According to its founders William Miller and Stephen Rollnick, motivational interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation to change in a counseling setting.
By steering conversations with patients in a certain way, motivational interviewing aims to help the person to realize his or her own personal and genuine motivation for changing problem behaviors. Though the clinician still guides the work in a particular direction, motivational interviewing should aim to inspire the patient to create and formulate a plan for moving toward appropriate therapeutic goals for him or herself.
Motivational interviewing (MI) is not in itself a psychotherapeutic modality but rather a tool to be used in conjunction with other comprehensive approaches to counseling ”for inspiring change in clients who may otherwise feel neutral about their situations or even reluctant to change. MI consists of four key, client-centered processes that work together to help the individual define his or her goals and begin to move toward them. These processes work together to guide patients toward their motivation for change and to move forward accordingly.
The following represent a limited explanation of each of the four processes. For more in-depth information about MI, there are many wonderful resources available, including a newly revised edition of Motivational Interviewing in the Treatment of Psychological Problems.
Establishing a solid therapeutic relationship is a foundational component of motivational interviewing. Qualities like empathy, acceptance, a focus on client strengths and mutual respect create the foundation for such an alliance.
Mutual respect is made possible in part by the establishment of a quality of collaboration between the counselor and patient so that the client-centered approach is not stymied by power dynamics. Encouraging a tone of equal partnership in a counseling relationship requires that the counselor be willing to not only acknowledge, but lean on the patient’s strengths, knowledge, wisdom and values throughout the process of doing the work.
Engaging also involves four client-centered skills that are abbreviated by the acronym OARS. OARS involves asking open 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.
While some therapeutic situations will come with some obvious focal points or goals–as in the case of court-ordered counseling, for instance, many will not.
Some clients will come in with material they are immediately ready to go to work on, while others may lack insight and direction regarding the next steps to take. Focusing is about helping the client determine what is truly important to him or her and using that information to set the tone for the work.
The goals should, of course, be mutually agreed upon by both client and therapist, but the focus in MI is on encouraging the person to do the work of identifying his or her own area of stuckness, ambivalence or struggle and setting goals accordingly.
Once a focus has been identified and is mutually agreed upon, evoking involves discovering the client’s personal interest in and motivation to change. Being able to recognize when clients say something that suggests they may be willing or ready to move toward change is an important part of the evoking process.
Patients may make a statement that expresses their desire to change, that they know they are able to change, that they are concerned about consequences if they don’t change or that change is absolutely critical to their ability to move forward. Such statements hold important information about whether or not the client is open, willing or ready to change.
But knowing how to invite this sort of “change talk” is an important part of MI. Open-ended questions are a useful tool for evoking this sort of talk and better understanding the client’s relationship and attitudes toward change. Asking for clients to share examples or elaborations on their responses to your open-ended questions about change is another good way to gather information. Once the individual is engaging in change talk, be sure to reflect and summarize, as mentioned in the OARS acronym above.
The important thing about the planning process in motivational interviewing is that the plan comes from the clients and is based on their unique values, wisdom and self-knowledge. Each of the four processes are geared toward fostering and building the clients’ motivation to change, and any attempts on behalf of the counselor to “take the reigns” during the planning process may undermine or reverse the client’s sense of empowerment.
That said, as a counselor you are responsible for inserting your expertise when warranted. For example, clients may express clearly that they want to change, have to change or even that they are ready to change, but they may be stuck on how to go about doing so. This situation is where your expertise comes in. As long as your advice is wanted, your input can be a valuable part of guiding the client toward creating a plan that they feel great about and motivated to stick with. If you’re not sure whether or not your advice is wanted, you can always ask.
For more about motivational interviewing in counseling, check out Motivational Interviewing in the Treatment of Psychological Problems.