Motivational Interviewing

Chapter 4

What is Motivational Interviewing?

What is Motivational Interviewing?

There is a fundamental spirit of MI that is much more important than any particular set of techniques 

Important aspects of that spirit include collaboration, evocation and autonomy

Collaboration

• The counselor avoids an authoritarian one-up stance, instead communicating a partner-like relationship.

• Exploration and support rather than persuasion or argument

Evocation

• The interviewers tone is not one of imparting things (such as wisdom, insight, reality) but rather of eliciting, or finding these things within and drawing them out from the person

Evocation

• It is not an instilling or installing but, rather, an eliciting, a drawing out of motivation from the person

Autonomy

• Responsibility for change is left with the client

• Respect is shown for the individual's autonomy

Autonomy

When motivational interviewing is done properly, it is the client rather than the counselor who presents the arguments for change

There are four general principles of Motivational Interviewing

1. Express empathy

2. Develop discrepancy

3. Roll with resistance

4. Support self-efficacy

Express Empathy

• A client-centered and empathic counseling style is one fundamental and defining characteristic of motivational interviewing

• The counselor seeks to understand the client's feelings and perspectives without judging, criticizing, or blaming

Express Empathy

• Acceptance is not the same thing as agreement or approval

• The crucial attitude is a respectful listening to the person with a desire to understand his or her perspective

Express Empathy

• The attitude of acceptance and respect builds a working therapeutic alliance and supports the client's self-esteem, which further promotes change.

Develop Discrepancy

• Motivational interviewing is intentionally directive -- directed toward the resolution of ambivalence in the service of change

Develop Discrepancy

• Motivational interviewing is specifically directed toward getting people unstuck, helping them move past ambivalence toward positive behavior change

Develop Discrepancy

• A second general principle of motivational interviewing is thus to create and amplify, from the client's perspective, a discrepancy between present behavior and his or her broader goals and values.

Develop Discrepancy

• If the behavior gap is very large, it can decrease motivation by diminishing confidence

Develop Discrepancy

• When skillfully done, motivational interviewing changes the person's perceptions (of discrepancy) without creating any sense of being pressured or coerced.

Develop Discrepancy

• People are often more persuaded by what they hear themselves say than by what other people tell them.

Roll With Resistance

• Resistance that a person offers can be turned or reframed slightly to create a new momentum toward change

Roll With Resistance

• In motivational Interviewing one does not directly oppose resistance but, rather, rolls or flows with it

Roll With Resistance

• What to do about a problem, if anything, is ultimately an individual decision

• It is not the counselor's job to provide all the answers and generate all the solutions

Roll With Resistance

• It is assumed that the person is a capable and autonomous individual, with important insight and ideas for the solution of his or her own problems

Roll With Resistance

• Resistance is an interpersonal phenomenon, and how the counselor responds will influence whether it increases or diminishes

Support Self-Efficacy

• Hope and faith are important elements of change

• A general goal of motivational interviewing is to enhance the client's confidence in his or her capability to cope with obstacles and to succeed in change

Support Self-Efficacy

• A person may also be encouraged by the success of others or by his or her own past successes in changing behavior

Summary

• It is vital to understand the overall spirit and underlying assumptions of the method

• Motivational interviewing is a skillfull clinical method, not a set of techniques that can be easily learned

Summary

Motivational interviewing is more than a set of techniques for doing counseling.  It is a way of being with people.