Motivational interviewing is a method that works on facilitating and engaging intrinsic motivation within an individual to change behaviour according to specific therapeutic goals. As such, motivational interviewing is an empathic, person-cantered therapy technique that prepares people for change by helping them resolve ambivalence, enhance intrinsic motivation, and build confidence to change.
In this article, we spend time familiarizing ourselves with the objective, the basic principles, and skills required of the therapist to effectively navigate the motivational process. The four core skills that a therapist have to develop to conduct successful motivational interviews are the ability to express empathy, develop discrepancy, man-age resistance, and support self-efficacy.
1. Express empathy: First of all, the therapist creates an atmosphere where the client can feel safe, secure, and open up to face and explore difficult realities. He or she fosters awareness and acceptance, which are necessary for the client to overcome shame, denial, and resistance. The therapist consistently practices active listening skills and seeks to understand the client’s problems without judgment, criticism, or blame. Ambivalence, which is wanting and not wanting the change or wanting incompatible things at the same time, is considered as normal and reasonable given the client’s life history and circumstances. Compassion is vital in the ability to efficiently and authentically express empathy.
2. Develop discrepancy: There is the impetus for change if a person recognizes that his or her behaviour is in conflict with their life goals. The therapist uses his or her skills to identify and amplify these discrepancies as reasons for change by utilizing change statements that recognize the problem, express concern, and establish an intention to change and optimism that it is achievable.
3. Accept resistance: The therapist does not argue or directly oppose resistance, but rather promotes an understanding and offer new perspectives. The client retains ownership of his or her options and decisions and becomes empowered in the change process.
4. Support self-efficacy: We have seen that confidence in his or her ability to succeed in change and achieve the desired outcome is a major factor in the client’s motivation to change. The therapist applies his or her skills to enhance confidence and emanates a belief that positive change is achievable.
By utilizing the skills above, the therapist uses basic interaction techniques that are used “early and often” in the motivational interviewing approach. These are the use of open questions, affirmation, reflective listening, and summary reflections—the very apt acronym is OARS, referring to instruments that can get a person from one point to the desired destination (Miller & Rollnick, 2012).
1. Open questions: Open questions encourage clients to talk and are not leading, judgmental, or presumptive. It is useful to establish rapport, gather information, and increase understanding. Rather than asking: “Did you have a good relationship with your parents?”, the therapist should ask: “What can you tell me about your relationship with your parents?”
2. Affirmations: Affirmations are statements and gestures that recognize clients’ strengths and acknowledge behaviours that can lead to positive change and goal achievement. Affirmations must be genuine and believable to build the client’s confidence in his or her abilities to change. Examples are: “That took a lot of courage to…”, and “You showed a lot of patience in the way you handled…”
3. Reflective listening: It is easy for a therapist to misinterpret what a client says, or assume what a client means or needs. Reflective listening requires the therapist to frequently repeat, rephrase, paraphrase, and reflect on what the client says and appears to feel and think. This technique not only deepens the interaction but tests whether the therapist has the correct understanding of the client’s spoken and unspoken words. It also reinforces the client’s insight of their own experiences.
4. Summary reflections: Summaries are part of active and reflective listening skills, and are mainly used at transition points in a session. Summarizing helps to ensure that there are clear communication and understanding between the therapist and client, which provides a basis for change. In the technique of synthesizing the focus is on change statements made by the client, including problem recognition, concern, intent to change, and optimism. Ambivalence is also acknowledged, and the therapist may begin his or her summary reflection with statements such as: “Let me see if I understand so far…”, or “Here is what I heard. Tell me if I missed anything.” The response from the client often then leads to concrete steps toward the change goal.
There are four general principles to achieve effective motivational interviewing.
1. Engaging is used to involve the client in talking about issues, concerns, and hopes, and to establish a trusting relationship with a therapist.
2. Focusing is used to narrow the conversation to habits or patterns that clients want to change.
3. Evoking is used to elicit client motivation for change by increasing their sense of the importance of change, their confidence about change, and their readiness to change.
4. Planning is used to develop the practical steps clients want to use to implement the changes they desire.
Therefore, the therapist uses his or her skills to apply the interaction techniques that will increase the client’s motivation to change. The principles and techniques are used interactively depending on the stage of the process, shared understanding between the therapist and client, and commitment and motivation of the client to achieve specific goals.
The skills require genuine empathy, acceptance, recognition, patience, and resilience from the therapist. These are not easy to apply effectively, and take time and practice to develop. However, the effort will definitely be rewarded with satisfied clients.
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York, NY: The Guilford Press.