Healthcare Training Institute - Quality Education since 1979
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Motivational interviewing is a brief, focused, client-centered, collaborative practice approach designed to elicit behavioral changes by helping alcohol- and drug-involved clients (and their partners) identify, explore, and resolve ambivalence (Miller & Rollnick, 2002). "Motivational interviewing is a narrative process of evoking from the client reasons for and commitment to change." (Miller, 1998, p. 169). It consists of two phases--phase 1 in which motivation for change is built, and phase 2 in which commitment to change is strengthened. Motivational interviewing facilitates change by evoking cognitive dissonance, usually between the current problem behavior (for example, excessive drinking) and the client's self-image, aspirations, or perceptions (Glasner, 2004). By selectively applying motivational interviewing tactics, professionals help clients recognize the adverse consequences of addictive behaviors and move from the precontemplation and contemplation stages toward preparation and action.
Proponents of motivational interviewing assert that people change when the costs of current behaviors begin to outweigh the benefits and when they perceive that the benefits of alternative actions outweigh the costs of those actions. Motivation is conceptualized as a dynamic state, fluctuating across time and situations. It is receptive to professional influence. During the initial phases of motivational interviewing, when clients are doubtful about the need to change, interview strategies use the clients' own statements to highlight the costs of current behaviors and the benefits of alternative behaviors. As motivational interviewing progresses and clients lean more toward change, interviewing strategies shift to helping clients explore the relative advantages of different change options, developing an action plan, identifying supports for and barriers to change, and enhancing their confidence to change.
Warmth, empathy, and genuineness characterize the collaborative motivational interviewing style. Practitioners avoid asserting authority. Instead, they share responsibility, build on client strengths, and assume that clients have the capacity to make informed, responsible decisions about their lives. This approach is particularly important for work with older people, who often are disenfranchised and given messages that they are not competent.
Five interview strategies and tactics are prominent in motivational interviewing (Miller & Rollnick, 2002). The first four consist of nondirective intervention skills--reflective listening, open-ended questions, affirmation (or validation), and summarization. Each of these tactics encourages clients to discuss their experiences in their own words. They show that the practitioner is interested in the client and willing to address concerns as the client sees them. The attention in the gerontological literature to reminiscence and life review attests to the importance of older people being able to tell their own stories.
A fifth interview strategy--eliciting self-motivational statements--is used to give direction and purpose to the intervention, to help clients examine ambivalence, and to encourage them to voice their concerns. Self-motivating statements are remarks made by clients that generally fall into four categories: ( 1) recognition that a current behavior or its consequences are problematic, ( 2) expressions of concern about the current situation, ( 3) indications of an intention or desire to change, and ( 4) words of hope and optimism about change (Miller & Rollnick, 2002).
Practitioners can elicit self-motivational statements in several ways: They can direct evocative questions toward the areas in which motivational statements are likely to emerge. (for example, "What do you think will happen with your health if you continue to drink as you have been?"). Practitioners also can help clients explore what they like and do not like about their current behaviors, as well as alternatives to those behaviors. Once clients make self-motivational statements, practitioners can use client-centered interview strategies, like reflective listening, to encourage them to expand on their concerns by taking a "what else" or "tell me more" approach to help them examine and clarify areas of ambivalent conflict. By reflecting the clients' self-motivational statements back to them, practitioners help clients "hear" themselves more clearly and increase motivation for change.
Labels are minimized in motivational interviewing (for example, "You are an alcoholic."). Personalized feedback that describes a person's actions and their consequences is presented instead. Clients are then invited to consider the implications of the new information. When clients express doubts about the accuracy of information, practitioners review the information at the clients' own pace, using the client's words as much as possible. Practitioners avoid aggressive, confrontational techniques and encourage clients to examine their lives, face the discrepancies they discover, and decide what they will do about their discoveries.
Reflection Exercise #7