Motivational Interviewing Overview and Principles

Motivational Interviewing Overview

• The client is responsible for articulating their own ambivalence about change
• Self-directed persuasion is an ineffective method for resolving ambivalence
• When resolving ambivalence, counselors should act with a quiet and eliciting style
• Effective outcome measures include the Motivational Interviewing Treatment Integrity (MITI) and the Behavioural Change Counselling Index (Becci)

Motivational Interviewing Key Principles

• Collaboration: Motivational Interviewing is a partnership with the client that honors their experiences and perspectives.
• Evocation: Intrinsic motivation is enhanced by drawing on the client's own perceptions, goals, and values.
• Autonomy: The client's right and capacity for self-direction are facilitated by informed choice.

Motivational Interviewing Process

• Establish rapport
• Set an agenda
• Talk about a single behavior with the client, while remaining open to other issues
• Assess the client's readiness for change by exploring their importance of and confidence in making the change
• Explore the importance of change by asking the client "Why?"
• Explore the client's confidence in making the change by asking the client: "How?"
• When concluding Motivational Interviewing, reinforce the client's commitment to the change and encourage follow-up

Motivational Interviewing Health Professional Actions

• Ask open-ended questions
• Listen reflectively
• Affirm the client
• Summarize the discussion
• Elicit self-motivational statements from the client

Eliciting Self-Motivational Statements

• Explore the importance of change, including:
  • Personal values
  • Expectations of change
  • Who will benefit from the change
  • What will change
  • "Do I really want to make this change?"
  • "Will it make a difference?"
• Explore confidence by taking into account:
  • Self-efficacy (How will I make this change?)

Assessing Readiness for Change

• Use a scale of 1 to 10 to assess the client’s importance of and confidence in making the change, with 1 being “not at all motivated” and 10 being “100% motivated”
• Explore why the client chose their specific number on the scale
• Ask how the client can increase their score

Importance: Explore

• Explore the client's reasons for wanting to change by asking them:
  • "Why should I change?"
  • "Why so high?" (If their score is high)
  • "How can you go higher?"
• Ask the client to examine the pros and cons (benefits and costs) of changing.
  • For both initiating and maintaining the new behavior
• Explore the client's concerns about changing
• Ask the client to imagine being "over the fence" to see the benefits from the other side

Confidence: How? What? Decisional Balance

• Explore how the client feels about the change by asking them:
  • “Can I do it?”
  • “How will I do it?”
  • “How will I cope with…? (Ask in relation to the disadvantages).
  • “Will I succeed if …?”
  • "What change?"

Decisional Balance for Ambivalence (MI)

• To examine client ambivalence, explore the advantages and disadvantages of both maintaining their current behavior and initiating new behavior:
  • Maintaining the current behavior:
    • What do they like about it?
    • What worries them about it?
  • Initiating a new behavior
    • What would they like about it?
    • What would concern them about it?

Agenda Setting

• Help the client identify more than one issue to address
• Elicit personal views and feelings about the issue
• Provide explanations about the issue including:
  • Causes
  • Symptoms
  • Solutions

Good Rapport

• Good rapport is essential for Motivational Interviewing, and can be achieved by:
  • Avoiding arguments
  • Employing skills such as:
    • Reflective listening
    • Shifting focus
    • Reframing