The definition below highlights the importance of not only the techniques and processes of MI but also the atmosphere for a supportive and productive session.
Motivational Interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person‘s own reasons for change within an atmosphere of acceptance, collaboration, and compassion.
When Bill Miller and Stephen Rollnick began teaching MI back in the 1980s, they talk about how much focus was placed on the techniques and “how to do” MI and less about the underlying “spirit” of MI. They speak about how they felt like they were teaching the words to the practitioners but not the music. So, the “music” of MI, or the “spirit” of MI involves four key elements: partnership, acceptance, compassion, and evocation. And as mentioned above, for each of these elements there is both an experiential and behavioral component. Below are the four elements explained in greater detail:
Partnership:
In a therapeutic relationship using MI, it is important to remind ourselves that the client is the expert of their own experience and that our intention is to honor their experiences, perspectives, and choices…even if they may be different from our own. In order for change to occur and for change to be sustainable, we know that the client must do the “heavy lifting” and our role is to provide the guidance and support through this process. It is a collaboration between two individuals who have a lot to offer each other. An example used by Miller and Rollnick is that the conversation is like sitting together on a sofa and the client is sharing with you their life photo album. The practitioner asks questions from time to time, but mostly, the practitioner listens to the client’s unfolding, attempting to understand and see the world through their eyes rather than influencing them with their personal values and agenda.
Acceptance:
Motivational Interviewing has a deep connection to the work of Carl Rogers, and especially as it relates to the profound acceptance of the client…again, not that the practitioner always agrees or approves of
the client’s actions but that the practitioner always honors the inherent worth and potential of every human being encountered. There are four aspects of acceptance:
1) Absolute Worth
a. Rogers termed the phrase “unconditional positive regard” against an attitude of judgment and placing conditions on worth…since when one feels they are unacceptable, their ability to change is diminished…but if one feels accepted just as they are, they are free to change.
2) Accurate Empathy
a. Being as genuine as possible as a practitioner and taking an active interest in attempting to understand the client’s internal perspective on experience is Accurate Empathy. It is “to sense the client’s inner world of private personal meanings as if it were your own, but without ever losing the ‘as if’ quality” (Rogers, 1989).
3) Autonomy Support
a. It is unlikely for a client to change their behavior if they are told what to do and how to it…or for a practitioner to believe they are able to make people change. There is much more likelihood for change to occur if the practitioner acknowledges a person’s freedom to choose and a belief that each human being has what is needed to do so.
4) Affirmation
a. This is being intentional about acknowledging the client’s strengths and efforts and not about what is “wrong” with someone and telling them how things can be fixed. An affirmation is not praise like “great job” but rather a genuine acknowledgment of how the client “persevered” in a situation or “prioritized” something important to them. Affirmations are more about the person than the behavior.
Compassion:
Since our primary goal in MI is to be of service to someone considering behavior change, the cultivation of compassion, or the commitment to pursue the welfare and best interests of another, is essential. A practitioner does not need to suffer with a client in order to act with compassion, as it is more about actively promoting the other’s welfare and giving priority to their needs. Interestingly, the promotion of others’ welfare is often an important motivation for many of us in the helping professions.
Evocation:
When individual change is being considered in many settings, there is often a focus on deficits…and what the person is lacking that needs to be installed. And in a therapeutic setting, the practitioner can often be seen as the person who can assess what is missing and provide it to the client, whether it is knowledge, insight, or skills. There is a very different premise in MI; a belief that each individual already has what they need within them, and that our role, as practitioners, is to evoke it, or bring it out. An example of this is thinking about ambivalence and the likely scenario that each individual often has motivations to change and motivations to continue maintaining a particular behavior. Therefore, as a practitioner, we attempt to evoke and strengthen these motivations to change that already exist.
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu