Motivational Interviewing (MI), as style of interaction to facilitate change, began in substance abuse treatment in the early 1980’s. It is a person-centered, collaborative process of decision-making. Its style is empathetic, nonjudgmental, supportive, and non-confrontational. MI acknowledges that behavior change is driven by motivation, not information. Motivation to change occurs when a person perceives a conflict between current behavior and important life goals.
MI is not about fixing people. It doesn’t come from a deficit view that people are lacking something that we need to put in place. Ultimately, people are free to choose what they will do and how they will be. MI is a “guiding” style of communication as compared to a more “directive” style. This style or a “way of being” with clients uses a specific set of skills that are used to convey empathy, and encourage clients to consider and plan change.[i] Because MI is based on person-centered theory and approaches, clients are seen as the experts on their lives, with the role of the peer specialist being collaborative in looking at thoughts and ways of addressing client-identified concerns.
MI is, first and foremost, a conversation about change. It can be brief or prolonged, but it is always a collaborative conversation. The process of MI unfolds most often in the following sequence in which the peer specialist can help the client …
- Discover their own interest in considering and/or making a change in their life
- Express in their own words their desire for change (i.e., “change-talk”)
- Examine their ambivalence about the change
- Plan for and begin the process of change
- Elicit and strengthen change-talk
- Enhance their confidence in taking action and noticing that even small, incremental changes are important
- Strengthen their commitment.
Consider that most people who need to make a change are “ambivalent” about doing so. They see the reasons to change and reasons not to. Ambivalence is simultaneously wanting and not wanting something, or wanting both of two incompatible things. It is fundamental to human nature, and, unfortunately, people can remain stuck there a long time. A common pattern is to think of a reason for changing, and then think of a reason not to change.
Motivational Interviewing, at its core, is about helping people find a way out of ambivalence and setting a direction for change. MI is based on the following assumptions:
- Ambivalence is normal and constitutes an important motivational obstacle in recovery.
- Ambivalence can be resolved by working with core motivations and values.
- The alliance between a helping professional and the client is a collaborative partnership to which each brings important expertise.
- An empathic, supportive counseling style provides conditions under which change can occur.
Watch the following video about the core concepts that represent the “spirit” of MI and the fundamental skills and process that underlie MI.
Video: Introduction to Motivational Interviewing (17:22 minutes)
Encouraging Change Talk
As stressed earlier in this module, one of the most important commitments that a peer specialist can make is to listen with the intent to understand the person behind the behavior. The strategies that are embedded in MI begin with a strong foundation of listening, and in using questions to explore and understand the person being interviewed. In fact, these strategies are not only used for the purpose of allowing the peer specialist to understand, but also to promote clearer understanding and insight in the client.
It is also important to listen for and respond to change talk, which are statements clients make regarding possible or actual change. One of the simplest ways to elicit change talk is to ask for it. Change talk is any discussion of the desire, ability, reasons, need, and commitment or taking steps to change.
The mnemonic DARN-CAT can be useful when generating questions to elicit different kinds of change talk. The DARN part of the mnemonic is used to generate ideas and guide the conversation, while the CAT portion is used for planning and seeking commitment for a change.
Preparatory Change Talk:
D: Desire to change: “I want things to be different. I am tired of living this way.”
A: Ability to change: “I stayed clean for three months the last time.”
R: Reasons for change: “If I want to get my kids back, then I know I have to go to treatment for my substance abuse and show the judge that I mean business.”
N: Need for change: “I need to stay on my medications in order to prevent a relapse.”
Implementing Change Talk:
C: Commitment to change: “I am going to look for work.”
A: Activation of change: “I looked up three A.A. meetings and I know when they meet.”
T: Taking steps in change: “I enrolled in the vocational program yesterday.”