Everybody knows someone who is making perplexingly unhealthy choices detrimental to their well-being. It’s quite tough to watch helplessly as a loved one acts self-destructively. We see their lives heading down a path leading to nowhere. We are brutally where the end of the road can take them but are helpless to stop them. All we can do is stand by and watch in horror. I experience this all-too-often as a student therapist and healthcare worker.
What is motivational interviewing?
Motivational interviewing is a unique client-centered approach that helps the client’s achieve lasting changes in their lives. It does this by helping the client resolve an feelings of ambivalence to change while clarifying internal motivations to change. Motivational interviewing is defined by the following characteristics (Miller & Rollnick, 1991).
A Client-Centered Approach
Motivational interviewing has an indebtedness to the work of Carl Rogers in its client-centered approach. It focuses on developing a concern and understanding of the client’s perspective. Miller & Rollnick (1991), note that by utilizing a client-centered approach to encourage change, Motivational Interviewing has the following unique characteristics.
It is collaborative in nature and avoids the authoritarian approach (Miller & Rollnick, 1991, p. 22).
This approach focuses in drawing out client insight and develop intrinsic motivation (Miller & Rollnick, 1991).
This method respects individual by asserting that responsibility for change rests upon the client. (Miller & Rollnick, 1991).
A Consciously Directive Approach
Motivational interviewing, however, diverges from the Rogerian approach, as a consciously directive alternative to instituting change. This approach is intentionally directed toward resolving any feelings of ambivalence to change. Getting unstuck, involves working through ambivalence by creating discrepancies between behavior, goals, values, and beliefs.
It is a Method of Communication
“Third, we emphasize that motivational interviewing is a method of communication rather than a set of techniques It is not a bag of tricks for getting people to do what they don’t want to do. It is not something that one does to people; rather, it is fundamentally a way of being with and for people—a facilitative approach to communication that evokes natural change” (Miller & Rollnick, 1991, p. 18).
It Elicits Intrinsic Motivation to Change
“The focus of motivational interviewing is on eliciting the person’s intrinsic motivation for change. It differs from motivational strategies intended to impose change through extrinsic means: by legal sanctions, punishment, social pressure, financial gain and such. Behavioral approaches often seek to rearrange the person’s social environment so that one kind of behavior is reinforced and another discouraged” (Miller & Rollnick, 1991, p. 19).
It Focuses on Resolving Ambivalence
This method focuses on exploring and resolving ambivalence within the client and is based on the idea that change cannot happen unless the client is willing to do so. Change cannot be imposed upon a client if it conflicts with their beliefs, values, and goals (Miller & Rollnick, 1991). By addressing the cause of a client’s own “stuck-ness” they develop an internal motivation for change.
Lessons to Learn about Motivational Interviewing…
An article I found titled “Eight Stages in Learning Motivational Learning” provides an overview of skills practitioners must develop in order to utilize Motivational Interviewing successfully (Miller & Moyers, 2006, p. 3).
“practitioners acquire expertise in this method through a sequence of eight stages: (1) openness to collaboration with clients’ own expertise, (2) proficiency in client-centered counseling, including accurate empathy, (3) recognition of key aspects of client speech that guide the practice of MI, (4) eliciting and strengthening client change talk, (5) rolling with resistance, (6) negotiating change plans, (7) consolidating client commitment, and (8) switching flexibly between MI and other intervention styles” (Miller & Moyers, 2006, p. 3).
STAGE #1: THE SPIRIT OF MOTIVATIONAL INTERVIEWING
The first lesson a new therapist must encounter in utilizing motivational interviewing adeptly is to appreciate how it is unique. What follows are three key descriptive characteristics of motivational interviewing:
COLLABORATION – “Certainly one key component of the spirit of motivational interviewing is its collaborative nature. The counselor avoids an authoritarian one-up stance, instead communicating a partner-like relationship. The method of motivational interviewing involves exploration more than exhortation, and support rather than persuasion or argument” (Miller & Rollnick, 1991, p. 33).
