What is Motivational Interviewing? It is a system of interacting with clients that is designed to assist them in buying into their own wellness and taking responsibility for their treatment. It was developed by Bill Miller and Steven Rollnick in the early 1990’s. They define Motivational Interviewing as, “A directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.” It is based on building empathy and compassion and a spirit of collaboration between the client and the therapist. It follows a “do no harm” approach. One of the key points in Motivational Interviewing is to engage with the client where they are in the change process, staying true to the essence of Carl Rogers client centered therapy, which is the heart of Motivational Interviewing.
Motivational Interviewing is non-confrontational. It is based on principles of partnership, acceptance, compassion, and evocation. The responsibility for change belongs to the client. The counselor is not the expert here, and makes this clear by deferring to the client and saying, “It’s up to you.” The freedom of choice lies with the client. Nothing in the therapeutic process is forced upon him. The client and the counselor negotiate, and a delicate dance takes place between them as rapport is established, as trust is built, as ambivalence is overcome, as goals are achieved. Unlike confrontational approaches, there is no wrestling involved.
How are these concepts integrated into the therapy sessions? The counselor asks evocative, open-ended questions; asks for collaboration; asks for examples; reflects; asks about the projected future if current behaviors continue. The goal of Motivational Interviewing is to help clients to be less defensive, to help them feel more accepted. Clients are then more likely to stay in treatment and less likely to relapse. The approach draws upon the client’s capacity to change, the client’s own ability to come up with and create solutions to solve problems. It is empowering and affirming, while still being realistic because goals are generated by the client and therapist together. Goals are flexible and attainable.
Motivational Interviewing is perfect for working with clients displaying a high level of ambivalence toward their treatment. It helps shed light on inconsistencies in thought, behavior, values, and emotions. Questions are often like, “And how is that working out for you?” “How does that support you toward achieving your goal?” And for clients who are already committed to change, the spirit of this approach is very affirming. It involves engaging with the client, narrowing their focus to develop goals, building on their motivation to change, and planning how to achieve these goals.
Counseling skills used in Motivational Interviewing are the essentials: rapport, empathy, active listening, reflection, affirmations, feedback, open-ended questions. One tenet of Motivational Interviewing is the eighty-twenty rule: the counselor should be listening eighty percent of the time and talking twenty percent. Open-ended questions, reflections/affirmations, and prompts are designed to get the client talking and to keep him talking. Counselors summarize periodically during the session to communicate the main points and to clarify what has been discussed.
Motivational Interviewing helps move a client toward change. A client will begin to use “change talk,” language that indicates readiness to change by saying things such as, “I am prepared to…” or “I am willing to…” Then the client will start to say phrases like, “I will…,” “I promise…,” “I am going to…” Counselors should listen for steps clients have taken to support their goals and affirm the efforts that have been made. Use the client’s own words in reflecting their change talk back to them. Any discord that arises between the client and the therapist is a sign to take a few steps back and resume work on trust-building and collaboration. It is an indicator for the counselor to show more empathy. Discord indicates that a nerve may have been touched. The clients fears are kicking in. Arguing with the client is not condoned by Motivational Interviewing. Rather, it’s important for the counselor to take a step back, refocus, and try to help client tap into his or her capacity and desire for change.
Being person-centered in nature, Motivational Interviewing integrates well with other therapies and can be used in any case where there may be some ambivalence on the client’s part.
All information in this article was taken from a workshop handout: A Guide to Motivational Interviewing. Sponsored by Gateway Foundation, and presented by Gaia McVey, MS, LCPC, A’nna Jurich, MS, LCPC, and Robert Gimmer, MS, LCPC in July of 2015.
For more information:
Motivational Interviewing: Preparing People for Change, 3rd Edition ( Applications of Motivational Interviewing). Miller, W. R., & Rollnick, S. 2013. Guilford Press, New York, New York.