Motivational Interviewing
Rather than a specific type of psychotherapy, motivational interviewing is a conversation method that creates partnership and trust between a client and their therapist.
Through creating trust between therapist and client, the client can better trust in themselves to change.
Often, a client walks into a therapist’s office with some apprehension and nervousness. It’s not usually easy to be vulnerable to someone you barely know.
A good therapist will work to build trust and a relationship with a client during treatment. That is what motivational interviewing is for. Psychotherapists use this technique to empower their clients through a strong relationship.
Motivational Interviewing as a Philosophy
Rather than a type of psychotherapy, motivational interviewing is more of a philosophy or method of approach. Therapists apply it to many different types of psychotherapy to encourage client interaction. All therapists should build a trust bridge with their clients, but this methodology places the client more in the driver’s seat.
Utilizing the motivational interviewing philosophy allows clients to guide the journey. The therapist wants to set a client up for success to reach their goals, but the client forms their own conclusions. In a sense, the therapist tells the client there is a door, and, through trust and assurance, the client walks through the door independently.
The Motivational Interviewing Network of Trainers describes how to break down the “spirit” of motivational interviewing into four core elements:
- Collaboration
- Evocation
- Acceptance
- Compassion
Through creating trust between therapist and client, the client can better trust in themselves to change.
Who Can Benefit From Motivational Interviewing?
While you can elevate nearly every method of psychotherapy with motivational interviewing, there are some cases where it is more effective and very much needed.
Some mental health issues affect your behavior and relationships more than others. Your therapist will probably supplement therapy with motivational interviewing when you want to make behavioral changes or need confidence or motivation to make these positive changes.
Those seeking therapy for the following issues may benefit the most:
- Substance use disorders
- Behavioral addictions
- Medication management
- Body issues
- Depression and anxiety
- Family therapy
Anyone with some level of apprehension to change, denial or unawareness of the need for change, or fear of change can benefit from motivational interviewing techniques. It’s all about empowering them to achieve their therapy goals.
Key Principles of Motivational Interviewing
Rather than a type of psychotherapy, motivational interviewing is more of a philosophy or method of approach.
Using these techniques rests on a set of principles or pillars. These will guide the therapist toward the next step in treatment.
Express Empathy
Understanding and validating a client’s thoughts and feelings is perhaps the most critical and prominent component of motivational interviewing. It should be present in all therapy settings.
Roll with Resistance
A mental health journey rarely goes perfectly smoothly. Everyone experiences hurdles, and most don’t stay 100% committed to change the entire time.
Instead of fighting this resistance or pushing back, the therapist should readjust. This obstacle is simply another part of this person’s journey, handled the same way the rest of their talk therapy treatment has been.
A widely used example is substance use. A person might use the substance again or admit their desire to do so. Motivational interviewing involves processing these mental decisions and creating a new goal for that client.
Develop Discrepancy
Considering this principle as less of developing discrepancies and more of identifying them may be helpful. Through the core skills of motivational interviewing, a therapist can guide the client.
In turn, the client learns to understand the gap between where they are and where they want to be. Patients are better motivated to change when they can identify the discrepancies between their current and goal behaviors.
Support Self-Efficacy
Clients should feel empowered to make changes, be confident in their decisions, and commit to their goals. Once again, the therapist is there to guide the client, not to make them do anything. Besides achieving the end goal, a client should also aim to feel steadfast in their ability to make it there mostly on their own.
OARS in Motivational Interviewing
We refer to the core skills of motivational interviewing as OARS, which stands for:
- Open questions
- Affirmations
- Reflections
- Summarizing
A therapist will use these skills and methods to guide and motivate the client. Positively presenting these skills will help create a better relationship between client and therapist, creating an environment that enables the client to achieve their goals.
Open Questions
Open-ended questions generally can’t be answered with one or two words. They invite a person to elaborate and provide background information. When a therapist asks an open question, they invite the client to reflect on their past, present, or future.
Affirmations
We all need a gentle confidence boost occasionally, especially in our most vulnerable moments. Therapists use affirming statements that recognize and compliment a person’s strengths and positive progress.
Motivational interviewing affirmations are more than a simple “good job.” They should be specific and used so that the client can feel empowered.
Reflections
The complement of open questions is reflective listening. Many use this tool when using active listening. It involves the therapist repeating a client’s words slightly differently to get more information or detail. It helps clarify any misunderstandings.
An example of reflective listening in motivational interviewing for substance abuse may look like this:
Client statement: “I can’t unwind after work without a drink.”
Therapist reflection: “It sounds like you’re saying you primarily use alcohol as a stress reliever.”
Summarizing
Summarizing can look like reflective listening and is often considered a subset of the skill. When a therapist summarizes, they compile all the information they’ve heard into a statement.
Clients usually struggle to articulate what they think and feel succinctly. Summarizing can organize those thoughts to make the next steps easier.
Stages of Motivational Interviewing
The core skills don’t happen in order but are used throughout the treatment to build trust and motivate the client.
They happen throughout the four stages of motivational interviewing, or four processes. These processes establish a relationship and work towards a client’s goals.
- Engaging—the therapist utilizes the four core motivational interviewing skills to establish the relationship through thoughtful and purposeful conversation.
- Focusing—through the evidence collected through engagement, the client and therapist agree on the goal or desired change of the client.
- Evoking—when the therapist gets to the bottom of the “why.” Why does the client want to make this change now? How much do they believe they need to and can change?
- Planning—After “why” comes “how.” How will the client make these changes? How can the therapist help them make these plans and encourage the client to stay on track?
The planning stage is sometimes the most challenging for most clients. It’s easy to say you want to change, but making that happen can feel emotionally taxing. The therapist must stick with their core principles of rolling with resistance and supporting self-efficacy to help clients navigate these difficulties.
Stages of Change
While the stages of motivational interviewing lay down the processes that the therapist leads, experts have also identified stages of change that can further break down where the client is in the process.
- Pre-contemplation—the client isn’t thinking about the specifics of the change, only that they aren’t in a place where they want to be.
- Contemplation—the client knows they want to change but not necessarily how or what it would look like
- Preparation—similar to the planning processes, the client and therapist work on what is feasible for the client to do to change
- Action—the client consciously works on behavior following the plan they’ve made
- Maintenance—change isn’t usually a singular event. The client and therapist continue to work together to keep the client working towards the lifestyle they want
In addition to creating tangible goals, therapy can be more effective with concrete actions to get there.
Change Talk
This modality isn’t exclusive to motivational interviewing but is widely used by those looking to make a lifestyle change.
Change talk is what a client says to portray their need and plan for change.
DARN CAT
Like many terms that go along with motivational interviewing, change talk also is broken down into acronyms. Change talk uses two. The first is DARN, which we utilize during the change preparation stage.
- Desire for change —“I want.”
- Ability for change — “I can,” “I think I can.”
- Reason for change —“if…then.”
- Need for change —“I need,” “I must”
The second is CAT, used during the action stage of change:
- Commitment — “I will.”
- Activation — “I am.” or “I will.”
- Taking Steps — “I did.”
DARN CAT in motivational interviewing helps clients contextualize their motivations, behaviors, and goals.
Motivational Interviewing at Sequoia Behavioral Health
We believe in everyone’s ability to change and live their life exactly how they want to. We know you can have many disorganized thoughts about that journey. And we recognize it’s not always an easy journey.
The staff at Sequoia are here to help. We use motivational interviewing techniques and principles to ensure you’re in the best environment possible to achieve your goals. Our treatment programs are built on trust and safety so that you can find motivation within yourself.
Reach out for a free consultation today. Together, we can feel better.