Motivational Interviewing (MI)
Motivational Interviewing (MI) is a counselling technique that was originally developed within medical settings to help people with addiction problems (Miller & Rollnick, 2002). It is based on the idea that people are not always in a state of readiness to change their patterns of drinking, smoking, drug use, exercise or diet.
MI differs from many other counselling techniques in that it does not assume a person wants to change a particular aspect of his or her behaviour. It also acknowledges that there may be strong reasons why a person chooses to maintain this behaviour such as peer approval or status, task avoidance or excitement.
Miller and Rollnick (2002) define MI as ‘a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’ (page 25). In order to understand MI in a bit more depth, let us first explore this definition a little further. This will allow us to move on to exploring the key components of MI.
First of all, the notion of MI being ‘client-centred’ means that it should be centred on the needs, hopes and aspirations of the young person involved. Professionals who are supporting young people may have concerns about behaviours that are potentially harmful or that impact life chances. Often these will be different to the priorities of young people. This does not mean that change cannot occur in relation to these behaviours, just that it is important to start from where the young person is at and that the MI intervention should reflect the young person’s values and experiences.
Secondly, Miller and Rollnick (2002) describe MI as ‘directive’. This term has certain connotations in some types of therapy, which might describe themselves as ‘non-directive’, therefore following the direction of the client. MI is not at odds with this principle, but seeks to help resolve ambivalence in a particular direction of change. McNamara (2009) uses the term ‘guided’ to reflect this element of MI.
Thirdly, MI seeks to enhance intrinsic motivation. This means developing commitment to change from young people in a way which does not rely on the provision of external rewards or sanctions. Instead young people would choose to engage in positive behaviour because they want to and it makes sense to them to do so.
Ambivalence is a term which will be used within this pack and is central to the idea of MI. Ambivalence is defined by Miller and Rollnick (2002) as feeling two ways about something. So, for example, an adult might identify that “Smoking is bad for me, but it’s something I enjoy”. Similarly a young person might feel that “truanting gets me into trouble, but it’s good fun and gets me out of lessons”. Allowing young people to explore and (hopefully) resolve ambivalence around behaviours that are potentially problematic is a central tenet of MI.
Key Elements of MI
Miller and Rollnick (2002) set out two key elements of motivational interviewing, the spirit of MI and the principles of MI. These will now be briefly covered in turn.
The spirit of MI
Miller and Rollnick (2002) describe the ‘spirit’ of MI which evolved from their evaluation of MI practice. This is based on three key components:
That “the method of motivational interviewing involves exploration more than exhortation, and support rather than persuasion or argument” (Miller & Rollnick, 2002; page 34). This means that MI is about exploring and challenging behaviour through developing a positive relationship with the young person, rather than trying to tell them what to do or what not to do.
This component states that MI is not about imparting information, but finding things within the person and drawing them out. It requires finding intrinsic motivation for change from within the person and evoking it. This involves helping the young person to explore and examine their behaviour in a non-judgemental way and allowing them to identify and present their own arguments for change.
Any responsibility for change is left with the client, no matter what the views of professionals. It is the client rather than the counsellor that should ultimately present arguments for change. This can be difficult for professionals working with young people, particularly those who are school or youth justice based, where the desired outcome of an MI intervention may constitute some sort of social control, albeit in the young person’s best interests (e.g. to avoid exclusion or incarceration). However, for the intervention to reflect the spirit of MI, responsibility for change should be left with the young person.
The principles of MI
Miller and Rollnick (2002) describe how the principles provide guidance for how to deliver the ‘spirit’ in practice. There are four key principles of MI.
1. Expressing empathy
It is important that adults working with young people seek to understand their feelings in a non-judgemental manner. Trying to understand perspectives from the young person’s perspective can be useful in establishing rapport which is fundamental to developing a positive relationship. Miller and Rollnick (2002) term the attitude underlying this skill as ‘acceptance’ and note that the facilitator should aim to listen to the young person’s feeling without judging, criticising or blaming. Edmunds (2009), describes MI as ‘a way of being with someone,’ in ‘…a way in which any of us might like to be treated.’ Furthermore, he suggests that doing MI is about providing the young person with ‘…an environment based on co-operation, respect for them and their ability to know what is bad for them’ (page 86).
2. Developing discrepancy
MI aims to help the young person develop a discrepancy between the present state of affairs and how they might like things to be. As Miller and Rollnick (2002) point out, ‘When a behaviour is seen as conflicting with important personal goals (such as one’s health, success, family happiness or positive self-image), change is more likely to occur’ (page 38). Young people may begin to realise that their current behaviour is impacting on their future career prospects and finances, lifestyle or relationships. In my experience, even quite young (primary aged) children can project what the consequences of behavioural problems and their effects (e.g. exclusion) will be in adult life.
3. Rolling with resistance
Miller and Rollnick (2002) suggest that resistance can be reframed to create momentum for change. The facilitator should not argue or persuade for change. The young person who is contemplating change may already have an internal dialogue going on about the pros and cons of, say, truanting. If strong arguments against are presented by the facilitator, the young person may challenge these and defend their behaviour. However, if the pros and cons are explored in a balanced, reasoned way, it allows the young person to develop their own solutions and present their own arguments for change.
4. Supporting self-efficacy
Self-efficacy relates to a person’s belief about his or her ability to carry out and succeed with a specific task (Miller & Rollnick, 2002). It can also be a powerful predictor of success, so if a young person thinks and believes they can accomplish positive behavioural change, they are much more likely to do so. Similarly, if a facilitator has positive expectations for a young person, this can also have a positive effect on the outcome, acting as a self-fulfilling prophecy. A young person can be encouraged by the success of others, or by their own previous achievements in changing their behaviour.