Motivational Interviewing: Helping People Change
Few methods have experienced such a spectacular advance in so little time as motivational interviewing. Its success is due to several factors. It facilitates the relationship with the patient, its efficacy is scientifically proven, and it’s been developed collaboratively. Nowadays, motivational interviewing is applied to many contexts. Clients, patients, students, ward, addicts, criminals, or even interns can benefit from it.
In the same way, those who practice motivational interviews can be mentors, educators, therapists, coaches, psychologists, doctors or nurses. This makes it a very powerful tool.
What is motivational interviewing?
Broadly speaking, motivational interviewing is a tool that helps people change what they don’t like about themselves. In this regard, these are things that produce a great dissonance and, therefore, displeasure. Talking with the interviewee achieves this. Through this tool, we’re able to break down barriers that keep people from changing.
The truth is that we talk about change every day and in a natural way. We make requests to others and we’re very sensitive to the aspects of everyday language that denote reluctance, willingness, commitment… In fact, apart from transmitting information, one of the most important functions of language is motivating and influencing other people’s behavior. It can be something as simple as asking someone to pass the salt or as complex as negotiating an international treaty.
There are also conversations about change that happen in the form of a professional consultation. Through them, someone tries to help another person change. Doctors, dentists, nurses, dietitians, and nutritionists also have conversations about changing behavior and lifestyle.
“Things do not change; we change.”
-Henry David Thoreau-
Motivational interviewing pays attention to natural change-related language. Its purpose is to have more effective conversations about it, especially when they occur in a context in which someone offers professional help to another person.
Many of these conversations take place in a useless or dysfunctional way, however good the interviewer’s intentions may be. Thus, motivational interviewing was designed to find a constructive way to overcome the challenges that appear when someone gets involved in motivating another person’s change.
In particular, motivational interviewing consists of organizing conversations. This way, people can persuade themselves to change, depending on their own values and interests.
We can think of help conversations as if they were located in a path. At one end, we find the management style. At the opposite end, we find the accompaniment style. Motivational interviewing follows a guiding style model, located in the center of this path. To situate ourselves better, let’s imagine that we’re traveling to a foreign country and hire a tour guide to help us.
“What people need is to feel heard.”
-Mary Lou Casey-
The tour guide’s job isn’t to tell you when you should arrive, where you should go, or what you should see or do. A skilled tour guide knows how to listen and offer expert information when necessary, according to your interests. Motivational interviewing is located in this intermediate territory between directing and accompanying and it includes elements of both. Guiding is a task in which many times it’s necessary to accompany others, to direct, and other times to do neither. It opens up the possibilities that the guided person is able to perceive and intercalates these three attitudes with intelligence.
For example, stimulating a child’s learning process in most cases means that we act as guides. It requires that we intercede periods of accompaniment or supervision with others of direction and others of freedom.
Avoiding the correction reflex is fundamental in motivational interviewing
People end up practicing a profession in which they help others for different reasons. It may be because they want to give something back to society, prevent and alleviate suffering, manifest their love of God, etc. Ironically, these same reasons can lead to excessive use of management style when it comes to providing help. Beware! Management style can be ineffective or counterproductive when it comes to helping people.
When we use a management style, we also use the correction reflex. We want to help the person so much that we often impose what they should or shouldn’t do. But this, unfortunately, creates resistance. One of the goals of motivational interviewing is minimizing this resistance.
What’s isn’t motivational interviewing?
It may be useful to clarify what motivational interviewing isn’t to differentiate it from other interviewing methods. Motivational interviewing doesn’t simply consist of being kind to others. Nor is it the same as Carl Rogers’ client-centered therapy. In motivational interviewing, there’s an intentional and strategic movement towards one or more specific objectives.
Motivational interviewing isn’t a “technique”, an easy trick to learn and simply add to our toolbox. It’s rather a style of being with others, an integration of concrete clinical skills that promote motivation for change.
It’s a complex style that can be perfected over the years. It isn’t a cure-all nor the solution to all clinical problems. Motivational interviewing was developed specifically to help people resolve ambivalence in the face of change and reinforce their motivation.
This process uses five key communication skills: formulating open questions, affirming, reflecting, summarizing, and providing information and advice, always with the client’s permission.
As we’ve seen, motivational interviewing is a powerful tool that facilitates change in people. It weakens the ambivalence before it and encourages motivation. All of this is possible through a communicative guide style, without imposing anything and letting the client decide.
Miller, W.R., Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York: Guildford Press.