Motivational interviewing is a way of being with a client. There are multiple benefits to adopting this style as well as a few setbacks where it may not be the most effective. The counselor kind of acts as a guide to the client and help them figure out what they want to do and why, what they would need to do to succeed and how important is it for them to figure this out. One of the interesting things about motivational interviewing is that it is a style of helping the client figure out their own reasons and motivation to change.
A brief example of an interaction could start off like this, it is not a perfect example:
Counselor: “Hi there! It is good to see you! How are you doing today?”
Client: “I’m good, I’ve just being thinking a lot lately. I think I might have drug problem. Well I know I do and I want to quit but I’ve been doing this for some time and I’ve gotten used to it.”
Counselor: “You’re conflicted about whether to try and get sober. You are aware that it has become a problem for you. I’m glad to be working with you on this. What are some of the reasons that you’re conflicted?”
Client: “Yeah, I don’t know, maybe I’m just scared because its unfamiliar to me and I’m not sure if I can quit and actually stay sober. It seems too hard.”
Counselor: “You seem fearful because you don’t know what is going to happen and you ‘re unsure if you can stick with it. What is it that seems hard about it?”
Client: “Yes, and it is much easier to just keep doing what I’m doing because I’ve been doing it for the last couple of years and its worked for me.”
Counselor: “You’re more comfortable when you know what works for you and what doesn’t rather than going into the unknown. What influenced you to start thinking about getting help about this?”
Client: “I’m just starting to think that maybe I shouldn’t do this every day, I spend a lot of money and cause a lot problem and I think part of it is my drug use, so I don’t know if I can quit right away but at least cut back on my use.”
Counselor: “I appreciate you talking to me about this, even talking about it can be hard. So let me make sure I’m understanding you completely; you’re starting to see some of negative consequences of your use and you are seeing that it might be causing more harm than doing any good. You are more comfortable because this is what you’re used to doing and it scares you to go out of your comfort zone. How’s that sound?”
Client: “Spot on, exactly!”
Counselor: “Sometimes when you step out of your comfort zone, you have an opportunity for growth. I am not here to tell you what to do or how to live but together we can explore this issue further and you can figure out what you want to do about it. Does that sound alright to you?”
Client: “Yes Thank you.”
Motivational interviewing is used when a client is ambivalent about changing their behavior. Basically, a client sees both the reasons to change and not to change and it can be conflicting for them. In the Substance Use Disorder (SUD) treatment process. Motivational interviewing involves a process that helps the client reach their own decisions for what they want to do in their life. In the SUD treatment process, the first step of recovery is admitting you have a problem so an example of when motivational interviewing would be used is if a client comes to you because they are starting to feel like they may have an addiction, but they also think that they have it under control because they are still able to maintain a job and take care of their responsibilities, so they don’t really see it as a problem.
Some of the benefits of motivational interviewing are that its low cost, it was designed to be a brief intervention, it has been shown to be effective in helping people change high risk behaviors, also stated in Treatment Improvement Protocols 35 (TIP 35), “Client motivation is a strong predictor of change, and this approach puts primary emphasis on first building client motivation for change” (Substance Abuse Treatment Ch. 3). In my opinion one of the biggest benefits of motivational interviewing is that it focuses on the client’s strengths and values and uses that to help the client with finding motivation and working to change.
Along with some of the benefits, it also can have a few setbacks or limitations. One of the limitations happens if the counselor is not aware of their own values and judgements, this would get in the way of giving the client the best service.
Another setback with motivational interviewing is that it is based on the idea that the client is willing to change certain behaviors so if a client was resistant and didn’t want to change their behavior or didn’t believe they need to change, then I don’t know how effective motivational interviewing would be in helping them. Others may need something more than just finding their own motivation to change and putting it into action. In addition to that, for motivational interviewing to be successful, the client has to be willing and able to participate fully in the process, if the client has to deal with additional issues and can’t really fully participate in the process, then it wouldn’t be an effective option.
I believe one of the most important elements needed to have a successful therapeutic relationship is building trust with the client. The client needs to feel like they can trust their counselor without fear of judgment, I also believe it is important for the counselor to remain non-judgmental and open minded when working with their clients, lastly it is essential you’re able to establish a connection with the client, this will help them feel more comfortable in sharing their stories or thoughts with the counselor.
