What is Motivational Interviewing?
By definition, Motivational Interviewing is: A collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
So many times in my field of work I see individuals hit rock bottom, or what I think is their rock bottom yet they are still unwilling to change. Why is that? Is it that they are lazy? In denial? Don’t have all the information? When we see that it’s natural to want to take over for them and be the "expert"and tell them what they need to do to make the positive changes in their life. Yet so often that doesn’t work. What is happening for most individuals who are thinking about change is that they will have mixed feelings about it. Ambivalence is a natural state of uncertainty that every person experiences throughout most change processes (i.e. dieting, exercising, remain sober). Ambivalence occurs because of conflicting feelings about the process and outcomes of change. Arguments both for and against change already reside within the ambivalent person. When a helper uses a directing style and argues for change with a person who is ambivalent, it naturally brings out the person’s opposite arguments. For example, I have mixed feelings about introducing a workout regime back into my life. I know the benefits of regular exercise but with three kids it’s hard to fit it in! Now when my sister hears my lack of discipline in the gym she likes to make statements like “You should really try to go to the gym at least 2 days a week, and you keep complaining about lack of energy and that will really help with that.” Now I know it comes from a good place but it becomes a reflex for me to give her all the reasons why it’s hard to exercise right now. I like to respond with “But I’m too busy!” “I would need a babysitter!” “I’m too tired.” You see with a confrontational style of working with individuals who are ambivalent, people can literally talk themselves out of changing if the helper is the only one voicing the pro-change side. What we want to do is create a space where the individual is voicing pro-change arguments or in MI it is known as change talk. How do we do that? In MI the core interviewing skills are Open-Ended Questions, Affirmations, Reflections and Summaries(OARS). What’s nice about these skills is that most counselors or other helping professionals already have these tools in their clinical repertoire. However, in MI we like to use these skills intentionally to help an individual resolve their ambivalence.
Open Ended Questions
What’s great about open-ended questions is that it encourages more elaboration and discussion from the individual than just a quick “yes” or no” response. It’s also nonjudgement and communicates no bias. What I would prefer my sister to ask me is “What are some reasons you want to start to work out again?” Or “What gets in the way of you working out on a regular basis?” I’m going to feel less defensive and I’m going to be able to share my own motivations for making this change.
This skill helps to recognize, support and encourage the individual’s strengths, efforts, achievements, struggles, and values. Affirmations also help build rapport and help display empathy. Wouldn’t it be nice to hear “That’s great that you see the benefits of taking time for yourself which must be hard to do with three kids!” My reaction to a statement like this would be “She gets it!!”
This is the most important skill in MI. The essence of a reflective listening response is a statement that makes a guess as to what the person means. This is the way the helper expresses their interest, empathy and understanding of the individuals. A well-formed reflective statement is less likely than a question to evoke defensiveness and more likely to encourage continued exploration. Furthermore, studies have shown that people report NOT feeling listened to in interviews comprised mostly with questions. With reflections, people report feeling listened to, heard and cared about. Therefore, with reflective listening, individuals are able to speak about what’s on his/her mind rather than answering what is on the listener’s mind. In conversations with my sister about exercising, reflective listening statements such as “This seems important to you” or “You are still wondering how you’re going to fit this all in your schedule” would communicate empathy, attention and interest.
Summaries are essentially reflections that pull together several things that a person has told you. To reflect and summarize is to shine a light on the individual’s experience, inviting further exploration.
In MI we integrate all of the OARS when interacting with the individuals, paying close attention to any change talk statements the individual may make. These change talk statements are the actual words spoken between the helper and individual-clues that will predict behavior change. This can be any speech that expresses desire to change, ability to change, reasons for change, need to change and commitment to change.
Throughout our interactions with the individuals we want to display the Spirit of MI. Four aspects of the underlying spirit of MI are partnership, acceptance, compassion and evocation. This is the mindset that MI is done “for” or “with” someone, not “on” or “to” them. It’s the ability to show accurate empathy as well support autonomy with each individual. In regards to supporting autonomy, this has been particularly helpful when dealing with my own client population. In reality, it really is up to the person whether or not to make a change. The teens I work with are court ordered on our program and often feel helpless that they have any control on the process of their services. They are also desperately trying to develop their independence. It's been a great way for me to respond to any status quo statement towards change or discord when I specifically acknowledge and honor their personal autonomy. The Spirit of MI was once described to me that we want to avoid seeing our clients as half empty glasses where we are seen as the faucets to fill their cup with our own knowledge and ideas. Rather we want to see our clients as half full glasses where we are seen as the straw, pulling up the individual’s own strengths, efforts and achievements. Thus, working with individuals with the MI approach is more like “drawing out” preferred behaviors than “putting in” something individuals lack.
- Disclaimer: The interactions with my sister are fictitious. She knows better than to take on the “expert” role with me and to avoid any potential sibling resentment I have already trained her on Motivational Interviewing