Overview

The clinician needs to keep in mind the following five principles when practicing MI:

  • Express empathy
    • use reflective reasoning
      • Fisher’s Model:
        • Eleminate any kind of distraction.
        • Genuinely embrace the speaker’s perspective without necessarily agreeing with it. By engaging in a non-judgmental and empathetic approach, listeners encourage the others to speak freely.
        • Mirroring the mood of the speaker, reflecting the emotional state with words and nonverbal communication. This requires the listener to quiet his mind and focus fully upon the mood of the speaker. This mood will become apparent not just in the words used but in the tone of voice, posture and other nonverbal cues given by the speaker. The listener will look for congruence between words and mood.
        • Summarizing what the speaker said, using the speaker’s own words rather than merely paraphrasing words and phrases, thereby mirroring the essential concept of the speaker.
        • Responding to the speaker’s specific point, without digressing to other subjects.
        • Repeating the procedure for each subject, and switching the roles of speaker and listener, if necessary.
        • During the reflective listening approach, both client and therapist embrace the technique of thoughtful silence, rather than to engage in idle chatter.
  • Develop discrepancy
    • Assist patients in developing discrepancies between the current self and what they want to be like in the future after a change has taken place.
    • The main goal of this principle is to increase the patient’s awareness that there are consequences to their current behaviors.
    • An effective way to do this is for the clinician to participate in active reflective listening and repacking what the patient has told them and delivering it back to them.
  • Avoid arguments
  • Roll with hte resistance
  • Support self-efficacy
    • Strong self-efficacy can be a significant predictor of success in behavior change.
    • By highlighting and suggesting to the patient areas in which they have been successful, this can be incorporated into future attempts and can improve their confidence and efficacy to believe that they are capable of change.

Four Processes

These steps do not always happen in this order

1 - Engaging

  • In this step, the clinician gets to know the patient and understands what is going on in the patient’s life.
  • This helps to build trust with the patient and builds a relationship where they will work together to achieve a shared goal.
  • This allows the patient to open up about their reasons for change, hopes, expectations as well as the barriers and fears that are stopping the patient from changing.
  • This creates an environment that is comfortable for the patient to talk about change.

2 - Focusing

  • This is where the clinician helps the patient find and focus on an area that is important to them, where they are unsure or are struggling to make a change. This step is also known as the WHAT? of change.
  • The clinician needs to ask questions to understand the reasons if and why the patient would be motivated to change and choose a goal to reach together.
  • The patient must feel that they share the control with the clinician about the direction and agree on a goal.
  • There are three styles of focusing:
    • directing: where the clinician can direct the patient towards a particular area for change. * following: where the clinician let the patient decide the goal and be led by the patient’s priorities
    • guiding: where the clinician leads the patient to uncover an area of importance

3 - Evoking

  • In this step the clinician asks questions to get the patient to open up about their reasons for change. This step is also known as the WHY? of change.
  • Usually, there is one reason that is stronger than the others to motivate the patient to change their behavior.
  • The clinician needs to listen and recognise “change talk”, where the patient is uncovering how they would go about change and are coming up with their own solutions to their problems. The clinician should support and encourage the patient when they talk about ways and strategies to change, as the patient is more likely to follow a plan they set for themselves.
  • When the patient is negative or is resisting change the clinician should “roll with resistance” where they don’t affirm or encourage the negative points but highlight the ways and reasons the person has come up with to change.
  • The clinician’s role is to ask questions that guide the patient to come up with their own solution to change.
  • If the clinician focuses more on their own reasons they believe the patient should change this would not come across as genuine to the patient and this would reduce the bond they made in the engaging process.

4 - Planning

  • This step is also known as the HOW? of change.
  • They can help to strengthen the patient’s commitment to changing, by supporting and encouraging when the patient uses “commitment talk” or words that show their commitment to change.
  • In doing this, they help to strengthen the patients motivation and support that they are capable of achieving this goal on their own.
  • The clinician should help the patient to come up with SMART goals which are; Specific, Measurable, Achievable, Relevant and Time bound. This helps to set benchmarks and measure how their behavior has changed towards their new goal.

Limitations

  • Underlying mental health conditions
  • Pre-contemplation
  • Motivation
  • Therapist/client trust
  • Time limitations
  • Training deficiencies
  • Group treatment

References

  • YouTube - Introduction to Motivational Interviewing
  • wikipedia
  • Miller, W.R. & T.B. Moyers (2017) Motivational Interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), 757-766
  • Miller, W.R. & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd Edition). Guilford Press.
  • Miller & Rollnick (2017) Ten things MI is not Miller, W.R. & Rollnick, S. (2009) Ten things that MI is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.