Motivational interviewing involves four key processes; Engaging is the first process and it means to develop a working alliance with them. Getting the client engaged in the treatment process is an important part and a key in keeping them engaged is the connection and the trust that they have for the counselor. This is so the client can feel open and comfortable enough with the counselor to explore their issues or concerns. Developing this relationship is a key in working in this field. That would be the first responsibility of the counselor when beginning to work with a client, to develop a trusting relationship or partnership with the client.
Focusing is the second process and it is about helping the client determine and set certain goals that they want to achieve. It helps to clarify the direction the client may want to go in. You can ask “What does the client hope to accomplish with this?” to help focus on a goal.
Evoking or evocation which is the third process, is helping draw out the client’s own motivation for change. Some of the skills that can help in evoking motivation is to recognize change talk and sustain talk in the client, evoking change talk out of the client and responding to change talk. Lastly, Planning is developing commitment to change and making a specific plan to accomplish that. A counselor helps the client figure out what works best for them to help them succeed. Motivational interviewing can still be successful and effective with just the first three processes but ideally, you should include all four of these processes (Bill Miller).
In my opinion the main responsibilities of the client is to just to try and be as open and honest as they can with the counselor during this process. The responsibilities of the counselor is to be non-judgmental and open-minded with the client to be able to work well with each other, It is important that the counselor has created a safe, warm, accepting environment for the client. In the book, Motivational Interviewing by William R. Miller and Stephen Rollnick, states that the purpose of the counselor is to “understand the life before you, to see the world through this person’s eyes rather than superimposing your own vision” (William R. Miller pg. 16).
The core communication skills of motivational interviewing are known as OARS. What it stands for is; asking Open-ended questions, Affirming, Reflections, and Summarizing. Asking open-ended questions play a key role in evoking motivation. Affirming which is giving the client positive feedback or looking at the client’s strengths and sharing that with the client. Reflections which means the counselor forms a guess about what the person means, this helps the client stay engaged and explore further because it can make them feel like the counselor understands their point of view. It is also beneficial because the counselor can make a reflection about what the client means and if they are wrong, the client will be able to correct them and continue and if they are correct, it encourages the client to continue with what they’re saying.
Summarizing is basically long reflections that can be used at the end of a session to pull together what has been said, it can also be used as a transition from one topic to another. Summaries help to promote understanding and to show the client that you have been listening carefully to what they say which can also help them feel validated.
Counselors need to be compassionate, open-minded, aware and honest regarding one’s owns values, and they should have good communication skills to be able to help the client. Motivational Interviewing has an underlying spirit that possess these four key aspects; partnership, acceptance, compassion, and evocation. The counselor is a partner with the client. “It is an active collaboration between experts” (William R. Miller).
Acceptance is broken down into four parts; absolute worth, accurate empathy, autonomy support and affirmation. “Together these four person-centered conditions convey what we mean by acceptance. One honors each person’s absolute worth and potential as a human being, recognizes and supports the person’s irrevocable autonomy to choose his or her own way, seeks through accurate empathy to understand the other’s perspective and affirms the person’s strengths and effort”. “To be compassionate is to actively promote the other’s welfare, to give priority to the other’s needs” (William R. Miller).
Motivational interviewing revolves around these processes of engaging the client, focusing on a task or goal, evocation, helping them find their motivation to achieve this goal, and planning a way to achieve the specific goal. Counselors can do this by using O.A.R.S. and there is a certain spirit to it that really makes it unique. The spirit of motivational interviewing is that the client is an expert on themselves and the counselors are here to help them pull the information out of themselves, it is a partnership and it is about showing the client full acceptance, compassion and aiding the client in finding their own motivation for change.
BIBLIOGRAPHY Bill Miller, Terri Meyers. “Teaching The Four Processes.” September 2012. Motivationalinterviewing.org. 28 May 2018.
Center For Substance Abuse Treatment. “Enhancing Motivation for Change in Substance Abuse Treatment.” 1999. https://www.ncbi.nlm.nih.gov/books/NBK64964/. 28 May 2018.
Jani, Anne. “Motivational Interviewing Skills and Techniques: Examples, Tips, and Tools.” 12 March 2013. Surroundhealth.net. 28 May 2018.
William R. Miller, Stephen Rollnick. Motivational Interviewing Helping People Change 3rd edition. New York: The Gulliford Press, 2013.