecting what was heard, enabling the client to articulate their own reasons for change (or not).

Both approaches are client-centered, emphasizing rapport-building, collaboration, and active listening as key components of facilitating change. When compared to the Dive Into a Coach Approach® framework, both follow a four-step process that provides structure to the flow of the conversation (see Figure 1).

Healthcare practitioners may find MI and the Coach Approach particularly adaptable, as both can be integrated into other therapeutic approaches such as harm reduction, skill building, and occupations.

ACCURATE EMPATHY

An active effort to understand and interpret the other person's view of their situation—their internal perspective of it.

-adapted by Hélène Thériault from Rogers & Miller,

...it seems simple until you try it
-Miller

Finally, both approaches emphasize a "way of being." In Motivational Interviewing (MI), this is known as the "Spirit of MI," grounded in four key elements: partnership, acceptance, compassion, and empowerment (Miller & Rollnick, 2023). Similarly, the Dive Into a Coach Approach® Mindsets encapsulate the International Coaching Federation (ICF) Core Competencies into four "ways of being" metaphors: Amateur, Environmentalist, Olympian, and Discoverer (Thériault, 2025).

What is different?

Comparatively, the Coach Approach is a comprehensive practice model that can be used both formally as an intervention and informally as an approach (Pentland et al., 2016; Perlman & Moain Abu Dabrh, 2020). Unlike MI's focus on ambivalence, the Coach Approach dives deeper—working from the inside out to create lasting transformation.

This deeper work focuses on shifts in perception—including beliefs, attitudes, judgments, and assumptions—which, in turn, influence behavior and decision-making (Reynolds, 2020). Because this approach requires a stronger foundation in "ways of being," advanced techniques, and more sessions, it supports clients in making sustained behavioural changes (Graham et al., 2021).

Furthermore, the partnering approach inherent in this communication style actively engages the client in developing the skills needed to self-manage their condition. This long-term engagement not only supports individuals in managing chronic illness but can also play a critical role in preventing disease by fostering proactive health behaviours.

Similarities & Differences — An Overview

Using the scuba diving metaphor from Dive Into a Coach Approach® training, clinicians choose their approach based on the client's needs:

• Motivational Interviewing (MI): The clinician snorkels just below the surface when a client faces a specific problem or dilemma but is reluctant to take action. MI provides a guiding communication style to help the client explore their reasons for change (or not) while remaining near the iceberg's surface.
• The Coach Approach: When a deep-seated belief or perception prevents the client from progressing toward their rehabilitation goals, the clinician dives deeper beneath the surface of the iceberg. This approach supports clients in challenging perceptions, exploring the underlying thinking that shaped the issue, and fostering sustained behavioural change.

Synergy Between Motivational Interviewing & the Coach Approach

While MI and the Coach Approach are distinct, they can work together in a complementary way:

• MI helps resolve ambivalence, while the Coach Approach supports deeper perceptual and behavioural transformation.
• MI is typically short-term (1-2 sessions), focused on exploring readiness for change, while the Coach Approach is longer-term (6+ sessions), allowing for sustained self-discovery and action.
• Both approaches prioritize client autonomy but differ in depth—MI guides clients through their reasons for change, while the Coach Approach supports long-term integration of new ways of thinking and acting.

By integrating coaching into healthcare, clinicians can:

• Enhance patient satisfaction
• Reduce burnout and improve clinician retention
• Shift healthcare from a curative model to a preventative one

About Function First Coaching

Function First Coaching™ is a leading micro-credentialing organization dedicated to transforming healthcare by equipping service providers, professionals, and leaders with a unique Coach Approach that enhances clinical outcomes and patient care. With 20+ years in healthcare, we developed an accredited, holistic framework that blends coaching best practices, leadership development, strength-based models, and practical tools designed for healthcare professionals. Our programs support business growth and drive lasting client results.

Disclaimer & Gratitude

I am a Master Certified Coach (MCC) accredited by the International Coaching Federation (ICF) with introductory-level training in Motivational Interviewing (MI) gained through 22 years in occupational therapy. Inspired by the transformative impact of a Coach Approach in OT practice, I drew on my Master of Adult Education background to develop the Dive Into a Coach Approach® model, framework, and certification program—designed to help healthcare professionals shift healthcare from the inside out.

Special thanks to Lisa Diamond-Burchuk, MI Instructor and Course Coordinator at the College of Rehabilitation Sciences, University of Manitoba, for reviewing the content of this white paper.

Coach Approach & Cognitive Behavioural Therapy

Interested in how the Coach Approach can complement CBT? Our new white paper, Coach Approach & CBT: A Synergistic Approach, is now available!

Co-authored with Lara Desrosiers, MScOT, OT Reg. (Ont.), from AMPS Healthcare Education, this resource will explore how integrating coaching principles with CBT can be blended together for improved patient outcomes.

Download Now →

Together, the Coach Approach and CBT create a powerful synergy—deepening client outcomes while reducing therapist burnout.

References

1. Cook, E., Greene, G. J., & Maxwell, J. (2024). Coaching for person-centred healthcare: A solution-focused approach to collaborative care (1st ed.). Taylor & Francis Group. https://doi.org/10.4324/9781003414490
2. Graham, F., Kennedy-Behr, A., & Ziviani, J. (2021). Occupational performance coaching: A manual for practitioners and researchers. New York, NY: Routledge.
3. International Coaching Federation. (2021). ICF core competencies. https://coachingfederation.org/app/uploads/2021/07/Updated-ICF-Core-Competencies_English_Brand-Updated.pdf
4. Miller, W.R. (2009). Ten things Motivational Interviewing is not. Behavioral and Cognitive Psychology, 37, 129-140.
5. Miller, W. R. (2018). Listening well: The art of empathetic understanding. Eugene, OR: Wipf and Stock Publishers.
6. Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781462552795
7. Pentland, W., Isaacs-Young, J., Gash, J., & Heinz, A. (2016). Enabling positive change: Coaching conversations in occupational therapy. Ottawa, ON: CAOT. Publications ACE.
8. Perlman & Moain Abu Dabrh. (2020). Health and wellness coaching in serving the needs of today's patients: A primer for healthcare professionals. Global Advances in Health and Medicine, 0: 1–8.
9. Reynolds, M. (2020). Coach the person, not the problem. A guide to using reflective inquiry. Berrett Koehler Publishers, Inc. Oakland, CA.
10. Thériault, H. (2025). Dive Into a Coach Approach® 1.0 Participant Workbook. Not published.