“Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence**.”
Stephen Rollnick and William R. Miller
Motivational Interviewing is more about mindset than techniques. The traditional mindset has been to “make” our clients change. It’s an “us” (the experts) against them (the “damaged in need of fixing”). We rationalize this this approach because their behavior heroin use, heavy drinking, cigarette or pot smoking, better living through shopping, gambling, or self-starvation, or couch-potato-ing themselves into a heart attack is dangerous if not deadly and we think we are responsible for their lives because clearly they are not handling things well. (This also sounds a lot like co-dependency.) And it doesn’t work.
One key to the Motivational Interviewing mindset is to trust that our client’s actually want to live healthier, more fulfilling lives and just need help to find their own internal motivation to change. Rather than assuming that our clients are somehow mentally deficient to engage in behaviors that are not rational, the Motivational Interviewing mindset pushes us to see that our clients engage in destructive behaviors as a strategy to get their needs met even when those behaviors are not effective. Therefore, it is the client’s job, not ours to explore and work through their ambivalence to change. Our job is simply to help them articulate the conflict inherent in their ambivalence to change by helping them explore the costs and benefits associated with each side of the conflict.
This is easier if you can remember your own internal conflicts – the “angel” on your right shoulder that says, “Don’t start reading your Facebook newsfeed. You have work to do,” while the “devil” on your left shoulder counters, “If you don’t check it out, you might miss something. Besides, it’s only a few minutes. You can’t be all work and no play. You deserve a little bit of pleasure….”
The reality is that attempts to “make” our clients change by threatening, bullying, or “persuading,” simply triggers their resistance. Sure, the rational response to, “If you don’t start working out and stop eating high cholesterol foods you’ll be dead of a heart attack in a year” is to join the gym, get a trainer and start on a healthy diet plan. But, the more likely response is, “F-you, I’m doing just fine. I don’t need your advice.” Or, “Get off my back.”
From a Motivational Interviewing standpoint, “resistance” and “denial” highlight our failure as therapists to meet our clients where they are at rather than about our clients’ inherent traits. Through the lens of Motivational Interviewing, client “resistance” and/or “denial” is great feedback that tells us that we need to change our strategy to be more in line with where our clients are at in terms of change.
Another key to the Motivational Interviewing mindset is the shift in how we frame the therapeutic relationship. Rather than viewing the relationship as one of “expert” verses “damaged client,” the relationship is seen as a partnership rooted in respect for the client’s autonomy and freedom of choice. The therapeutic relationship has repeatedly been shown to a larger impact on client outcome than particular treatment interventions. Respect is a cornerstone of relationship. Respect demonstrates to our clients that we value them – that we and recognize that they are worth something, even if their behavior has been destructive to themselves and/or others. This particularly important given that many of our clients don’t respect or value themselves and have experienced disrespect and rejection from others.
It’s only when we approach working with clients from a standpoint of respect for their autonomy and freedom of choice that we can be directive and help them explore the pros and cons of making changes and find their own internal motivations for doing so.
Built on this philosophical mindset, Motivational Interviewing techniques involve engaging in acceptance and affirmation, empathy, and reflective listening. It is helpful to help clients explore their own motivation to change whether it’s a desire to avoid negative consequences such as incarceration, relational conflict, or guilt, or to pursue positive consequences such as better mental and physical well-being, better self-esteem, improved finances, or the ability to pursue deeper, more fulfilling dreams. Motivational Interviewing requires us to be able to monitor our clients’ motivation to change and work with them where they are at on the change continuum.
Why Action Methods?
Psychodrama, Sociodmrama and Socimetry are action methods developed by JL Moreno. They are particularly useful in cutting through rationalization, denial, justification and various other defenses that people use to avoid change. When you do things in action your body takes over and your mind gets out of the way. Experiential methods such as these move the client from a highly cognitive and intellectual process into a lived experience that engages them both cognitively and emotionally.
Psychodrama and Sociodrama enliven the Motivational Interviewing process by concretizing clients’ ambivalence to change and helping them see for themselves the discrepancy between their current unhealthy behavior patterns and their goals and values. Clients are able to identify the results of destructive behavior patterns, experiment role-playing different choices; experience how things could be if they changed, and practice doing things differently.
Furthermore, clients can step into the shoes of someone they love and experience how their current or past behavior has impacted this person. More than simply helping clients think about how their loved one feels, role reversal allows clients to feel the impact of their behavior at the body level. Clients have reported that reversing roles with their loved one has increased their desire to change.
*Originally posted on http://www.hvpi.net/category/articles-of-interest/
**Stephen Rollnick, Ph.D., & William R. Miller, Ph.D.
What is motivational interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334.