Motivational Interviewing

Have you ever felt relieved after having a long conversation with your friend, who gave you his or her full attention and listened to you without any judgement? Most of us would feel ‘healed’ by this experience. This is the essence of motivational interviewing.

Motivational interviewing aims to encourage the patient’s autonomy in decision making where the therapist acts as a guide, clarifying the patient’s strengths and aspirations, listening to their concerns, boosting their ability to change and eventually working together on a plan for change.

The process consists of engaging the client to decide what to change, the reasons for making those changes, and agreeing on a concrete plan.

Who is Motivational Interviewing for?

Motivational interviewing is commonly used to address addiction and management of physical health conditions like diabetes, asthma, heart disease etc. This intervention enables people to become motivated to change their behaviours that were preventing them from making healthier choices. As the name suggests, this intervention is effective for individuals who were initially unmotivated for change. It is not as effective for who are already motivated.

Additionally, motivational interviewing also works well for people who are hostile or angry. They may not be ready to commit to change, but this intervention can facilitate their movement through the emotional stages of change necessary to find their motivation.

What can you expect?

The therapist would get the ball rolling by encouraging clients to talk about their need for change and their own reasons behind it. The therapist would mainly be evoking a conversation about change and commitment. After listening to the client, the therapist would reflect the client’s thoughts so that the client can hear their reasons and motivations expressed back to them. Motivational interviewing is mostly a short-term counselling of one or two sessions. It can also be included as an intervention along with other, longer term therapies.

How does Motivational Interviewing work?

Motivational interviewing rests on the assumption that people are ambivalent about change. It is an optimistic approach aimed at resolving this ambivalence through change talk.

Change talk is the statements we make that reflect our desire to change, list the specific reasons driving the change and express the commitment to change. Research has shown that change talk, particularly in a clinical setting, has resulted in the success of behavioural change.

There are 2 goals to this approach.

1. The first goal is to boost the client’s motivation

2. The second goal is for the client to make the commitment to change

To facilitate the process of eliciting change talk, there are 4 key communication skills used in Motivational Interviewing.

1) Open-ended questions

Open-ended questions in motivational interviewing allows us to find out more about the client’s perspective and ideas about change. They are useful in evoking the client’s motivations for change. They are also important in building rapport between the client and therapist.

2) Affirming

This is done through recognising and commenting on the patient’s strengths and abilities and validating their emotions. For instance, “sounds like this is really interesting, no wonder you feel overwhelmed”.

3) Reflective listening

When the therapist paraphrases what the client has said in the form of a statement instead of a question, the therapist encourages the client to continue sharing. The most beneficial part of reflective listening is that it helps to engage the client, especially when he or she is very distressed as it can help to calm them down and feel understood. Also, reflective listening allows the therapist to clarify what the client is saying with the intention of understanding correctly and reflect back to the client so that they can hear what they are saying and choose to either pause to reflect or move forward with the conversation. Reflective listening is critical in helping the patient consider a change.

4) Summarising

Summarising allows the therapist and client to identify the core ideas of the client’s story. Reflection listening together with summarising, allows the client to find himself/herself talking about change. As the therapist reflects back to the client what he/she has said, it becomes a powerful process of evoking the client’s motivation for change.

Motivation to change varies across individuals, situations and over time. Some are more willing than others to change, some are more ready than others to change. Motivational Interviewing is an evidence-based approach designed to boost motivation for change. Going for motivational interviewing is one possible step towards making that positive change in one’s life.