Motivational Interviewing Techniques

This approach defines motivation as a state of readiness to take action and moves away from the stereotypical idea of persons either being motivated or not motivated. Motivational interviewing was originally developed independently. Prochaska and DiClemente (1984, 1992, and 2002) described their transtheoretical “Wheel of Change” model due to research in the field of addiction. The duo noted that many people follow a pattern of changes characterized by specific attitudes and statements towards making life changes. The “Wheel of Change” provides us with a way of theorising change as being made up of a series of changes.

Motivation is context specific, changes with time, and can be prompted by power relationships. In regards to being context specific, here’s an example. I may be highly unmotivated in one part of my life, such as making a trip to the dentist, but highly motivated in some other area, such as purchasing a new car. The motivating feature depends on where you look.

In regards to motivation changing with time, here’s any example using the research of Hodkinson and Sparkes (1997). Young people often make decisions in opportunistic, pragmatic ways that are at odds with the technically rational way most guidance models advocate. For example, a client may leave an interview stating his intention of attending a follow-up interview. However, other priorities may take over when he leaves, leaving him unmotivated to attend.

Motivation can also be prompted by power relationships. In counselling sessions, this is sometimes called “resistance,” such as when a client is defensive, unwilling to engage in the session, or even aggressive. However, this can be reframed as feedback or a client’s reaction to a perceived threat. There is something resistant clients are missing. It could be that the interviewer is following an agenda the client doesn’t wish to.

Referring back to the “Wheel of Change” behaviour change model, it’s important to understand that while it was developed from work in the addiction field, it also strongly resonates with people making career changes or working towards professional development. In terms of career guidance, it is possible to indicate potential attitudes or statements that correspond with each of the stages above.

Here’s an example of the stages:

Precontemplation: This person isn’t considering the possibility of change. He or she may be a referral from another agency and may tell you “I don’t have a problem” or even express shock or frustration at having to attend an interview. They may be defensive, with comments including “I’m only here because they made me come.”

Contemplation: In this case, the individual may be aware that they have an issue that needs to be addressed. They may appear ambivalent. For example, saying “Yes, I probably need to go to that interview, but there’s no reason. I won’t do well.”

Determination/ Preparation stage: In this stage, the balance shifts to making a plan to act. For example, a client may say “I need to learn how to manage my anger issues” or “I need to get a job and make some money to pay these bills.”

Action Stage: Here, the client takes steps toward making a change by doing something constructive. For example, he or she may look for anger management programs in the area, take courses to further their education, or apply for a job.

Maintenance: Just as it suggests, this phase involves keeping up with the plan for change by reviewing their progress and not giving up if they experience a setback. For example, if they did not get called for an interview for their first choice job, they would fill out an application elsewhere.

Relapse: Everyone won’t reach this phase, where after trying to make a change, they revert back to their old behaviours/ attitudes. They may say “Well, I applied, but they didn’t call me back. There’s no sense looking for something else. They won’t call me either.”

Motivational Interviewing: Putting it into Practice

Miller and Rollnick (2010) stressed the fact that motivational interviewing is more than a series of tactics. Its “spirit” is critical for its effectiveness in practice. The act of engaging with clients is considered a collaboration or sharing of resources. It’s important that there is a positive partnership that focuses on client autonomy because, ultimately, the client will decide what he/ she is going to do. The interviewer is there to help arouse whatever motivation for change the client may have.

Four Principles

There are four principles involved. They include:

Expressing empathy or trying to understand the client’s point of view or feelings with judging or blaming them.

Developing discrepancy, when appropriate. This involves determining with the client what they want to accomplish and how their current behaviour is helping them get there. It’s important to get the client to talk about the possibility of making a change, rather than the interviewer.

“Rolling with resistance.” This phrase refers to avoiding any arguments with the client by always respecting their right to make their own decision.

Supporting self-efficacy or the client’s belief that he/she can make a change. Remember, the goal is to help the client believe there is a possibility for change.

Tactics

There are specific tactics recommended for encouraging clients to discuss the possibility of change. If the client is in the precontemplation or contemplation stage, a reflective approach that supports the client in talking about their own view of the situation at hand may be beneficial. Again, the idea is to allow space for the client to examine what they like about the situation, while also encouraging them to evaluate the potential risks of not making a change.

The goal is to encourage “self-motivational statements” or talking about change. Statements may be evoked by asking strategic questions. Areas to examine may include recognizing a problem, concern, intention to change, and optimism for making a change.

Summaries may be incorporated into a client’s self-motivational statements to lead to the “key question” at hand. For example, saying “In light of what we’ve talked about, what do you feel your next move should be?” This reinforces that the next move must be made by the client.

A Word about the Nature of Directedness

In the available literature, the terms “non-directive” and “directive” aren’t used consistently. Directive may refer to direct confrontation, offering advice, or “expert” models of matching in the case of traditional career guidance models. Strategic questioning may be a better term to use as it fits within the aspects of narrative and constructivist approaches. The idea is to assist the client in reflecting upon certain parts of their story and not directly telling the client what to do.

Motivational Dialogue

The use of language is crucial in motivational interviewing because you want to link the client to the issue being discussed. For example, if a client says, “That training course was awful,” motivational interviewing dialogue could include, “What aspects were you most troubled with?” or “What bothered you the most about it?” The use of the words “troubled” and “bothered” link the client to the issue being discussed.

Additional strategies for encouraging the client to discuss the issue of change include:

Information Handling: This is similar to a two-act play. During the first act, listening and questioning are used to determine the reason for the interview, create a shared agenda, and learn more about the client’s ideas or feelings about the issue at hand. During the second act, depending on what he or she has learned, the interviewer falls into “expert mode” and takes over the conversation to discuss options and ways of moving forward. This can seem informative and helpful, but it must be done so that the questions being asked address whether there are more effective ways of working with information that involve the client more efficiently. According to Miller and Rollnick, there is a simple and effective way of working with information. It involves increasing client participation and avoiding going into “expert mode.”

The Model is Summarised as Elicit, inform, and Elicit.

First Stage

Elicit: Determine that the client already knows about taking initiative and using resources, opportunity, and facility. For example, “You said you were interested in getting help with your anger. Can you tell me a little about what you already know about doing this?” You could also say, “Tell me what you already know about anger management programmes.”

Second Stage

Inform: Assist in filling in any knowledge gaps. Rather than being direct, consider being tentative. For example, use phrases such as “Some people find …. helpful.” You could also say “Most people usually do this…” The goal here is to make it readily apparent that the client is responsible for making the choice.

Third Stage

Elicit: Identify what this information means for the client, as well as the next step. For example, “So, what do you make of this?” You could also say “What do you feel your next move should be?”

Motivational Interviewing is a collaborative method that uses distinct techniques and principles that emphasis patient autonomy in making a decision that fits well within principles related to career guidance and education. If you are interested in this area of practice, you are encouraged to explore it further as there is way too much information to explain it all in this small space.