by Lynn Hetzler
What motivates one person to take action might leave another uninspired. Differences in motivation are particularly apparent when managing clients with mental illness or addiction. In many cases, mental illness or addiction can interfere with a client’s ability to enact a change to improve his or her own well-being; these conditions can change a person’s impetus and halt their progress toward their life goals. Simply getting out of bed each morning can be a significant challenge to some; for them, mustering the drive to show up for weeks of counseling may be next to impossible.
Motivational interviewing (MI) can improve the chances of a second counseling visit and help clients maintain their forward momentum toward reaching a goal, such as overcoming alcohol or substance abuse. MI is an evidence-based clinical approach that helps people with mental health and substance use disorders make positive behavioral changes. MI can also help those with heart conditions, diabetes and asthma make behavioral changes to support physical health.
MI helps clients discover their own interests and motivations to make positive life changes. Motivational interviewing gives clients permission to express their desire for change in their own words. Many counselors refer to this as “change-talk.” The conversation creates a safe place for clients to engage in change-talk, one in which they can examine their own ambivalence about the change without fear of judgment. The interviewing technique can also help clients claim responsibility for managing symptoms of a physical or mental illness, reducing or eliminating alcohol or drug use, improving diet, or even exercising more.
Motivational interviewing then supports clients as they begin to plan for and implement changes. It enhances their confidence in taking action, and it helps them realize that even small, incremental changes can lead to positive outcomes. Motivational interviewing also strengthens commitment to change by quieting uncertainty.
Motivational Interviewing and Ambivalence
MI is a conversational approach that addresses ambivalence to change by identifying and stoking the client’s own sources of motivation. Each conversation empowers the client to identify his or her own sources of motivation and move in a positive direction at their own pace.
Ambivalence is a natural state of uncertainty, mixed feelings or contradictory ideas. In psychology, ambivalence is the coexistence of both negative and positive feelings toward a person, object or action. Most people experience some level of ambivalence while undergoing changes. Ambivalence arises from conflicting feelings about the process of change and the potential outcomes of change.
While ambivalence is natural, particularly during change, many people are not aware of it. In fact, many service providers do not have the training to recognize and respond to ambivalence about change. Furthermore, service programs do not always have the structure and culture to support motivational interviewing.
The Four Principles of Motivational Interviewing
Motivational interviewing upholds four principles:
- Expressing empathy
- Developing discrepancy
- Rolling with resistance
- Supporting self-efficacy
Expressing empathy shows acceptance and increases the likelihood that the provider and the client will develop a rapport. Participant ambivalence is normal and skillful; reflective listening is essential.
Developing discrepancy allows clients to recognize that their situation does not fit their values or their goals for the future; the discrepancy between current behavior and important goals motivates the change.
Rolling with resistance prevents arguments and other breakdowns in communication. Resistance is a clear signal that the counselor should respond differently.
Self-efficacy places the onus on the client, rather than the provider, to enact change. A client’s belief that he or she has the ability to change greatly increases the chance that changes will occur.
Motivational Interviewing From the Provider’s Point of View
William R. Miller provided the first description of motivational interviewing (MI) in 1983. Miller’s experience in the treatment of problem drinkers helped form his description of MI. Subsequent research and clinical experience have applied and tested the fundamental principles and methodologies of MI, and they demonstrate its efficacy.
Studies show that motivational interviewing is effective as an intervention for excessive drinking and drug abuse, for example, and as a general intervention strategy in the treatment of lifestyle problems and disease. Because of this extensive research into the efficacy and benefits of motivational interviewing, many therapists now regard MI as a highly effective evidence-based practice in the treatment of substance abuse disorders.
MI helps care providers engage and activate people to make positive health changes. Motivational interviewing is a conversational style that sets behavioral change in motion.
Motivational interviewing begins with a shift in mindset, both for clients and for counselors. To engage in effective MI, the counselor listens for the client’s expressions of desire, need and ability to generate a positive outcome, and then uses what he or she has heard to find an opportunity for forward movement.
Motivation ultimately comes from within, of course, but using MI can help guide clients as they come to their own conclusions and support clients as they discover their inner drive. MI has a person-centered approach – it brings the therapist or counselor to where the client is. The care provider listens for clues about what is important to the client and then elicits and supports steps toward changes that are most meaningful for that client.
MI is somewhat like a dance, where the counselor leans in at some times and leans out at others. MI allows the client to take the lead in setting the pace, while the counselor supports the choreography. Just as in dancing, proficiency in the conversational style comes with practice, retraining and coaching.