Understanding Motivational Interviewing
Understanding Motivational Interviewing
Motivational interviewing – usually referred to as MI from now on – is a theoretically sophisticated approach to helping that has a strong evidence base in other settings, including health care, rehabilitation, public health, dentistry, coaching and education (Miller and Moyers 2017). There is also good evidence that it can be helpful in child protection or similar settings (Forrester et al. 2018).
According to clinical analyses, motivational interviewing techniques are over 70% effective at helping people resolve physiological and psychological challenges. Whether you want to inspire a client on their health journey or motivate an employee to be more productive, you’ve probably discovered how ineffective it is trying to force someone to change.
External pressure can, paradoxically, make someone less likely to change. Motivational interviewing does just the opposite: It empowers people to ignite change within themselves.
Social work and MI just seem to belong together. At the heart of social work is a desire to empower people, to find and call upon their own strengths and abilities. Social workers accomplish this primarily through talking, and a skillful sensitivity to language is central in MI. Components of the underlying spirit of MI converge with core values of social work: a compassionate empathy for those we serve, an accepting and collaborative partnership, and a proactive intention to call forth the best in others. MI is not about fixing people. It does not come from a deficit view that people are lacking something that we have to install. Ultimately people are free to choose what they will do and how they will be. MI is about helping people find their own personal motivation for positive change, which leads naturally to planning and connecting them with the resources needed to accomplish it. That facilitator role is home territory for social workers (Hohman, 2021).
Social workers love to talk. And it is a good thing we love to do it. Other than the dreaded paperwork, it is what we do all day long: interview clients, consult with colleagues, meet with families, present cases at team meetings, go to lunch with a friend, and perhaps teach a class of social work students.Understanding Motivational Interviewing
Though social workers work in many different kinds of settings, we have in common that we spend most of our time talking. We think we are pretty good at talking; why, we have been doing it for years! No one has to teach us how to communicate. Sure, we learned a bit about interviewing skills in social work school and, as students, we watched our field instructors interact with clients. But for the most part, as in parenting, we tend to rely on communication skills we developed in growing up and have used all along.
Sometimes, though, as social workers, we run into clients that we find particularly challenging, and it seems the usual methods of communication aren’t that helpful. Clients may be angry, argumentative, or apathetic, seeming to have no desire to change despite being on an obvious (to us) destructive course.
When this happens, it is easy for any of us to try to persuade or even argue with clients. Sometimes we feel responsible for our clients and the outcome and react by trying to fix the problem. It feels like if we could only give them enough information, ask the right questions, or lay out the consequences of a particular action, then clients would be open to change or at least, to calm down. This can especially occur in situations that have a dire outcome, such as in child welfare or probation (Mirick, 2013).
The Four Processes of MI
Based on feedback from clinicians as well as their own experiences, Miller and Rollnick (2013) sought to establish a structure of how an MI interview can best flow and provided what they call the four processes:
- Engaging
- Focusing
- Evoking
- Planning
Engaging
Engaging is key to establishing any kind of helping relationship or working alliance. It does not happen only in counseling or therapeutic relationships. Social workers work in many roles and need to engage with clients in all settings (Rollnick et al., 2016). Engaging clients is important as it is strongly related to positive outcomes (Moyers & Miller, 2013). In the Engaging process, clients are essentially wondering about their social worker (or doctor or other helping professional), “Can I trust this person?” Understanding Motivational Interviewing
Engaging involves social workers setting the tone using the MI spirit of acceptance, collaboration, autonomy support, empathy, and evocation, and using MI skills including open-ended questions, reflective listening, affirmations, and summaries. You convey the spirit of MI as you get to know clients, including their current concerns, or hopes, or values. The art of MI is that there is no one direction to go in during the Engaging process. The goals are to establish a trusting relationship as well as to learn enough about the client to guide them to the next process of focusing.
Focusing
Focusing is determining in collaboration with clients what the agenda or the goals of the conversation will be. What are some typical change behaviors that social work clients might identify? They could include getting one’s children back, making changes in alcohol use, giving up a driver’s license, taking needed medication, meeting requirements of getting a job, dealing with depression symptoms, enrolling in a food assistance program, and so on.
Evoking
Once the goal has been established, social workers then begin evoking change talk from clients, asking about the why of change, reasons for change, abilities to change, or the need to change, reflecting as they go along. Understanding Motivational Interviewing
The goal is for clients to discuss their own motivations for change and to hear themselves discuss them (self-perception theory). “People talk themselves into changing” (Miller & Rollnick, 2013). Reflections and summaries are MI skills to provide empathy as well as to reinforce what clients are stating. These skills help you to guide the conversation.
Planning
The last process is Planning. Clients may or may not choose to engage in planning. Clients may describe why and how they may engage in a certain change and then get overwhelmed with a lack of confidence, feeling that it is too much, and then back off.
You would then return to Evoking, to ask perhaps about other times when clients were successful. Or, clients may state they are just not ready to make the commitment to planning steps on how to change. Does this mean that the MI was not successful? Not at all, as seeds for change have been planted. Planning has been characterized as moving from the “why” to the “how” (Resnicow, McMaster, & Rollnick, 2012).
Clients who are ready to engage in Planning utilize language that describes commitment (“I think
I am ready to do what it takes”). Social workers evoke from client what steps they think are appropriate. Their own ideas can be added in only after clients’ ideas have been exhausted, with permission to share some thoughts on other choices (self-determination theory).
- Understanding Motivational Interviewing
- Sajjad Majidi Parast
- PhD of Social work, Allameh Tabataba’i university
References
Hohman, M. (2021). Motivational Interviewing in Social Work Practice. Second Edition
Forrester, D., Westlake, D., Killian, M., Antonopoulou, V., McCann, M., Thurnham, A., et al. (2018). A randomized controlled trial in motivational interviewing for child protection. Child and Youth Services Review, 88, 180–190.
Miller, W. R., & Moyers, T. B. (2017). Motivational interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), 757–766.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York: Guilford Press.
Mirick, R. G. (2013). An unsuccessful partnership: Behavioral compliance and strengths-based child welfare practice. Families in Society, 94(4), 227–234.
Rollnick, S., Kaplan, S. G., & Rutschman, R. (2016). Motivational interviewing in schools: Conversations to improve behavior and learning. New York: Guilford Press.
Resnicow, K., McMaster, F., & Rollnick, S. (2012). Action reflections: A clientcentered technique to bridge the WHY-HOW transition in motivational interviewing. Behavioural and Cognitive Psychotherapy, 40, 474–480.
