Motivational interviewing is a technique used in interacting with substance-using clients in which you become a helper in the change process and express acceptance of your client. It is not merely as an adjunct to other therapeutic approaches, but a style of counseling that can help resolve the ambivalence that prevents clients from realizing personal goals.
Motivational interviewing builds on Carl Rogers’ optimistic and humanistic theories about people’s capabilities for exercising free choice and changing through a process of self-actualization. The therapeutic relationship for both Rogerian and motivational interviewers is a democratic partnership. Your role in motivational interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating client discrepancy to enhance motivation for positive change.
Essentially, motivational interviewing activates the capability for beneficial change that everyone possesses. Although some people can continue change on their own, others require more formal treatment and support over the long journey of recovery. Even for clients with low readiness, motivational interviewing serves as a vital prelude to later therapeutic work.
| The Basic Skills of Motivational Interviewing | |
| Ask Open-ended questions*
· The patient does most of the talking · Gives the practitioner the opportunity to learn more about what the patient cares about (eg. their values and goals) |
Example I understand you have some concerns about your drinking. Can you tell me about them? Versus Are you concerned about your drinking? |
| Make Affirmations
· Can take the form of compliments or statements of appreciation and understanding · Helps build rapport and validate and support the patient during the process of change · Most effective when the patient’s strengths and efforts for change are noticed and affirmed |
Example I appreciate that it took a lot of courage for you to discuss your drinking with me today You appear to have a lot of resourcefulness to have coped with these difficulties for the past few years Thank you for hanging in there with me. I appreciate this is not easy for you to hear |
| Use Reflections*
· Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement · Encourages continual personal exploration and helps people understand their motivations more fully · Can be used to amplify or reinforce desire for change |
Example You enjoy the effects of alcohol in terms of how it helps you unwind after a stressful day at work and helps you interact with friends without being too self-conscious. But you are beginning to worry about the impact drinking is having on your health. In fact, until recently you weren’t too worried about how much you drank because you thought you had it under control. Then you found out your health has been affected and your partner said a few things that have made you doubt that alcohol is helping you at all |
| Use Summarizing
· Links discussions and ‘checks in’ with the patient · Ensure mutual understanding of the discussion so far · Point out discrepancies between the person’s current situation and future goals · Demonstrates listening and understand the patient’s perspective |
Example If it is okay with you, just let me check that I understand everything that we’ve been discussing so far. You have been worrying about how much you’ve been drinking in recent months because you recognize that you have experienced some health issues associated with your alcohol intake, and you’ve had some feedback from your partner that she isn’t happy with how much you’re drinking. But the few times you’ve tried to stop drinking have not been easy, and you are worried that you can’t stop. How am I doing? |
| * A general rule-of-thumb in MI practice is to ask an open-ended question, followed by 2–3 reflections | |
