About Motivational Interviewing
Motivational
Interviewing (Miller & Rollnick, 2002) is a
style of talking with clients in a constructive
manner about the whys, whens, and hows of
health-risk reduction and behavior change. Based
upon the tenet that most individuals already
have the requisite skills to successfully modify
lifestyle and decrease health-risk, MI employs
strategies that will enhance the client’s own
motivation for and commitment to change.
Motivational Interviewing integrates an
empathic, non-confrontational style of
interviewing with powerful behavioral strategies
for helping clients convince themselves that
they ought to change. Consequently, resistance
is minimized, self-motivation enhanced, and
treatment compliance and behavior change
secured.
Motivational Interviewing provides an effective
alternative to coercion, confrontation, and
exhortation as a means of promoting behavior
change and treatment compliance. With
applications to a wide variety of health care
concerns, Motivational Interviewing has been
incorporated into the treatment of alcohol
problems, tobacco use, weight control, diabetes
management, cardiac rehabilitation, the control
of chronic hypertension, and many other
behavioral health care problems.
Motivational Interviewing is grounded in the
following principles:
| 1.
Motivation, or readiness to change, is
better considered an ever-changing state
rather than a static personality trait.
The client is neither motivated nor
unmotivated; in “denial” nor
“surrendering;” more accurately, the
interpersonal (e.g., clinical) situation
and the activity of the health care
provider serve to increase or decrease
the client’s readiness to change.
Readiness to change is an ever-changing
product of the helping relationship. |
| 2.
Accordingly, the health care provider’s
interviewing style determines, to a
large extent, client readiness to change
and, indeed, significantly impacts
long-term behavior change. For example,
Patterson & Forgatch (1985) were able to
manipulate client resistance in a single
interview just by switching between a
confrontational and an empathic
interviewer style. Miller, Benefield, &
Tonigan (1993) found that a single
feedback session varying only in
empathic versus confrontational
interviewer style resulted in different
rates of alcohol use one year later; the
empathic interviewers’ clients were
drinking less than those of the
confrontational interviewers.
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| 3.
Ambivalence regarding change is a normal
aspect of the process of behavior
change. This is true of all behavior,
not just the behaviors of excess.
Furthermore, there are almost always
compelling reasons not to change. |
| 4. It is
only human to defend the other side of
the ambivalence. If we argue for change,
clients naturally will argue against
change. The stronger we push for change,
the more forcefully they will articulate
the argument for staying the same. This
is human nature. Impassioned arguments
for change often undermine the clients’
investment in the change process. |
| 5. To
get clients to argue the case for
adopting healthier lifestyles, we must
understand, accept, and sometimes
support the argument for not changing.
Remember, the more we lecture, confront,
or otherwise argue for change, the more
“defensive” will become our clients. |
| 6.
People commit to change more readily
when they have convinced themselves that
they are better off changing. There is
much truth to the idea that you can
convince yourself of anything, if you
just state your case thoroughly enough.
Therefore, the ultimate goal of
Motivational Interviewing is to create a
situation in which clients persuade
themselves to change, rather than having
the health professional doing all of the
persuasion. |
| 7.
Consistent with the active,
client-centered approach, clients decide
what behavior to focus upon and what
health-risk reduction goals, if any, to
set. Health care practitioners provide
information and options, but leave
decision-making to the client. |
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© Gary S. Rose, Ph.D. 2003-2006 |
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