Motivational Interviewing (MI) is a well-known, accepted approach to helping people struggling with behaviour change. It has been proven effective in randomised control trials across a number of health care settings (Lundahl 2010). It is only recently, however, that scholars have begun to question exactly how Motivational Interviewing works and to suggest a causal theory (Madson et al, 2016).
Miller and Rose (2009) suggest there are two components critical to the effective practice of MI. The two components are the relational and technical skills of the MI practitioner.
In looking at the relational skills of the practitioner we might consider their ability to demonstrate the Spirit of Motivational Interviewing including the building of trust, collaboration with the client and non-judgemental recognition that the client is the expert in their own life. The Spirit also includes the practitioner listening and gaining an appreciation of the client’s beliefs, skills and abilities as well as their hopes for the future. Other relational behaviours and attitudes such as empathy and affirming the client’s attempts to manage their problem are critical to building the relationship and being able to assist the client to move toward change (Miller & Rollnick 2013).
The technical component is focussed on the practitioner’s effectiveness in guiding the client towards change talk and reducing sustain or status quo talk (previously called resistance). Sustain talk is the opposite of change talk in that the client is treading water rather than moving towards change.
Miller and Rollnick (2013) argue that ‘the more the client is engaged with sustain talk the further they are from moving towards change’. When people are not ready to make a change or feel pressured, shamed or coerced they often revert to sustain talk in order to defend themselves. For MI to work the practitioner needs to elicit change talk. Some of the ways this can be achieved include using evocative questioning, scaling for importance and confidence around change, and querying extremes such as ‘if you continue to do what you have been doing (or if you make the change) – where do you think you will be in 5 years’?
Research continues into how MI works, however, mastery of both the relational and technical components of MI appears to be essential for delivering effective help to clients.
Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137-160. doi: 10.1177/1049731509347850
Madson, M.B., Schumacher, J.A., Baer, J.S., & Martino,S. (2016). Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. Journal of Sustance Abuse Treatment , http:dx.doi.org/10.1016/j.jsat.2016.02.003
Miller, W. R., Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford Press.
Miller, W.R., Rose, G.S. (2009). Toward a Theory of Motivational Interviewing. American Psychologist, 64,527-537.