Motivational interviewing (MI) is a therapy approach that works on facilitating and engaging intrinsic motivation within a client in order to change behavior. While it is goal oriented, it is also client-centered, meaning that the course is less directed by a therapist and focused on the level of the client. the therapist and client are in more of a partnership rather than in an expert/client relationship. MI starts by targeting, exploring, and working to resolve ambivalence about treatment, behavior, or change. Unlike other client-centered approaches, it is not completely non-directive, but the goal oriented nature allows the therapist to attempt to influence clients to consider making necessary changes by reaching their own level of motivation. Meaning the therapist is intentionally directive in achieving the primary goal of the resolution of ambivalence. It is important to balance that directive nature with the idea that MI is also non-judgmental, non-confrontational, and non-adversarial.
MI allows the recognition and acceptance that clients who are in need of change in their lives will approach therapy in differing levels of readiness to change, ranging from actively attempting and working towards change to not yet wanting or being ready for change. MI strives to motivate and move a client gently through the stages of readiness for change. This may be done through focusing on the pros and cons of change, examining the problems behaviors have caused in life, or focusing on the benefits on the future the change would cause. No matter the technique, MI strives to help a client think differently about their behavior and accept how change will effect their future.
Goals of Motivational Interviewing:
The primary goal of MI is to identify ambivalence and work to resolve it; however, the other goals of MI are to engage clients, encourage change talk, and evoke motivation to make positive changes. Having knowledge of why change is important is generally not enough to achieve these goals; rather, making and maintaining change requires collaboration not confrontation, evocation not education, autonomy not authority, and exploration not explanation. It is often believed that the concepts and goals or spirit of motivational interviewing is more important than the formal techniques; however, there are a number of beliefs/concepts or techniques that are considered standard practice.
General Processes:
Engaging: involving the client in talking about issues, concerns, and hopes in order to create a trusting relationships between therapist and client. It is the client’s responsibility to verbalize and resolve ambivalence. This means direct persuasion does not work and it must be an engaged interaction between client and therapist.
Focusing: narrowing the conversation to habits or patterns that the clients wants to change.
Evoking: eliciting client motivation for change by increasing the importance of change, their confidence about the change they need to make, and building on their readiness to change. Change is to be elicited from within the client not without, or by focusing on the client’s intrinsic values and goals to motivate change.
Planning: developing the practical steps the client needs or wants to do in order to start and make the changes they want. In this area the therapist is directive in helping the client to examine and resolve ambivalence as well as determining how to make changes.
Create Environment: the therapist is generally more quiet and encouraging in MI. Confrontation and persuasion are avoided, focusing more on quiet and encouraging.
Assessing Readiness: assessing readiness to change is an ongoing process and fluctuates. It is not a straight path and the therapist must be attentive and responsive to the motivational signs. Also, ensuring that resistance is not generated by jumping ahead of the client.
Basic Skills:
In Motivational Interviewing there are core skills that are strategically used to achieve goals, while addressing a variety of topics; a typical day, the importance of change, confidence, the future, etc. All of these are done in a warm, genuine, and empathetic environment that encourages positive growth while focusing on the present. Some basic examples are asking open ended questions, providing affirmations, reflective listening, and providing summary statements.
- Reflective Listening: seeking to understand the person’s frame of reference.
- Providing Affirmations: expressing acceptance and affirming the client’s ability to self-direction.
- Providing Summary Statements: eliciting and selectively reinforcing the client’s own self motivational statements expressions of problem recognition, concern, desire and intention to change, and ability to change by summarizing them back to the client.
