In early counseling therapies and treatment, there were many approaches where the clinician attempted to convince the client to make healthier choices in their lives. If the clinician were able to ask appropriate questions, provide important information, encourage certain emotions, and persuade the client to see things in a certain way, the client would be able to change. These approaches lasted for an extended period-of-time where these kinds of beliefs, judgments, labels, etc. existed related to a lack of motivation on behalf of the client.
Over time, it became clear that this approach was not effective and that it did not allow the client to engage in the process. To illustrate this point, and to give a better sense of the foundation of Motivational Interviewing, Miller and Rollnick offered this experiential experiment:
Ask someone to choose a behavior they have been contemplating to change. Tell them how much they need to make this change, provide a list of all the reasons to change, explain the importance of making this change, tell them how to do it, and let them know that they will be able to make this change. How would this person likely respond? Miller and Rollnick state that they have used this exercise all over the world, and not surprisingly, people’s responses have been very consistent. Most people feel angry, annoyed, irritated, not heard, defensive, judged, oppositional, uncomfortable, ashamed, overwhelmed, powerless, discouraged, and disengaged. Understandably, not only does the person feel this way, but they also are not interested in changing their behavior.
And if this experiential experiment was tried again, and you asked someone to choose a behavior they would like to consider changing, but this time, you ask the person several questions that are MI consistent:
1) Why would you want to make this change?
2) How might you go about it in order to succeed?
3) What are the three best reasons for you to do it?
4) How important is it for you to make this change, and why?
5) So, what do you think you’ll do?
Even though there was very little information or introduction to this conversation, this is a great example of the use of open-ended questions in Motivational Interviewing. And when Miller and Rollnick asked people who participated in this exercise how they felt after having this conversation, responses included feeling engaged, interested, empowered, optimistic, open, respected, understood, heard, and connected.
Again, the content of the conversation was the same but the approach and the outcomes were very different. Motivational Interviewing is not asking these five questions but it is a conversation about change. It involves guiding the collaborative conversation and having the client come up with their own motivations for changing their behavior. Miller and Rollnick in their 3rd edition of Motivational Interviewing: Helping People Change offer this beginning definition:
Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
We will continue our blog series next month about “conversations about change” and begin to focus on the spirit of Motivational Interviewing. Continue to enjoy the ongoing practice of Motivational Interviewing and remember that we are always learning. Have a great month!
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu