By Maria Morales, MA, MHC-LP

What is Motivational Interviewing?

Similar to other therapeutic modalities, motivational interviewing (MI) is an evidenced-based approach to therapy that aids in bringing about change in a person’s life and mental health. Therapy is best done when a therapist and client have built a great rapport and work as a team to create positive change, so the collaborative approach of motivational interviewing piques the interest of many. In contrasts to other styles of therapy, MI takes neither a directive “doctor-patient” approach, in which a therapist simply tells a client what to do to feel better, nor a talk therapy approach with a “blank-slate” therapist who’s just there to listen. Instead, therapists who use MI are somewhere in the middle and are seen more as a guide.

Think about it this way: imagine you are traveling to a foreign country where a relative or long-distance best friend lives. The excited explorer in you has some idea of the things you want to do and places you want to see; however, as the foreigner you might not know about some hidden gems of the country and/or the safest and most efficient ways to get from point A to point B. Your friend who’s been living there for the past 10 years probably does though. When exploring, this friend is not just there to follow your every move, and they are also not there to create your exact itinerary for you. What they might do is listen to your wants and needs to suggest options for you to achieve your travel goals – guiding you according to their experience in the country and you as their friend/relative.

How to become a successful MI therapist?

There are four fundamental elements that make up the spirit of MI: collaboration, acceptance, evocation and compassion. Additionally, there are another four techniques commonly known as the acronym OARS to convey this spirit: open ended questions, affirmations, reflections, summaries.

Spirit of MI

1. Collaboration: People are the experts of their own life, and therefore the responsibility of changing and decision making cannot fall on anyone else but them. The therapist’s role in MI is to guide and help “brainstorm” the options for change.
2. Evocation: This is the notion that people have within them what it takes to change their problems. They might not know this, because it is buried deep within them. The MI therapists’ job is to help the individual dig within them to uncover their reasons and skills to change.
3. Acceptance: The MI therapist must learn and understand the individual before them without the urge to “fix” or “demand” change. The practitioner here is empowering the individual by emphasizing their autonomy and respecting their right to make choices and changes.
4. Compassion: This is the commitment to prioritize the client’s welfare above all. Through understanding the client and their experiences, the MI therapist “suffers with” the client instead of placing judgment on their actions or lack of actions.

O.A.R.S Technique

1. Open ended questions: These are questions that aid both practitioner and client. For the MI therapist, open ended questions aid in the learning and understanding of a client and their experiences. For the client, open ended questions serve as invitation for introspection, as they explore the depths of their mind and past experiences. Open ended questions differ from close ended questions in that they do not allow for simple answers such as “yes” or “no.” Open-ended questions tend to start with the words “what” “how” or “why.”
2. Affirmations: These are statements generated from the therapist, and show support, appreciation and respect. To form them, therapist identify the effort and strength they see in the individual. Often using “you” instead of “I.”
3. Reflections: With a reflection, you can capture the essence of what the client is telling you, and giving them the words they might have had difficulty expressing themselves. For example, when a client who’s been struggling with addiction for years says something along the lines of “I’ve done everything I can to overcome this” as they bow their head in shame, you may offer a reflection by saying something like “It sounds like you may feel defeated.”
4. Summaries: Sometimes clients who have developed trust and rapport with a therapist can unload a great deal of information all at once. Summarizing what they’ve shared shows you are listening while also providing clarity, which is essential for the “brainstorming” part of MI.

To wrap up, I like to think of MI as an ongoing conversation about change. Keeping the 8 basic elements of MI discussed above will help you engage your client in what is known as “change talk” – which is where clients are getting started on the changes they want to make. When clients are engaged in “change talk”, you as the MI practitioner will learn their considerations for change, their commitment to the change, and their motivation for the change. This is paramount in MI, as simply talking about changing in combination with receiving support, empathy and guidance can be sufficient in creating meaningful advances towards their goals.

References

Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother. 2009 Mar;37(2):129-40. doi: 10.1017/S1352465809005128. PMID: 19364414.

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

Sheftel, A. (2013). YTP and the Motivational Interviewing Approach. Youth Transition Program. https://ytp.uoregon.edu/content/motivational-interviewing