If you’re new to Motivational Interviewing, let me first offer up a definition: At its most basic, Motivational Interviewing begins as a conversation where you’re trying to help someone manage ambivalence that is preventing them from acting on a potentially problematic behavior. The overarching goal is to help the individual sort through the ambivalence they’re experiencing, and reach a decision that fits within their life circumstances. It’s a way of talking to people that helps them summon forth their motivations for changing something – rather than telling them they need to change. It’s not psychotherapy for sure, because psychotherapy is so much more than just interviewing; it’s more akin to coaching someone whereby the interviewer guides the person toward decisions that reflect their own self-interest.
The Conversation
Think about getting started like this: There are more clinical models nowadays than we can shake a stick at, so think of them along a continuum. At one end of the spectrum is instructing, that is, telling a client specifically what to do. This approach can be very appropriate in the physical medicine field, as patients often welcome being told specifically what to do to best remedy or at least ameliorate their situation. On the opposite end of this spectrum is just listening to someone’s issues or concerns. This is the prototypical supportive client-focused approach. Motivational Interviewing is somewhere in between in that the interviewer uses “active” listening as a tool that will get clients to advocate for themselves on behalf of change and why it’s important to them, not the interviewer.
Connecting with the client begins in the “Engaging” phase. These conversations should always open with a positive focus, because doing so encourages positive emotions. Focus on areas of happiness, what made the client laugh or smile today, what had them feeling content in the past week? This is classic rapport building which helps ease the client into the meat of the discussion to come.
The conversation then moves to what’s referred to as the “Evoking Phase.” In this phase, the interviewer is focusing on what kind of language the client is using. Is the client engaged in “change talk,” “neutral talk,” or “sustain talk?” Change talk is anything a client may say that’s moving him or her in the direction of changing their circumstances. “My life would be better if I gave up the drugs.” “I just can’t keep going on this way.” Neutral talk is just that – it’s neither for nor against change. The goal is to get neutral talk to progress toward change talk. And then there’s sustain talk. The simplest way to describe this is it represents the “other side” of the person’s ambivalence, in that it’s their “I want to hold on to what I’m doing” position. When encountering sustain talk, it’s best to shift the focus of the conversation to a less threatening topic the client may be more willing to address, and to embrace the autonomy concept at the heart of Motivational Interviewing: It has to be okay with the interviewer that the person is holding their position, in spite of the interviewer’s beliefs and feelings to the contrary. Sometimes change is happening below the surface even though it’s not being expressed by the client.
Problematic Behaviors Best Suited For Motivational Interviewing
I find motivational interviewing works best for people who are wrangling with ambivalence over substance abuse issues and those with certain physical health matters such as weight loss. These people come to me with insight about the problem, and are able to aptly describe the ambivalence they’re having about changing. They’re also able to clearly articulate the pros and cons associated with changing or sustaining their current behavior.
On the other hand, if someone has moderate or severe emotional issues and mental health problems, such as major depression or bipolar disorder that prevent them from being present, rendering them unable to discern their situation effectively, they aren’t a good fit for Motivational Interviewing.
Doing It Right
Motivational Interviewing is never about influencing someone to take one position over another. It’s about being sensitive to the person’s challenge and their ambivalence. It’s about being curious, listening carefully, not offering advice without consent, being patient, and most importantly, it’s about guiding them toward reconciling the internal battle they’re facing.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.