Motivational Interviewing Tips

Motivational interviewing is a therapeutic intervention designed to move a person stuck in a self-destructive pattern by using the client's values and strengths as the powers to keep moving to more healthy behaviors. Repeated clinical trials show interventions that have a component of motivational interviewing have more recovery and less recidivism than those that do not use this technique. It strengthens the client's own intrinsic motivation to change for the better.

Understand stages of change

• In 1983, William Miller of the University of New Mexico published an article in Behavioural Psychotherapy, a British Journal, in which he reported a observing a series of stages of change through which people move from problem drinking to sobriety. Eight years later, researchers from University of Rhode Island--James Prochaska, Carlo DiClemente and John Norcross--wrote a seminal article on Stages of Change for the American Psychologist from what they learned helping smokers stop smoking. Miller and Stephen Rollnick also described Motivational Interview techniques for that periodical within the same 12 months.

  Precontemplation is the stage in which people are in denial about having a problem, or about how serious their problem is. The role of the therapist or clinician at this stage is to use empathic and reflective listening, to help the client see the cognitive dissonance in their stance. There is another part of them that they may not listen to that yearns for health, and the therapist listens for faint hints that this part is also present, and helps the client notice that part of themselves. Questions like "What would need to happen to let you know this is a problem?" help the client listen to the part of himself that is scared about the impact of his behavior. Asking if she had tried changing before may bring out the sense of hopeless she feels about this situation.

  After the client begins to wonder if he might have the power to make the change after all, or if the problem is really as serious as it is, the therapist uses motivational interviewing again to help the client actively contemplate the advantages and barriers to making a change. The client is encouraged and prompted to identify the people and situations she previously found helpful or a hindrance. Clients may also actively explore the options available to them in terms of treatment program styles or attend a 12-step meeting or explore will happen to their stuff, and who will take care of their children if they are away in treatment for a season. The client is always in charge and coerced.

  When the client decides to change, the preparation stage involves actually carrying out the tasks one had previously contemplated. Cognitive behavioral therapy is suggested as a more useful strategy than motivational interviewing in this stage, as it is in the Action and Maintenance stages, along with the support of a 12-step group.

  The final stage, relapse, finds motivational interviewing a helpful technique again, by reminding the client of the strengths and areas of identity that yearn for health. It is useful to know that relapse is a stage, in that it alleviates the blame of the client for her personal failure, while allowing her the thought that it is a temporary state and not a permanent condition.

  A clinician familiar with the stages of change will use the motivational interviewing in the appropriate way at the stages at which it is most useful. He will also chose other techniques, such as cognitive behavioral therapy, for the stages it is not indicated.

If You Hit Counter-Motivation, STOP

• Resistance and other forms of counter-motivation are signs that the therapist or clinician is moving faster that the client can tolerate. Clients who feel pushed become even more resistant--it's human nature. It also can break the trust between the client and the therapist. Some people may spend years in the contemplation stage and the therapist needs to maintain a hopeful, friendly, empathic stance, encouraging and praising even tiny steps toward the goal.

  Persuasion and confrontation are counterproductive techniques.

The Readiness to Change Ruler

• Have the client rate her readiness to change on a straight line drawn on a piece of paper, with the left end of the line representing "not prepared to change" and the right end representing "already changing."

  This is the basis for learning more about the client and their motivations and perceived barriers. By asking the client why he did not put his mark closer to the "not prepared to change" side, you can hear his motivations. By asking what would be necessary to move it farther right, perceived barriers are brought out into the open.