A Primer on Motivational Interviewing (MI)
MI Helps Clients to Articulate, Plan and Make Needed Changes
Jan 19, 2009
Motivational interviewing (MI) is a way to look together - to "inter-view", not "grill" - with the client into areas of life that are problematic and perhaps even tragic, and to help them create and implement their chosen plan for change.
MI began in the substance abuse field, created by psychologists William Miller, PhD, and Stephen Rollnick, PhD as a means of transforming ambivalence and resistance into a force for positive change. MI itself has transformed into a methodology used by therapists and counselors, MDs, HR staff, supervisors, and other leaders to elicit "change talk" and motivation in the people with whom they work.
Talking Change Increases the Probability that it Will Happen
Researchers and counselors have long known that fighting a client's resistance only succeeds in increasing it. Instead, MI uses resistance as a stimulus to explore the current unsatisfactory situation and to imagine a better future that's important to the client. This heightens cognitive dissonance, which is uncomfortable and must be resolved; MI encourages the client to clarify the discrepancy between current reality and future dreams, knowing that this activity often manifests in changes toward the future.
The MI therapist talks only as necessary, encouraging the client to do the vast majority of the talking. Hearing the changes talked about in their own language and at their own speed facilitates the client's owning and being excited about the change. The therapist supports and guides the change plan as "doable", adding the power of a positive self-fulfilling prophecy/placebo effect into the process.
The Spirit of Motivational Interviewing - Collaboration, Evocation, Autonomy
Collaboration is integral to MI. An authoritarian "power-over" approach is avoided. Counselor and client are partners on this journey, not antagonists, and the client is the expert on him/herself. The counselor knows, and the client learns, that a positive interpersonal climate is more conducive to change and positive outcome.
The counselor speaks to evoke and draw out the client's increasing usage of change talk and motivation to change. Four general principles for evocation are:
- Express empathy. This therapeutic skill as described fully by Carl Rogers is characterized by asking open-ended, nonjudgmental questions for clarification, accepting (though not necessarily agreeing with) the client's views, and reflectively summarizing the client's words to increase understanding.
- Develop discrepancy. Asking open-ended questions about the difference between the here-and-now and the future moves this process along.
- Roll with resistance. Encourage all perspectives as grist for the mill, avoid arguing, and see continued resistance as a signal to change counseling responses.
- Support self-efficacy. The client's belief in their own ability to change is the major motivational engine that is stoked in motivational interviewing.
These principles support the client's autonomy and their responsibility for self-direction, informed choice and successful change.
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