Introduced by Miller and Rollnick in 1980s, Motivational Interviewing (MI) came about through their work in treating alcohol abuse patients. There was a broad-sweeping impression of alcoholics as deceptive and unreliable. Therapist’s therefore took an authoritarian position and commonly questioned clients’ wrongdoing in a confrontational style and believing they were to impart knowledge, insight, and motivation for change. However, domineering approaches such as disagreeing/arguing led to higher level of resistance.
MI has a Rogerian theory basis. There is an emphasis on positive human potential, appropriate empathic understanding, positive regard, and radical acceptance as providing a basis that will encourage people to naturally move towards a healthy, self-fulfilling state.
- Express empathy for the client.
- Develop discrepancy between the client’s goals and values and their current behaviour.
- Avoid argument and direct confrontation.
- Roll with client resistance instead of fighting it.
- Support the client’s belief they can change.
Typically, in MI, the client speaks most of the time as the therapist listens. This involves a partnership in which the therapist is not the expert but collaborating in an egalitarian manner. Effective change is seen to come from the individual and is based on their own interests and values.
When the client speaks of change of their own free will, it results in that person feeling more favourable towards the change and being more able to take steps towards improvement. Miller believes the conventional approach in which the therapist asks questions about why it is important to change, what will happen if change does not occur, will only lead to the client denying there is a problem.
Instead, MI encourages practitioners to selectively reinforce clients’ own reason for change, almost like clients talk themselves into change. This encompasses two phases: stimulating motivation for change and reinforcing commitment for change.
Indications it is time to strengthen commitment and offer the change plan include:
- Decreased resistance: Dissonance sessions diminishes
- Decreased discussion about the problem: less conversations on the concern
- Resolve: the client appears more peaceful, relaxed, open and settled
- Change talk: the client makes direct change talk, less satisfaction with the status quo, more look forward to a new start
- Questions about change: the client asks questions about how to implement change
- Envisioning: the client talks about what benefit will come after the change
- Experimenting: the client tries out change actions between sessions
In practice this can be considered in four stages:
- Engaging – establishing the collaborative working relationship.
- Focusing – helping the client to focus on their most pressing concerns.
- Evoking – eliciting the client’s personal reasons for change.
- Planning – guiding the client to their best options for moving forward.