Do you ever talk with people who tell you they have a goal to lose weight, get a different job, stop drinking so much, be a better spouse, or a more attentive parent but they don’t ever reach their goal? Although desire is a prerequisite to reaching goals, more is required to attain results. As a counselor, I have helped thousands of people over the past 24 years make progress toward achieving their personal goals. One of the treatments I have found to be effective in doing this is Motivational Interviewing.
Motivational Interviewing first emerged in Norway in 1982. It is a collaborative conversation style between a helper and a person desiring to make a positive change. Motivational Interviewing (MI) is designed to strengthen the person’s motivation and commitment to a specific goal. As a helper, we are to create an atmosphere of acceptance and compassion while asking open-ended questions that elicit the person’s own reasons for making their desired behavior change. MI can be used as a standalone treatment; although when it is combined with other evidence- based treatments it enhances treatment outcomes.
The styles of communication used in MI have not only been found to produce positive results for people struggling with substance abuse, but also proved effectual with probationers in lowering recidivism rates, and with insubordinate employees, by increasing cooperation with supervisors in the work place. Many mental health facilities worldwide have added MI to their assessing and treatment planning protocol for behavior change with their clientele.
William Miller, Ph.D., further developed MI in the United States during the late 80’s while treating drug and alcohol dependent clients at an inpatient treatment center. Miller’s colleagues were complaining that their clients were ‘difficult,’ ‘resistant,’ ‘in denial,’ and ‘out of touch with reality.’ When he was working with these clients, he did not experience the same types of problems. This led him to question whether or not the complaints were a client problem or a counselor skill issue. He then set out on a quest to discover how to counsel in a way that evoked people’s own motivation for change rather than putting them on the defensive.
After many years of researching specific communication styles that decreased resistance and increased successful outcomes Miller, along with Stephen Rollnick, Ph.D., published their findings, in the book Motivational Interviewing: Preparing People to Change Addictive Behavior (1991). Their findings showed that when MI techniques were used, there was a 51% decrease in alcohol use, substantially fewer relapses, and double many of the positive outcomes of 12- step, or Cognitive Behavioral Therapy treatments. When using MI, developing a collaborative relationship with the person desiring the change is crucial for the treatment to be effective. This interpersonal relationship is based on the helper coming from the perspective that the person desiring the change is the expert on him or herself. As the helper we do not tell the person what their goals should be or how they must proceed in reaching them. We develop this collaborative relationship through asking open-ended questions, which evoke the person’s internal strengths and resources.
Most open-ended questions start with How, What, Why and Tell me. Some examples of open ended questions might be:
What would you like to accomplish from our time together today?
How do you want your life to be different?
Tell me what you don’t like about the way your life is right now
Why do you think you have a drinking problem?
What kind of a life do you have to create that would make you want to stay sober for it?
Through extensive research in working with clients, Miller and Rollnick discovered that people were blocked in their ability to change when they experienced themselves as unacceptable. When, on the other hand people experience being accepted as they are, they are freed to change. They also found that the more accurate empathy a counselor showed toward a client who was dependent on alcohol or drugs, the less they would relapse. These discoveries led them to design four specific skills necessary for helpers to use when working with people who verbalize wanting to make changes in their life.
1. Acceptance- prizing the inherent worth and potential of the person wanting to make the
2. Accurate Empathy- actively being interested in understanding the person’s own
perspective and frame of reference for desiring the change
3. Autonomy Support- allowing the person to choose their own way and determine what
changes they want to make for their own life
4. Affirmation- acknowledging the person’s strengths and efforts they have already made in working toward their goals for change
Ambivalence was found to be another barrier to people wanting to make a positive change. It is common for people to contemplate thoughts about making a change, while wrestle with reasons to sustain their current behavior. When they verbalize this indecision to a helper, it is important that the helper doesn’t try to persuade them one way or another, because this often calls forth resistance against the helper’s advice. When people experience resistance it prevents change.
Instead, as a helper we can collaborate with the client using the four key processes of MI:
1. Engaging- establishing a helpful connection and collaborative relationship with
the client. One in which they can trust us and know that we accept them
2. Focusing- maintaining conversation about
the change the client wants to make
3. Evoking- eliciting the client’s own motivation for change, usually done with open-
ended questions such as, “What do you think would be some advantages
to making this change?”
4. Planning- formulating a concrete plan of action the client is motivated to follow,
once they have committed to making the change.
In addition, Miller and Rollnick discovered through reflective listening that commitment language predicted behavior change in people.
Commitment language is when the person speaks of:
1 Their desire to change
2. Their belief that they have the ability to make the change
3. Their reasons and need for the change to occur
4. Their verbalization of goals and plans to acquire the change
It is possible to help people make positive changes in their lives- and Motivational Interviewing can help that process. The rationale for change can come about for many reasons; some people feel forced to make changes due to outside circumstances beyond their control, while others desire to make changes because they want to better themselves or generate more positive outcomes in their life. Whatever the basis for change, using the MI approach can move people toward the transformation to which they aspire.
If you are interested in becoming trained in the MI approach you can visit http://www.motivationalinterviewing.org for training dates.
If you are interested in self-directed learning Dr. Miller and Dr. Rollnick have written four books on Motivational Interviewing, which can be found on Amazon.com
Motivational Interviewing: Preparing People to Change Addictive Behavior
Motivational Interviewing, preparing People for Change
Motivational Interviewing In Health Care: Helping Patients Change Behavior
Motivational Interviewing, Helping People Change
Written by: Elisabeth Davies, MC -Author of Good Things Emotional Healing Journal: Addiction
*Miller, W & Rollnick, S. Motivational Interviewing, Helping People Change, 3rd edition 17-18