In a recent workshop I presented on Motivational Interviewing (originated by Dr. William Miller and Dr. Stephen Rollnick), the audience of interprofessional clinical practitioners came with varying degrees of familiarity with this well-established and evidence-based practice model. Below is a short summary of the essentials, with links for further reading, exploration and video examples. Start with this short interview with Dr. Miller, offering an overview of the background and basics of Motivational Interviewing.
The “righting reflex” happens when we are triggered to want to “fix it” for the person…and tends to evoke a “Yes, but…” response from the person we are trying to motivate. As soon as we hear a person respond “Yes, but…”, that is feedback that we have likely slipped into the righting reflex.
The spirit of Motivational Interviewing (compassion, acceptance, partnership, evocation) is even more important than the specific skills (Open questions, Affirmations, Reflective listening, Summary statements – OARS). The ‘spirit’ is the essential foundation from which we practice.
There are Four Processes in Motivational Interviewing. They are not all necessarily sequential or linear, and we may need to jump backwards and forwards depending on where the person is at.
1. The process starts with engaging: without engagement there can be nothing
2. Motivational Interviewing is directional (as opposed to directive), with a trajectory toward a common goal (with engagement comes the process of focusing)
3. Once we identify and agree on a goal with the person, we move to the process of evoking change talk to enhance motivation for change
4. Commitment language signals a person’s readiness for the process of planning key strategies and supports to mobilize change
Note that these processes are not linear – we are continuously moving between processes as we stay alongside the person we are working with.
There are four foundation skills in Motivational Interviewing. The OARS skills are used in different ways throughout the processes of Motivational Interviewing. Caution: these skills are simple but not easy!
1. Open questions help us to get to know the whole person – closed questions gather focused information
2. Affirmations offer a neutral observation of a person’s strengths, resources, efforts, values – and statements of affirmation are more motivational than praise
3. Reflective listening communicates understanding and attention. Complex reflections aren’t complicated – shorter can be better!
4. Summary statements offer an opportunity to gather together diverse aspects of a problem, issue or conversational journey, and can also link back to previous material or ideas, and/or further exploration and dialogue.
Here are some of my favourite “Motivational Interviewing Axioms”:
“People are most able to change when they feel free not to” (affirm autonomy)
“You have two ears and one mouth. Use them in that ratio” (listen to understand)
“People only change when the pain of change is less than the pain of staying the same” (working with ambivalence)
“I learn what I believe as I hear myself speak” (evoke change talk)
Guilford Press offers the definitive series of Motivational Interviewing ‘textbooks’ across a range of clinical practice populations, disciplines and target areas.