Motivational Interviewing

“Motivational interviewing is a skillful clinical method, not a set of techniques that can be easily learned.... It is a way of being with people.... It is designed to resolve motivational issues that inhibit positive behavior change” (Miller & Rollnick, 2002, p. 41). It is also a client-centered and directive method for increasing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002, p. 25). As stated previously, it involves four general principles which help in facilitating change. These principles include (1) expressing empathy, (2) developing discrepancy, (3) rolling with resistance and (4) supporting self-efficacy.

In terms of expressing empathy, the MI approach emphasizes the importance of expressing empathy.

Empathy involves such therapist characteristics as warmth, respect, caring, commitment, and active interest (Miller and Rollnick, 1991). Empathy usually entails reflective listening — listening attentively to each client statement and reflecting it back in different words so that the client knows you understand the meaning. (CSAT, 1999, p. 28)

In developing discrepancy, the counselor works with the client in evaluating their present behavior in light of their goals and values. A “better way to understand this state is simply as a discrepancy between the current state of affairs and how one wants to be” (Miller & Rollnick, 2002, p. 38).

Roll with resistance focuses on avoiding arguments for change, but engaging the client in the process of problem solving. Last is the concept of self-efficacy. Self-efficacy is the belief in one’s ability to achieve or accomplish a task, activity, etc. Here the counselor invests in supporting the clients self-efficacy.

In addition to these principles, MI also focuses on ambivalence, recognizing that there is an approach—avoidance conflict with addictive behaviors: while clients want to change they also do not want to change. According to Miller and Rollnick (2002), ambivalence is not seen as an obstacle to change, but “makes change possible” (p. 23). Much of the work in MI deals with ambivalence. MI involves intensifying and then resolving ambivalence by identifying the discrepancy between the actual present and the desired future (Miller & Rollnick, 2002, p. 23).

Counselors collaborate with clients and listen for and elicit change talk. Change talk falls into one of four categories: disadvantages of the status quo; advantages of change; optimism toward change; and intention to change (Miller & Rollnick, 2002, p. 24). Examples of change talk may include:“! feel terrible about how my drinking has hurt my family,”“! don’t know what to do, but something has got to change” and “I guess this has been affecting me more than I realize” (CSAT, 1999, p. 53).

Early methods to use in MI include: asking open-ended questions; listening reflectively; affirming, summarizing and eliciting change talk. Later methods include asking key questions; giving advice with permission; and negotiating a change plan (Miller & Rollnick, 2002).

Another technique of MI is to match the clients stage of change with MI methods and techniques. As explained in the Stages of Change section, counselors can use MI strategies that work best with that stage of change.These MI strategies were listed with each stage of change earlier in the chapter.

Lastly, MI is famous for its OARS, which is to be used when working with clients. The O refers to Open-ended questions. While closed questions lead to yes/no answers, open-ended questions are less restrictive and allow the client to explain.The A refers to Affirmative, which means acknowledging the clients strengths and movements towards positive change. The R refers to Reflective listening. With reflective listening the counselor listens actively and intently to the client and responds back with reflections regarding what the client stated. Here a counselor can repeat, rephrase, paraphrase or reflect back with feeling regarding what the client stated. Lastly, the S refers to Summary, which is when the counselor summarizes what has been stated.

Learning Opportunity 9.5

For this learning opportunity, each person should have a partner. Each person should pick an unhealthy behavior (smoking, binge drinking, etc.) that someone might want to change. Using Motivational Interviewing/ counseling techniques and strategies, create a counseling scenario with one person as the counselor and the other person as a client trying to change an unhealthy behavior (selected earlier). Practice using Motivational Interviewing/counseling skills for 15 minutes as the counselor. Be sure to use the following: (1) express empathy, (2) develop discrepancy, (3) roll with resistance and (4) support self-efficacy.