Motivation is Essential for Change….
“clients’ level of motivation for change is often a good predictor of outcome. Motivation can be influenced by many naturally occurring interpersonal and interpersonal factors and by specific interventions…three are at least three critical components of motivation: readiness, willingness and ability” (Miller & Rollnick, p. 9).
Willingness to Change
Change happens if an individual feels it is important for them. Miller & Rollnick, (1991) describe a psychological self-monitoring function that acts like a thermostate. Any aspects of our reality that are not in sync of our personal values produce a desire for change. This discrepancy between our current reality and desired goals produces a willingness to change. It’s polar opposite is resistance.
The Righting Reflex: “When people perceive a discrepancy between how things are and how they ought to be, they tend to be motivated to reduce that discrepancy if it seems possible to do so.” (Miller & Rollnick, 1991, p. 20)
Ability to Change
Ability to change can be thought of a belief in our level of capability to achieve a specific goal.. When individuals believe they don’t have the ability to change, they are resistant to trying. Individuals that face a discrepancy between actions and values (as desired above) who are do not feel capable of change can resort to using defense mechanisms. Defense mechanisms provide an alternative to change via the adjustment of perceptions, beliefs, and thoughts.
Readiness to Change
“One can be willing and able to change, but not ready to do so…this third dimension, readiness, has to do with relative priorities: ‘I want to, but not now'” (Miller &Rollnick, 1991 p. 11). Motivational Interviewing suggests we do not see low readiness in a pathological manner but as a normal part of the change process.
When Client’s are Not Motivated….
According to Motivational interviewing, human beings are seen as having a “built-in desire to set things right” (Miller & Rollnick, 1991, p. 20). As stated earlier, change is a byproduct of motivation. Motivation is a byproduct of any perceived discrepancies between what how things are and how they ought to be. So what happens when we encounter a client who is resistant to change despite clear evidence that it is needed? Here are just a few examples from Miller & Rollnick (1991).
“You would think that having a heart attack would be enough to persuade a man to quit smoking, change his diet, exercise more and take his medication.” (Miller & Rollnick, 1991, p. 3).
“You would think that hangovers, damaged relationships, an auto crash, and memory blackouts would be enough to convince a woman to stop drinking.” (Miller & Rollnick, 1991, p 3).
In the examples, it is often natural to react with frustration and sadness. We see behavior that appears self-destructive, yet are unable to help the client see this. Motivational interviewing, suggests not conceiving the client’s resistance in a self-destructive or maladaptive in nature, but instead a part of the process of change. Consider the following:
What happens when someone with a righting reflex (R) [i.e. motivated] meets a person who is ambivalent (A) [resistant]? As A speaks to R about the dilemma of ambivalence, R develops an opinion as to what the right course of action would be for A to take. R then proceeds to advise, teach, persuade, counsel, or argue for this particular resolution to A’s ambivalence….By virtue of ambivalence, A is apt to argue the opposite, or at leastpoint out problems and shortcomings of the proposed solution. It is natural for A to do so, because A feels at least two ways about this or almost any prescribed solution. It is the very nature of ambivalence.” (Miller & Rollnick, 1991, p. 20-21)
In this above example, we see what happens when the client and the counselor are not on the same page. So what is the missing piece of the puzzle that the counselor is missing? The client lacks motivation to change. They are not ready, willing or able…
“Our perspective is that exploring and enhancing motivation for change is itself a proper task, at times even the most important and necessary task, within helping relationships such as counseling, health care, and education.” (Miller & Rollnick, 1991, p. 21)
OUR GOAL: Developing Discrepancy
Miller & Rollnick, (1991) state that our goal should be to have the client voicing arguments in favor of change. “When you find yourself in the role of arguing for change while your client (patient, student, child) is voicing arguments against it, you’re in precisely the wrong role” (Miller & Rollnick, 1991, p .22).
So how can we get our clients to begin arguing in favor of change? In motivational interviewing, arguments in favor of change are called “Change talk”. The client engages in “change talk when they are motivated. “The larger the discrepancy, the greater the importance of change” (Miller & Rollnick, 1991, p. 22). In other words, clients become motivated as feelings of ambivalence are resolved and they gain awareness of discrepancies between their reality and desires. Change talk falls into one of four categories…
“Disadvantages of the status quo. These statements acknowledge that there is reason for concern or discontent with how things are. This may or may not involve an admission of a ‘problem.’ The language generally reflects a recognition of undesirable aspects of one’s present state or behavior.” (Miller & Rollnick, 1991, p. 24).
“Advantages of change. A second form of change talk implies recognition of the potential advantages of a change. Whereas the first type of change talk focuses on the not-so-good things about one’s current status, this second type emphasizes the good things to be gained through change. Both kinds, of course, are reasons for change.” Miller & Rollnick, 1991, p. 24).
“Optimism for change. A third kind of talk that favors change is that which expresses confidence and hope about one’s ability to change. It may be stated in hypothetical (I could) or declarative form (I can do it). The common underlying theme is that change is possible” (Miller & Rollnick, 1991, p. 24).
“Intention to change. As the balance tips, people begin to express an intention, desire, willingness, or commitment to change. The level of intention can vary from rather weak to very strong commitment language. Sometimes the intention is expressed indirectly by envisioning how things might be if change did happen” (Miller & Rollnick, 1991, p. 24).