counselling models Archives - Promises Healthcare
ENQUIRY
Motivational Interviewing

Motivational Interviewing

Motivational Interviewing (MI) is a widely used evidence-based technique to encourage behaviour change. According to clinical psychologists William R. Miller and Stephen Rollnick, “MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” In the clinical setting, it has been proven effective in tackling certain issues such as smoking, substance abuse, or other compulsive behaviour disorders including problem gambling, hypersexuality, or compulsive spending. In a way, MI serves as a decision aid and to guide clients towards making the necessary lifestyle changes. It assists clients in weighing the pros and cons of their respective situations, and encourages them to assess the benefits they can reap if they were to change their behaviour. 

 

MI works best for individuals who fall within any one of these categories below. Of course, this is not to suggest that MI doesn’t work for conversations and discussions outside of these categories.

 

  • High ambivalence: These people are still experiencing mixed feelings about their situation. They sit on the fence, contemplating if they should make any changes.
  • Low confidence: These individuals are doubtful of their abilities to make the necessary lifestyle changes in order to overcome difficulties.
  • Low desire: These people are uncertain as to whether they really want to make a change.
  • Low importance: The line between the costs of the current situation and benefits of change is blurred, leaving the situation unclear.

 

In general, there are 4 fundamental processes to MI: 

 

  1. Engaging

As with all other therapeutic methods, establishing a solid and productive therapist-client relationship is extremely important. This involves asking open-ended questions, affirming clients’ strengths, reflecting to clients what they may wish to express but have not yet spoken aloud and summarizing what has occurred in the therapeutic interaction. Having respect for the client’s autonomy is also a key aspect.

 

  1. Focusing

At the beginning, not all clients will have a clear goal in mind, and may lack direction and insight. This process gives the interviewer and the client the opportunity to narrow down on a shared goal or purpose that they can work towards. With that, the clinician is better able to steer the client into a directional conversation about change.

 

  1. Evoking

Essentially, the interviewer needs to be able to pick up on hints or cues which may suggest the client’s willingness to change. Oftentimes, clients may express their desire to change and their fear of the potential consequences if they do not. Interviewers will then employ more open-ended questions to guide the client, giving him a chance to elaborate on his attitudes, thoughts and motivations. Normalising ambivalence and ensuring that sensitive information is explored without judgement is also important.

 

  1. Planning

Planning should come from the clients themselves based on their insights, self-knowledge, values and motivation. Typically, interviewers do not attempt to take full control and to force a commitment plan onto the client. Doing so will not only disempower the client, but also strips the client of his autonomy. However, they can step in when clients are stuck or unsure as to what they can do to make the necessary changes, as long as their advice is wanted.  

 

In a MI, a decisional matrix is often used. This involves an open discussion of the situation at hand, allowing the client to assess the costs and benefits involved. What are the benefits of staying the same, versus the benefits that come with change? What costs are involved if they chose to stay where they are, than if they made changes? MI isn’t about having psychologists force their views on the client and having them follow their orders. By having an open discussion in a safe, non-judgemental space, clients are able to reflect on their behaviour and come to a decision based on a “fair” hearing. By getting clients to think about the costs of staying the same, this also allows for greater cognitive dissonance, making changes more likely. 

 

Another common aspect of MI involves the Columbo approach, which can be characterised as deploying discrepancies. This technique was inspired by 1970s television series Columbo, in which TV detective Columbo would apply it to rationalise discrepancies and to seek additional supporting information. When contradictory information surfaces, the interviewer will then present a question in a way that makes the client reflect on their mindset. For example, a question could be phrased as, “How does your (risky behaviour) fit in with your goals?” 

 

Motivational interviewing is sometimes used on its own or may be combined with other treatment approaches. In short, MI is a method of communication rather than an intervention, and it  serves to help you attain greater confidence in self-improvement and to make crucial behavioural changes for the better. MI doesn’t force you to commit to a plan, nor involve scare tactics to pressure you into making decisions that you feel uncomfortable with. It does, however, motivate you and aims to help you achieve greater clarity on the importance of making a change. If you or a loved one needs to seek professional mental health support, do reach out to our team!

 

References:

  1. https://www.mentalhealthacademy.co.uk/dashboard/catalogue/motivational-interviewing-the-basics (Accessed 13/06/2021)
  2. https://motivationalinterviewing.org/understanding-motivational-interviewing (Accessed 13/06/2021)
  3. https://psychcentral.com/pro/the-four-processes-of-motivational-interviewing#2 (Accessed 14/06/2021)
  4. Miller, W.R.  & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd Edition). Guilford Press.