EVOCATIVE – “Consistent with a collaborative role, the interviewer’s tone is not one of imparting things (such as wisdom, insight, reality) but rather of eliciting, of finding these things within and drawing them out from the person…It is not an instilling or installing but, rather, an eliciting, a drawing out of motivation from the person. It requires finding intrinsic motivation for change within the person and evoking it, calling it forth” (Miller & Rollnick, 1991, p. 33).
AUTONOMY – “In motivational interviewing, responsibility for change is left with the client—which, by the way, is where we believe it must lie, no matter how much professionals may debate what people can be ‘made’ or ‘allowed’ or ‘permitted’ to do and choose. Another way to say this is that there is respect for the individual’s autonomy” (Miller & Rollnick, 1991, p. 33).
STAGE #2: (OARS) CLIENT-CENTERED COUNSELING SKILLS
“The second stage of skill development is not unique to MI. It involves acquiring proficiency in the use of classic client-centered counseling skills…Along with reflective listening, three other counseling micro-skills are particularly emphasized in MI, using the mnemonic acronym OARS: asking open questions (O), affirming (A), reflecting (R), and summarizing” (Miller & Rollnick, 1991, p. 8).
STAGE #3: RECOGNIZING CHANGE TALK
“MI departs from client-centered counseling in being consciously and strategically goal-directed. Originally developed to help people change addictive behaviors…[it] is directed toward particular behavior change goals. A key process is to help clients resolve ambivalence by evoking their own intrinsic motivations for change. When MI is done well, therefore, it is the client rather than the counselor who voices the arguments for change. Particular attention is given to client “change talk,” verbalizations that signal desire, ability, reasons, need, or commitment to change…If unable to recognize change talk when it occurs, the counselor cannot reinforce and shape it toward commitment” (Miller & Moyers, 2006 p. 7). Another resource for this article notes paradoxically, that it is the reflective, supportive, and client-centered approach that increases a client’s openness to change (Miller & Rollnick, 1991). In contrast, traditionally confrontational and directional techniques increase resistance (Miller & Rollnick, 1991)
STAGE #4: REINFORCING CHANGE TALK
Once the client recognizes the client’s openness & desire to change, therapists utilizing MI, must learn to further reinforce it. This intentional reinforcing can happen through a series of strategies such as the following: “(e.g., ‘In what ways might this change be a good thing?’), and is cautious with questions the answer to which is resistance (e.g., ‘Why haven’t you changed?’)” Miller & Rollnick 1991, p. 8)
STAGE #5: ROLLING WITH RESISTANCE
“The client rather than the counselor should present the arguments for change. Change is motivated by a perceived discrepancy between present behavior and important personal goals or values.” (Miller & Rollnick, 1991, p. 26). Using this method effectively requires therapists to understand that arguing directly with a client’s resistance to change, only reinforces it. Rolling with resistance means inviting arguments against change and seeing resistance as a need to change the way you are communicating with the client. Change can be enabled through a process of active problem solving the includes an acknowledgment the client’s concerns.
STAGE #6: DEVELOPING A CHANGE PLAN
“Miller and Rollnick described therapeutic skillfulness in timing, in knowing when to move on to the development of a change plan. The usual procedure is to offer a transitional summary of change talk (desire, ability, reasons, need) that the client has offered for making a change, and then to ask a key open question, the essence of which is “What next?”… Part of the skill here, then, is knowing when to attempt the transition from Phase 1 to Phase 2…is proficiency in developing a specific change plan (not necessarily treatment plan) without evoking resistance” (Miller & Moyers, 2006, p.10)
STAGE #7: CONSOLIDATING CLIENT COMMITMENT
Once the client has been to acknowledge a need for change, helping them follow through with their plans is the next critical task. Commitment talk implies that a decision has been made, the client is committing to it and attempting to develop a plan.
STAGE #8: SWITCHING BETWEEN MI AND OTHER COUNSELING METHODS
“MI was never meant to be the only tool in a clinician’s repertoire. It was developed primarily to help clients through motivational obstacles to change. Within the language of the transtheoretical stages of change (Prochaska & DiClemente, 1984), MI was originally conceptualized for helping people move from precontemplation and contemplation, through preparation and on to action” (Miller & Moyers, 2006, p. 21). Therefore, therapists must learn to utilize it alongside other methods.
What it is & What it Isn’t