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The Spirit of Motivational Interviewing

Motivational interviewing is defined as "a directive, client-centred counselling style for eliciting behaviour change by helping clients explore and resolve ambivalence". There are two implied active ingredients in motivational interviewing - a relational component and a technical component. The spirit of motivational interviewing is concerned with this relational aspect. Miller and Rollnick (2002)1 comment on how they have, since the first publication of their book in motivational interviewing in 1991, placed less emphasis on techniques of motivational interviewing and ever greater emphasis on the fundamental spirit that underlies it.

So, motivational interviewing, while a learnable set of techniques, is more importantly a style or approach to assisting clients in resolving ambivalence and changing behaviour. Without the underlying spirit of motivational interviewing, it risks becoming a vehicle for client compliance with little long term change.

The spirit of motivational interviewing owes much to the Rogerian person-centred counselling approach. In fact, at a recent seminar by Miller (18 July 2007, Wellington), I was struck by his comments that 80% of motivational interviewing is about this. The key difference is that motivational interviewing is more focussed and goal-directed than non-directive person-centred counselling. Motivational interviewing has, as its central purpose, the examination and resolution of ambivalence, and the interviewer is intentionally directive in pursuing this goal.

Miller and Rollnick talk about bringing a fundamental approach to motivational interviewing. This fundamental approach has three components - collaboration, evocation and autonomy. What do these components look like in practice?

 Collaboration means working in partnership with the client, where the interviewer is supportive rather than persuasive.

 Collaboration means working in partnership with the client, where the interviewer is supportive rather than persuasive. It means working alongside a client rather than in front of or opposed to them. A confrontative approach is the antithesis of the spirit of motivational interviewing. So while the interviewer respects the autonomy of the client and the ownership of the issues as the clients, the language of the worker will be inclusive, e.g. "how do we work together to come up with options..." The interviewer, by working collaboratively with the client, creates a positive atmosphere conducive to change

Evocation means to draw out of the client their own perceptions, goals and values, so the interviewer starts with the assumption that the resources and motivation for change reside in the client. In practice, this means that the interviewer is eliciting from the client, rather than imparting information or opinions and so is doing more listening than talking.

Autonomy in motivational interviewing terms means that the responsibility for change is left with the client. This means that the interviewer demonstrates respect for the client, for their resourcefulness and their ability to make choices. The antithesis of this is for the interviewer to take an authoritarian approach where they tell the client what he or she must or should do, which comes from an assumption that you know better than the client.

How easy is it to work with clients from this position? How easy it is to maintain this approach when clients are stuck in ambivalence, resisting what they know they should do, attack or resist your best efforts or are unaware of the risks of their behaviour? How easy it is to maintain this approach when you are feeling frustrated with a client's apparent lack of progress, or when they make decisions you consider unwise, or when you feel pressured for time, are juggling multiple clients and they are mandated? The spirit of motivational interviewing requires the interviewer to take a rigorous look at their beliefs regarding clients and their own position in relation to clients.

Test yourself using the questions and scaling below.

Am I genuinely interested in people? 

                                                                                                         100

0 = I have no interest at all

100 = people are what I am the most interested in

 

Am I able to accept other people as they are or do I have a desire to direct or change them?

0                                                                                                          100

0 = I have a desire to direct or change others

100 = I can accept others as they are

 

Am I willing to understand others?

0                                                                                                          100

0 = I am unwilling to understand others

100 = I will put everything aside in order to understand others

 

How comfortable am I in letting go of being an expert?

0                                                                                                          100

0 = extremely uncomfortable in letting go of being knowledgeable (an expert)

100 = high level of comfort in letting go of being an expert

 

How able am I to let go of solving other's problems?

0                                                                                                          100

0 = I am uneasy when I am not solving other's problems

100 = I am very comfortable in letting others resolve their own problems

 

How confident am I that clients have inner resources to change? 

0                                                                                                          100

0 = I am not at all confident

100 = I have absolute confidence

 

Margaret Robinson is a designer and trainer who previously worked as part of the HMA team. For more information about how HMA can help you with your motivational interviewing training contact info@hma.co.nz

Endnotes: 1 Miller, William R. & Rollnick, Stephen. (2nd edition) Motivational Interviewing: Preparing People for Change.  New York: Guildford Press (2002)


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