Why and how do people change? Psychotherapy took a confrontational style up until about the 1970s. But we have developed more of a collaborative approach called Motivational Interviewing (MI) since the 1980s. With MI we will develop “the righting reflex.” People become ambivalent. MI has developed sort of a science of change. I will develop a partnership with my clients. MI involves a sense of acceptance, absolute worth, accurate empathy, autonomy, and affirmation. Compassion and evocation. MI is person centered, done “with” and “for” the client. MI is about evoking what is already present not installing what is missing.
The four processes of MI include: engaging, focusing, evoking, and planning. In MI I will ask open questions, affirm, engage in reflective listening, and summarizing. I will engage in reflective listening. In MI we use OARS core skills. Ask open questions. Affirm. Reflect. Summarize.
Explore Values and Goals in MI
In MI we will engage in an open-ended values interview and also a structured values exploration. Recognize the importance of integrity and being consistent. Explore any discrepancies in your life. Focusing is important in MI. Setting an agenda. Focus on the therapy is on the client, the setting and the clinical expertise. There are three types of focusing: directing, following, and guiding.
The Guiding Spirit of Motivational Interviewing
In MI there’s a partnership between the therapist and the client. The therapist utilizes acceptance, compassion, and empowerment. MI is a way of being. MI is person centered like the work of Carl Rogers. People tend to be reluctant to change. MI helps to get people towards a state of ambivalence. The four tasks of MI are: engaging, focusing, evoking and planning. The therapist strives to ne genuine and engages in some self-disclosure.
My clients can expect me to actively listen. Engage in mirroring. Ask open questions. Affirm my clients and summarize.
Focusing
We will develop straightforward goals, choose a path, and clarify the client’s goals. The therapist and the client will develop a collaborative alliance.
Evoking
The therapist will utilize “evoking” which means “calling forth what is already present.” Utilize the patient’s voice of reasons and resources for change. Evoking involves “how” and “why” questions.
Ambivalence
Ambivalence in MI is an opportunity to develop a decisional balance. One side of the balance is to maintain the status quo. The other side is about change.
The Language of Change
MI takes the language of change talk seriously. There’s a preparatory change talk. Including the acronym DARN. Desire language. Ability language. Reasons language and Need language. After preparatory change talk then there’s mobilization change talk.
Mobilization Change Talk is summarized by the CAT acronym. Commitment language means that the client says, “I will” or “I promise.” Activation language involves moving towards action. Taking Steps Language is the final part of Mobilization Change Talk. Taking-Steps language “is a form of speech indicating that the person has already taken some action in the direction of change.”
Sustain Talk
Ambivalence “is an inner debate between the arguments for and against change.” The ambivalence is between language supporting change and also language supporting the status quo. Maintaining the status quo is called “sustain talk” or “counter change talk.” In change and sustain talk, we will examine your desire, ability, reasons, need, activation, commitment, and willingness to take steps.
Miller, W.R., & Rollnick, S. (2023) Motivational Interviewing: Helping people change and grow. (4th Edition). The Guilford Press, NY