Understanding Motivational Interviewing

“People are more likely to be persuaded by what they hear themselves say.”- William R. Miller

As the quote above indicates, you can be your own motivation. When you find your reasons to change, you will begin the journey toward healing. However, quite often, the first step is the most difficult to take. Many can require just that bit of encouragement and support to explore these reasons. This is where motivational interviewing (MI) can be very effective. MI is a client-centered interviewing technique that engages, focuses, evokes, and plans for change.

If you find yourself feeling a bit stuck or ambivalent toward making changes in your life, then MI can be an excellent choice to begin with.

Motivational Interviewing (MI) is a client-centered psychotherapy (or therapy) that enables you to explore and enhance your motivation to change. Developed by William R. Miller and Stephen Rollnick, this method was found to be effective when people showed ambivalence about making changes in their life. Specifically, in regard to overcoming substance use disorders and mental health challenges.

In contrast to traditional therapy, motivational interviewing therapy focuses on your feelings and desire to increase responsibility for your actions. Motivational interviewing techniques have been very effective in bringing about behavioral changes, such as reducing alcohol and tobacco consumption.

Motivational interviewing therapy is built on four core principles that develop a trustful, collaborative relationship between the therapist and the client. These are:

Express Empathy:

At the core of MI is empathy. First, your therapist will seek to understand the context of your ambivalence to change. Many times, a person may be ashamed of this ambivalence as they know the path they are on is dangerous. So, the therapist will explore both sides of the coin and express empathy, even toward the side that others may consider negative.

Develop Discrepancy:

Discrepancy can be used as a tool to instill change. When your therapist sheds light on the discrepancy between where you are and where you wish to be, it can instill the motivation to change. While this can be discomforting, it will be beneficial in motivating you toward your desired outcomes.

Support Self-Efficacy:

MI is empowering. It is based on the principle that there is a potential for change in every person. You will find motivation to change when you are encouraged to take a proactive role in their therapy. Your therapist will support self-efficacy by making you aware of your strengths, skills, and past achievements.

Rolling With Resistance:

For MI therapists, resistance to change is expected. You will find that your therapist will not confront or debate you; rather, they will explore your perspective and ambivalence so that you can reach a point where you are in congruence with your goals.

Reflective listening, open-ended questions, and summarizing are some of the tools your therapist will use to overcome resistance.

The “spirit” of MI is collaborative and empowering. To elaborate a bit further:

Collaboration Over Confrontation:

In MI, you and your therapist are equal partners. Your therapist will facilitate your interest in making changes. They will seek to develop a trusting relationship within which you can open and move forward.

As your therapist will approach you with empathy and little to no intrusion, you will slowly begin to take responsibility for your healing.

Evocation, Not Education:

Unlike traditional therapy, where the therapist takes a more directive role, MI elicits within you the reasons to change. The belief is that motivation must come from within (intrinsic motivation) for lasting psychological and behavioral change.

Autonomy Over Authority:

MI leaves one thing crystal clear: the power to change is within you, not with your therapist or any other external force or entity. MI respects and celebrates your autonomy, thereby facilitating an empowering journey toward healing.

In their book “Motivational Interviewing: Helping People Change,” the creators of MI, Miller and Rollnick, defined the four processes of motivational interviewing that establish a positive therapist-client relationship.

1. Engaging:

Engagement is at the crux of a strong therapeutic relationship. It indicates that your therapist is invested in you and wants the best for you. Typically, the therapist uses empathy, autonomy, acceptance, and OARS (open questions, affirmations, reflections, and summaries) for strong engagement.

Engagement is not a one-and-done thing. It is ongoing. It assures you that you enter the therapeutic relationship knowing that your therapist will not enforce changes; rather, it is you who will find the motivation to change.

2. Focusing:

Focusing means goal setting. Everybody is different, so your needs and goals will be different from the next person. With collaborative goal setting, you and your therapist can ensure that the therapy is aligned with your goals and expectations.

3. Evoking:

Once you and your therapist have set the focus, you move toward the most unique aspect of MI. This is what sets it apart from other therapies. In evoking, your therapist will seek to engage you in “change talk.” The change talk will center around the goals you set during focusing. For instance, if your present talk is, “I know I need to quit smoking, but somehow, I cannot do it,” then your change talk will be, “I know I need to quit smoking.”

Once again, your therapist will use OARS in evoking. The goal is not to advise or direct you toward change but to enable you to find reasons for change within yourself.

4. Planning:

Planning is somewhat like the culmination of MI. It follows evoking, where your therapist will trust that you are the expert on your life. You will proactively plan on how to incorporate changes in your life.

You can rely on your therapist for expertise and to explore barriers that may hinder your path to change. Regardless, you find yourself motivated to make lasting positive changes in your life.

Therapists use a range of motivational interviewing techniques to motivate positive change:

1. Open-Ended Questions:

Open-ended questions allow for deeper reflection. Rather than a simple yes or no answer, these questions call for more significant responses that involve introspection and exploration. Examples are:

• “How would you like things to be different?”
• “What have you done in the past when problems arose?”

2. Affirmations:

Affirmations acknowledge your strengths and past achievements. They reassure you that you are capable of making changes by boosting your self-esteem and confidence. Examples are:

• “You have faced this challenge with a lot of strength and perseverance.”
• “It took a lot of courage to come for help today.”

3. Reflective Listening:

Reflective listening is when your therapist mirrors your thoughts and emotions. It assures you that you are heard and understood. Reflecting back to you clarifies your thinking and feelings, and also serves as feedback. For example,

• “It sounds like you are feeling quite undecided about what to do next.”

4. Summaries:

Summaries put together your thoughts, emotions, and ideas. They give a clear overview of your conversations with your therapist. You can see how far you have come and where you have to go from here on.

Motivational interviewing was initially developed to treat substance use disorders. In time, it has expanded and is now being used in the treatment of a broad spectrum of mental, behavioral, and physical health conditions:

• Substance Use Disorders: MI helps reduce and quit substance use. In fact, it is a crucial part of the Matrix Model, which involves MI, cognitive behavioral therapy, contingency management, and 12-step recovery programs.
• Physical Activity: Instills motivation toward regular exercise.
• Diet and Obesity: By instilling the motivation toward modifying lifestyle, MI can bring positive changes in diet and obesity.
• Diabetes Management: As diabetes is a chronic condition, MI instills motivation toward making lifestyle changes so as to better manage the condition.

Struggles are a fact of life. At the same time, overcoming struggles is also a fact of life. There are many things you know you need to do, but you fight against them. At the NuView Treatment Center, we recognize ambivalence exists, and there is no shame in it. Once you acknowledge it, you can begin to change it. The power to change is within you. We can empower you to bring it out.

References:

• Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change. Guilford Press.
• Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527.
• Morton, K., Beauchamp, M., Prothero, A., Joyce, L., Saunders, L., Spencer-Bowdage, S., ... & Pedlar, C. (2015). The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health Psychology Review, 9(2), 205-223.