Some of us come into the counseling field with the assumption that people who are struggling will come to therapy with a natural inclination toward change. In reality, even when patients knows their situation is not working for them, they may be up against barriers that keep them from moving forward. No matter how well intentioned, all of the advice in the world is not enough to initiate change in someone who is not fully ready and on-board with the process. And that is why we use motivational interviewing.
At the heart of motivational interviewing (MI) is the goal of evoking change. The decision to make a change takes time and it is rarely an easy process. Whether people don’t have enough information or are simply ambivalent about the changes that are needed in their lives, MI helps get patients unstuck.
The following are the four basic processes of MI, in the order in which they are typically done. Planning cannot happen if you have not engaged the patient. For example:
It may go without saying that any healthy relationship must be based on trust and respect, and it is especially true in the counseling relationship. Client engagement can be achieved in many different ways, but the important thing to note is that nothing else can be done until a connection is established.
Basic counseling skills, such as asking open ended questions, providing positive affirmations and reflecting back to the client what they’re saying can go a long way in the engagement process.
You may also want to avoid bombarding your patient with yes or no questions, making diagnoses, labeling the client, or offering advice before the person has earned your trust.
If change is to happen, a sense of direction is a must. This outcome will likely come from a combination of listening to what the client would like to see change and your own insight about what would constitute an improvement based on your knowledge and expertise in the area.
But it’s important that the individual feels a sense of responsibility and ownership over his or her process, so be mindful that you aren’t defining goals for them, even if you do think you know best.
This process will be on-going. It may shift and change as the client makes progress or experiences setbacks, but the direction toward a valued direction will stay generally the same. Values work that help the patients clarify what’s truly important to them and how they’d like their lives to look can be tremendously useful in this process.
The process of evoking is about drawing out and lifting up the clients’ own desire and motivation to make change in their lives. Look for language that clients use around their relationship to the change they need to happen in their lives. Listen closely for statements about change and make efforts to encourage this “change talk.”
If clients are not talking about change on their own, you can always ask questions to evoke change. You might try exploring why change is needed or wanted, what it might take to happen, what benefits might come with making change, or what consequences might come with not making change.
The final process of MI is about creating a plan of action that will lead to the change the clients have chosen for themselves, with your guidance. This piece of the puzzle is important because it will take into account the information shared during the evoking process—such as what might get in the way of change, and what could potentially be done to break through those barriers.
Plans should always be measurable with clear objectives that correspond to time periods so that you can effectively track whether the patient is making progress or not during your work together.