Motivational Interviewing

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Motivational Interviewing ❊

Founders

❊ Developed Motivational Interviewing together in the 1980s

❊ Evolved from Carl Roger’s person-centered approach to counseling & therapy

❊ Believe that people tend to back off & resist when information & advice is inserted into them

❊ Originally developed to help those with substance use disorders, but has since been applied to many other fields

William R. Miller

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Stephen Rollnick

Basic Principles

Motivational Interviewing:

A client-centered, collaborative, goal-oriented style of communication for enhancing intrinsic motivation & commitment to change by eliciting & exploring the person’s own reasons for change within an atmosphere of acceptance & compassion

Rather than asking:

“Why isn’t this person motivated?”

Ask:

“What is this person motivated for?”

do not assume you know

Goals of Counseling

Spirit of Motivational Interviewing

❊ Emphasizes not just WHAT the counselor does, but HOW they do it

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❊ By embodying both mindset & heart set, counselors can create a collaborative relationship that respects the client’s wisdom, autonomy, & readiness to change

Further Insights

  • ❊ “Dancing Instead of Wrestling”

    ❊ Counselor & client should work together as two experts - the counselor as the clinical expert, & the client as an expert of their own behaviors, motivations, attitudes, & barriers

    ❊ Collaboration NOT confrontation

  • ❊ Counselor acknowledges that everybody has an inherent worth & provides positive appreciation of this in an unconditional manner, showing support of autonomy, empathy, & respect to the client

    ❊ Emphasize client control & choice & honor this right

    ❊ Autonomy NOT Authority

  • ❊ Sincere commitment to prioritize the client’s well-being & act in their best interest

    ❊ Showing a heartfelt desire to alleviate suffering & support growth

    ❊ Demonstrate genuine care for client & listen deeply

  • ❊ Counselor encourages & aids the client to generate their own action plan to change their behavior

    ❊ Motivation for change is elicited by drawing on the client’s own perceptions, experiences, & goals

    ❊ Counselor conveys curiosity & optimism to show the client that their ideas, strengths, & internal resources are valued & sufficient

    ❊ Evoking change is NOT educating for change

Motivational Interviewing = Empathy + Change Talk

Role of Counselor

Help clients explore their own reasons for change & support in developing a plan to enact those changes

❊ Reduce/Minimize resistance

❊ “Roll with Resistance”

❊ Explore discrepency between behavior & values/goals

❊ Resolve ambivalence

❊ Elicit “change talk” & move into behavior change

❊ Support their client’s self-efficacy by reinforcing their power to make the changes they want

❊ Directive, client-centered counseling style

❊ Empathetic, collaborative, supportive, autonomy, respect

Therapeutic Process

❊ MI progresses through four processes

1. Engaging: Building rapport and trust

2. Focusing: Narrowing the conversation to areas of desired change

3. Evoking: Exploring the client’s motivations, values, & ambivalence to encourage change talk

4. Planning: Developing a concrete plan of action based on the client’s readiness

Therapeutic Techniques

❊ OARS Framework:

❊ Open-Ended Questions: Encourage clients to elaborate on their thoughts

❊ Affirmations: Recognize & validate the client’s strengths and efforts

❊ Reflective Listening: Mirror the client’s words & feelings to show understanding

❊ Summarizing: Recap key points to highlight progress & ensure clarity

❊ Eliciting Change Talk: Encouraging statements that indicate readiness or desire for change (e.g., "I want to stop drinking")

❊ Decisional Balance: Exploring pros & cons of the current behavior & change

❊ Scaling Questions: Assessing readiness, confidence, & importance of change on a scale from 0 to 10

❊ Rolling with Resistance: Avoiding arguments & reframing client resistance as an opportunity for discussion

LIMITATIONS

Multicultural Groups

❊ Very responsive to diverse populations due to focus on therapeutic relationship & getting to know the client’s wants, needs, & life experiences

❊ Core conditions (respect, acceptance, & cultural awareness) are very helpful for understanding cultural differences

❊ Phenomenological view, as well as respectful & accepting view of human nature

❊ Consider the cultural definition of the Self & self-concept

❊ Be aware of the importance & role of the collective/family as this may be at odds with the pursuit of self-actualization & the idea of autonomy

❊ Unconditional positive regard may seem insincere to some

❊ May need to adjust expectations around self-disclosure as some cultures may view this differently when interacting with a perceived authority figure

Application of MI