What is Motivational Interviewing and Why Should I Use It? Psychologist Shelley Jacks explains …
The definition of Motivational Interviewing (MI) has continued to develop over time however the basic concept is still as relevant today as it was in its initial conception by William R. Miller in 1983. He developed the concept whilst working with problem drinkers, and since this time the principles and methodologies of MI have been tested and applied in various settings and found to be very effective.
Motivational Interviewing (2009) is:
“…a collaborative, person-centred form of guiding to elicit and strengthen motivation for change.”
Essentially the purpose of Motivational Interviewing is to use explorative conversation to identify and resolve ambivalence towards change.
This technique can be employed in any type of conversation, about any type of change. In a therapy session, clients often appear “stuck” – unable to make a decision about their situation because of ambivalence to change. They appear to understand, for the most part, a need to engage in a new behaviour, hence their arrival at counselling, however they are unable to move forward and can oscillate backwards and forwards over many sessions without actually ever moving into the action stage.
The most beneficial course of action can often seem clear to the therapist and the temptation is to confront or convince the client of the changes s/he should make, without sufficiently addressing the ambivalence being experienced. Sometimes as therapists, we forget that change is a slow process and often the behaviour or situation requiring change has been around for many years and has many benefits associated with it. Sometimes we are unable to resist the urge to place ourselves in the role of the expert and continue to provide advice, wondering why the client continues to remain the same or even resists our suggestions.
Contemporary explanations of MI include three important aspects. Motivational Interviewing is a conversation about change, a collaboration (not expert-recipient) and evocative (seeks to encourage the person’s inner motivation and commitment)
Important in Motivational Interviewing is the therapeutic alliance, the trust and rapport built between the client and therapist. The focus is on the client’s own view and experiences, not on the therapist as an expert. The therapist seeks to evoke the person’s own motivation rather than impose their views on the client.
MI understands that change occurs when a person discovers their own reasons to change. The client is ultimately responsible for their own decision to change, and is facilitated to identify a number of preferences about how they might attain their chosen outcomes.
Principles of Motivational Interviewing
Miller and Rollnick (1995) described a number of principles which are at the heart of motivational interviewing:
- Express Empathy
Empathy involves “walking in the client’s shoes”, seeing the problem from their perspective. This forms the basis for the client to feel heard and understood. If the client feels as though the therapist “walks alongside them”, they are more likely to be honest and share their experiences fully.
- Support Self-Efficacy
MI is a strengths-based therapy which focuses on previous successes, and highlights skills that the client already has. A therapist who can instil hope in a client and improve their confidence through focusing on strengths they know they have increases the client’s self-efficacy and improves their ability to make changes.
- Roll with Resistance
In MI, therapists avoid eliciting resistance by not confronting the client and when resistance occurs they attempt to avoid an unhelpful interaction and “roll with it”. That is, they do not challenge actions or statements which indicate resistance, particularly early on in the therapeutic relationship.
The focus is on autonomy which facilitates the client to identify their own problems and solutions – this provides little for the client to resist. Counsellors, when exploring the problems, should encourage the client to consider new points of view and not impose their own way of thinking onto the client.
- Develop Discrepancy
The therapist’s focus must be to develop discrepancy between, “where they are and where they want to be”. The client is encouraged to explore how their current behaviour is in conflict with their values or interferes with their future goals. It is only when people feel uncomfortable with the status quo, that they decide to change their lives.
Change talk is defined as statements by the client illuminating contemplation, motivation or commitment to change.
In Motivational Interviewing, the therapist seeks to elicit change talk as a conduit to changing behaviour. Research indicates a definitive correlation between client statements about change and outcomes. Motivational Interviewing uses the psychological law, “I learn what I believe as I hear myself speak”. The more someone talks about change the more likely they are to change. The following mnemonic DARN-CAT illustrates different types of change talk.
Change Talk which indicates Preparation
- Desire (I want to change)
- Ability (I can change)
- Reason (It’s important to change)
- Need (I should change)
And the most predictive of a positive outcome:
Change Talk which indicates Action
- Commitment (I will make changes)
- Activation (I am ready, prepared, willing to change)
- Taking Steps (I am taking specific actions to change)
Strategies for Eliciting Change Talk
Your therapist may use any or all of the following when utilising the Motivational Interviewing technique.
- Open Questions – Use open questions that are likely to illicit change talk.
- Look for the Nuggets of Gold – When change talk emerges, explore it in more depth, ask many open questions about it.
- Use a Cost/Benefit Analysis – explore the pros and cons of changing and staying the same.
- Look Forward – Ask what would happen if things were to continue on the way they have been. Try the miracle question, explore the answer in detail.
- Explore both sides – This involves the good things as well as the not-so-good things, look at the not-so-good things in more depth.
- Explore Extremes – What is the worst thing that might happen if you don’t change? What is the best thing that could happen if you do change?
- Look Back – To the time before the target behaviour and ask – What it was like? Was it different? How did you cope?
- Use Continuums – On a scale from 1-10, how important is it that you change? And why did you place yourself __ and not __? How could you move yourself from__ to __? What are the barriers likely to get in your way?
- Use the Internalised Other – If your son/daughter was here what would they say about….?
- Explore Goals and Values – Identify the person’s guiding values. Ask how the target behaviour fits with their values or goals. Build discrepancy if it doesn’t.
- Play the Devil’s Advocate – Maybe it is just too important for you to maintain the current behaviour?
- Identify the Options – Facilitate the client to list a range of ways to make the change. If they are struggling, tentatively make some suggestions, however empower the client to make the final decisions. Some people find suggestion helpful, what do you think?
- Explore Strengths – Let’s look at time you made a change in your life, how did you do that? How did it feel to be successful in that area? What can you use from that time in your life to help you now?
If Motivational Interviewing sounds like something that could be of benefit to you, please make an appointment with me!
Author: Shelley Jacks, B Psych (Hons), AMAPS.
Shelley Jacks is a psychologist with nearly a decade of experience delivering therapy to mandated clients both in groups and individually. Shelley delivers training in Motivational Interviewing and Group Facilitation. She is an engaging and enthusiastic presenter and facilitator. Training can occur at M1 Loganholme or on your premise. Please contact Shelley for a quote.
To make an appointment with Shelley Jacks try Online Booking – Loganholme or call M1 Psychology (Loganholme) on (07) 3067 9129.
- Rollnick, S., & Miller, W.R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334.
- Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.
- Miller, W.R. & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. 2nd Edition. New York: Guilford Press.