Lably
Skip to content

Motivational interviewing

Approach to psychological counseling

  • 23 min read
  • 5 chapters

Related on Lably

Through Person-centered therapy, Motivation and Empathy

Lab · Class 11Empathize & Define

Core concepts evolved from experience in the treatment of problem drinkers, and MI was first described by Miller (1983) in an article published in the journal Behavioural and Cognitive Psychotherapy. Miller and Rollnick elaborated on these fundamental concepts and approaches in 1991 in a more detailed description of clinical procedures. MI has demonstrated positive effects on psychological and physiological disorders according to meta-analyses.

Overview

Motivational interviewing (MI) is a person-centered strategy. It is used to elicit patient motivation to change a specific negative behavior. MI engages clients, elicits change talk and evokes patient motivation to make positive changes. Change talk refers to statements made by clients that express desire, ability, reasons, or need for change. For example, change talk can be elicited by asking the patient questions such as: "How might you like things to be different?" or "How does ______ interfere with things that you would like to do?"

Unlike clinical interventions and treatment, MI is the technique where the interviewer (clinician) assists the interviewee (patient) in changing a behavior by expressing their acceptance of the interviewee without judgement. By this, MI incorporates the idea that every single patient may be in differing stages of readiness levels and may need to act accordingly to the patient's levels and current needs. Change may occur quickly or may take considerable time, depending on the client. Knowledge alone is usually not sufficient to motivate change within a client, and challenges in maintaining change should be thought of as the rule, not the exception. The incorporation of MI can help patients resolve their uncertainties and hesitancies that may stop them from their inherent want of change in relation to a certain behavior or habit. At the same time, it can be seen that MI ensures that the participants are viewed more as team members to solve a problem rather than a clinician and patient. Hence, this technique can be attributed to a collaboration that respects sense of self and autonomy.

To be more successful at motivational interviewing, a clinician must have a strong sense of "purpose, clear strategies and skills for such purposes". This ensures that the clinician knows what goals they are trying to achieve prior to entering into motivational interviewing. Additionally, clinicians need to have well-rounded and established interaction skills including asking open ended questions, reflective listening, affirming and reiterating statements back to the patient. Such skills are used in a dynamic where the clinician actively listens to the patient then repackages their statements back to them while highlighting what they have done well. In this way, it can improve their self-confidence for change.

Furthermore, at the same time the clinician needs to keep in mind the following five principles when practicing MI.

Express empathy

This means to listen and express empathy to patients through the use of reflective listening. In this step, the clinician listens and presents ideas the patient has discussed in a different way, rather than telling the patient what to do. This hopes to ensure that the patient feels respected and that there are no judgments given when they express their thoughts, feelings and experiences but instead, shows the patient that the clinician is genuinely interested about the patient and their circumstances. This aims to strengthen the relationship between the two parties and ensures it is a collaboration, and allows the patient to feel that the clinician is supportive and therefore will be more willing to be open about their real thoughts.

Develop discrepancy

This means to assist patients in developing discrepancies between the current self and what they want to be like in the future after a change has taken place. The main goal of this principle is to increase the patient's awareness that there are consequences to their current behaviors. This allows the patient to realize the negative aspects and issues caused by the particular behavior that MI is trying to change. This realization can help and encourage the patient towards a dedication to change as they can see the discrepancy between their current behavior and desired behavior. It is important that the patient be the one making the arguments for change and realize their discrepancies themselves. An effective way to do this is for the clinician to participate in active reflective listening and repacking what the patient has told them and delivering it back to them.

Avoid arguments

During the course of MI the clinician may be inclined to argue with a patient, especially when they are ambivalent about their change and this is especially true when "resistance" is met from the patient. If the clinician tries to enforce a change, it could exacerbate the patient to become more withdrawn and can cause degeneration of what progress had been made thus far and decrease rapport with the patient. Arguments can cause the patient to become defensive and draw away from the clinician which is counterproductive and diminishes any progress that may have been made. When patients become a little defensive and argumentative, it usually is a sign to change the plan of attack. The biggest progress made towards behavior change is when the patient makes their own arguments instead of the clinician presenting it to them.

Roll with resistance

"Rolling with resistance" is now an outdated concept in MI; in the third edition of Miller & Rollnick's textbook Motivational Interviewing: Helping People Change, the authors indicated that they had completely abandoned the word "resistance" as well as the term "rolling with resistance", due to the term's tendency to blame the client for problems in the therapy process and obscure different aspects of ambivalence. "Resistance", as the idea was previously conceptualized before it was abandoned in MI, can come in many forms such as arguing, interrupting, denying and ignoring. Part of successful MI is to approach the "resistance" with professionalism, in a way that is non-judgmental and allows the patient to once again affirm and know that they have their autonomy and that it is their choice when it comes to their change.

Support self-efficacy

Strong self-efficacy can be a significant predictor of success in behavior change. In many patients there is an issue of the lack of self-efficacy. They may have tried multiple times on their own to create a change in their behavior (e.g. trying to cease smoking, losing weight, sleep earlier) and because they have failed it causes them to lose their confidence and hence lowers their self-efficacy. Therefore, it is clear to see how important it is for the patient to believe that they are self-efficacious and it is the clinician's role to support them by means of good MI practice and reflective listening. By reflecting on what the patient had told them, the clinician can accentuate the patient's strengths and what they have been successful in (e.g. commending a patient who had stopped smoking for a week instead of straining on the fact they failed). By highlighting and suggesting to the patient areas in which they have been successful, this can be incorporated into future attempts and can improve their confidence and efficacy to believe that they are capable of change.

While there are as many differences in technique, the underlying spirit of the method remains the same and can be characterized in a few key points:

  1. Motivation to change is elicited from the client, and is not imposed from outside forces.
  2. It is the client's task, not the counsellor's, to articulate and resolve the client's ambivalence.
  3. Direct persuasion is not an effective method for resolving ambivalence.
  4. The counselling style is generally quiet and elicits information from the client.
  5. The counsellor is directive, in that they help the client to examine and resolve ambivalence.
  6. Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction.
  7. The therapeutic relationship resembles a partnership or companionship.

Ultimately, practitioners must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.

Sign in to keep reading

4 more chapters are free with a Lably account.

More in Health

Food and Drug AdministrationFederal agency of the United States Department of Health and Human ServicesCenters for Disease Control and PreventionUnited States government public health agencyNauseaMedical symptom or conditionSeizurePeriod of symptoms due to excessive or synchronous neuronal brain activityVomitingExpulsion of stomach contents via the mouth or noseIntravenous therapyMedication administered into a vein