Motivational Interviewing: making a change
Motivational Interviewing (MI) is an approach you may have learned about or used in your practice. More directive than many other therapies, MI is often effective and may reward you for the time it takes to master it. As a strengths-based approach, MI aligns well with the ethical principles of clinical social work.
MI is intended to facilitate discussion of clients’ ambivalence about changing their behavior. As therapist using MI must be warm and empathetic in collaborating, evoking, allowing for autonomy, and exploring with the client. “Start where the client is”: each client comes to therapy in their own “stage of change” (see below), the nature of which the therapist and client should determine at the outset.
The Transtheoretical Model (or “Stages of Change” Model) is important in MI, as a framework for identifying the client’s readiness for behavior change. The model is often depicted as a circle, as people can enter or exit at any point.
The Stages of Change are: Precontemplation, in which the client tends to be unaware that their behavior is problematic, and dwells on negative aspects of changing; Contemplation, in which the clients recognize their behavior as problematic and are thoughtful about the pros and cons of change; Determination, in which clients are ready to take action within a month; Action, in which clients change behavior and intend to continue; Maintenance, in which clients have sustained behavior-change for six+ months; and Relapse.
In my work with individuals and groups, I’ve been impressed at the effectiveness of a pro/con list or cost-benefit analysis, both of which can be revisited a month or two down the road, as good ways for clients to track their changes.
MI’s key techniques are as follows (Miller et al., 1992):
- Motivation to change is elicited from within the client.
- The client, not the clinician, articulates and resolves the client’s ambivalence.
- Direct persuasion is not used to resolve ambivalence.
- The counseling style is generally quiet, encouraging the client—the expert on their situation—to provide information.
- The counselor is directive in helping the client to examine and resolve ambivalence. Sometimes this involves asking really tough questions.
- Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction. The counseling relationship can be a good tool for modeling appropriate discussion about a difficult topic!
- The therapeutic relationship resembles a partnership or companionship.
The client’s “stage of change” will determine what questions to ask and where to direct the conversation. The therapist must pay close attention to “change talk” (e.g. “if I continue to [engage in a behavior], something bad might happen”; “I don’t always like doing [this behavior]”; “I want to do something about this, I just don’t know how”). These are the little golden nuggets that determine the success of MI. Explore these with your clients and you will elicit the change talk from them.
To learn more, please see the reference list.
LaMorte, W. W. (2018 August 29). The Transtheoretical Model (Stages of Change). Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html
Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. (1992) Motivational Enhancement Therapy Manual. Washington, DC: National Institute on Alcohol Abuse and Alcoholism.