Motivational Interviewing - Four General Principles

Four General Principles

Express empathy.

Empathy involves seeing the world through the client's eyes, thinking about things as the client thinks about them, feeling things as the client feels them, sharing in the client's experiences. Expression of empathy is critical to the MI approach. When clients feel that they are understood, they are more able to open up to their own experiences and share those experiences with others. Having clients share their experiences with you in depth allows you to assess when and where they need support, and what potential pitfalls may need focused on in the change planning process. In short, the counselor's accurate understanding of the client's experience facilitates change.

Develop discrepancy.

This guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs. how they currently are (or between their deeply-held values and their day-to-day behavior). MI counselors work to develop this situation through helping clients examine the discrepancies between their current behavior and future goals. When clients perceive that their current behaviors are not leading toward some important future goal, they become more motivated to make important life changes. Techniques used can include decisional balance sheets

Roll with resistance.

In MI, the counselor does not fight client resistance, but "rolls with it." Statements demonstrating resistance are not challenged. Instead the counselor uses the client's "momentum" to further explore the client's views. Using this approach, resistance tends to be decreased rather than increased, as clients are not reinforced for becoming argumentative. MI encourages clients to develop their own solutions to the problems that they themselves have defined. In exploring client concerns, counselors may invite clients to examine new perspectives, but counselors do not impose new ways of thinking on clients. Rolling with resistance allows therapists to accept client reluctance to change as natural rather than pathological.

Support self-efficacy.

This guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence. As clients are held responsible for choosing and carrying out actions to change in the MI approach, counselors focus their efforts on helping the clients stay motivated, and supporting clients' sense of self-efficacy is a great way to do that. One source of hope for clients using the MI approach is that there is no "right way" to change, and if a given plan for change does not work, clients are only limited by their own creativity as to the number of other plans that might be tried.

The main goals of motivational interviewing are to establish rapport, elicit change talk, and establish commitment language from the client. For example, change talk can be elicited by asking the client questions, such as "What makes you think this is a problem for you?" or "How does ______ interfere with things that you would like to do?" It is important to keep in mind that client behavioral issues are common in the process of motivational interviewing. Change often takes a long time, and the pace of change will vary from client to client. Knowledge alone is usually not sufficient to motivate change within a client, and relapse behaviors should be thought of as the rule, not the exception. Ultimately, therapists must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.

While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points:

1. Motivation to change is elicited from the client, and is not imposed from outside forces
2. It is the client's task, not the counselor's, to articulate and resolve his or her ambivalence
3. Direct persuasion is not an effective method for resolving ambivalence
4. The counseling style is generally quiet and elicits information from the client
5. The counselor is directive, in that they help the client to examine and resolve ambivalence
6. Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
7. The therapeutic relationship resembles a partnership or companionship