Motivational Interviewing

Motivational interviewing is a therapeutic orientation as much as it is a therapy in itself; it's a way of doing therapy, rather than a model of mental illness or a set of techniques. It is possible to practice motivational interviewing in harmony with many other types of therapy, and I like to approach most of my sessions in the spirit of motivational interviewing.

Motivational Interviewing is defined by its creator, Bill Miller, as: a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence.

Motivational interviewing is based on the observation that how therapists behave in session changes clients’ behaviour outside of sessions. (If you are a therapist who is interested in offering effective therapies, you had better hope this is true!) What's interesting about motivational interviewing, however, is the details of what predicts change outside of sessions:

• High resistance from the client in session predicts Low compliance outside sessions, whereas:
• High change talk from the client – that is: talk focused on the desire and the need for change – predicts High compliance from a client.

Importantly, however, motivational interviewing does not propose that the therapist is responsible for the client's life changes. Appropriately, it sees the client as the agent of change. As a therapist, you cannot make change happen; change comes from the client.

Looking into the definition above in more detail, motivational interviewing, from a therapist's perspective, is:

• Directive
  • The therapist uses specific techniques, especially reflective listening.
  • The therapist provides the structure, the client provides the content.

• Client Centred
  • The therapist adopts a perspective of unconditional positive regard: no matter how stuck the person before them seems, they believe that the client has the potential to change.
  • The therapist accepts the client as they are right now.
  • The therapist remembers that change comes from the client, not from themselves.

• Non-judgmental
  • The therapist's role is to provide a safe and supportive environment for the client to explore their difficulties.

• Focused on Resolving Ambivalence
  • Ambivalence is a normal part of life. If you find that difficult to accept, try answering these questions:
    • Think of somebody that you love very much. In the last week, can you think of a time when you were furious with them? That's completely normal.
    • Imagine having a serious health concern. Can you relate to wanting to get it checked out by your doctor right away, and wanting to avoid seeing the test results in case they're bad news? That's normal too.
  • Ambivalence is particularly common when you are considering major changes in your life.
  • There is nothing pathological about ambivalence- it just needs to be resolved for you to take action.

Unfortunately, as therapists (and friends and mentors!), our instinct is often to push clients towards change. There are, however, serious risks in pushing clients towards change. Some clients shut down and appease you without changing their behaviour outside sessions. Some clients get furious with you. Pushing people towards things they're not willing or ready to do can damage to your relationship with the client. Providing a pressured or invalidating therapeutic environment can cause damage to the client’s relationship with mental health services generally, preventing them from accessing help in the future.

Motivational Interviewing gets you away from these risks, and helps you to develop good active listening skills to help you conduct therapy in a way that will actually get a person moving towards their goals.

Academic Resources

Hal Arkowitz, Henny A. Westra, William R. Miller and Stephen Rollnick (2007) Motivational Interviewing in the Treatment of Psychological Problems (Applications of Motivational Interviewing)

Hettema, J (2009) Motivational Interviewing Training Video. DVD set. http://www.motivationalinterviewing.org/motivational-interviewing-training-video-tool-learners

Helpful Resources

Xavier F. Amador (2011) I Am Not Sick I Don't Need Help: How to Help Someone with Mental Illness Accept Treatment.