Motivational Interviewing An M I Learning Resource clip
Motivational interviewing, I think fundamentally,
is an approach to helping people who are ambivalent
about any kind of decision or area of their
life whether it’s making a particular kind of change
in their substance use or health
behavior, but also other kinds of changes
– changes in their relationships, changes
in how they deal with life in general.
For me, motivational interviewing is about
inspiring people to change, and respecting people,
and looking up to them in such a way
that they remember to look up to themselves,
and help enhance their strength and their
confidence about making changes to their lives
to make them as fulfilling as possible.
The attraction for me as a practitioner working
in addiction around motivational interviewing
is that it sets a different relationship with
the client from the start off.
With so many of the other interventions – that
we might draw on, that we might use –
they’re often about giving information, they’re often
about taking people through a particular
course of strategies, about helping them develop
techniques about managing things that need to change
and being able to maintain their
change – all of which is good – but what
motivational interviewing does which, I think, and it’s
such a great boon for the practitioner,
is that it allows you to develop a relationship with
the client whereby you’re not the expert,
you’re not trying to say I know what’s wrong
with you and here is the solution.
It’s a relationship whereby you come together
and you’re knotting something out as peers,
as equals, as – I’ve got something to put
in this kitty, you’ve got something to put
into the kitty, into the basket of shared
knowledge, and that is what underpins motivational interviewing to me.
And it’s because you come together as equals
in a joint exercise that things can begin
to happen, and those things that begin to
happen are that the client starts to look more
inwards around “what are the resources that
I’ve got, what’s the understanding I’ve got
about what’s going on, what are the skills
that I can call on to be able to make some change”
– and the practitioner kind of almost
becomes a secondary player here who nudges
this internal problem-solving exercise that
goes on.
I think a lot has been made about ambivalence
around people not being sure what it is they want to do,
but what I’ve seen a lot is that people
often are on the fence not because they don’t
really know which way they want to go, but
because they’re frightened and
they don’t have the confidence to make their lives what
they want.
We’ve learned something about mechanisms of
action in motivational interviewing.
We know that the clinician’s interpersonal
skills are important in making MI effective.
We know that change talk is likely to be implicated
in the effectiveness of motivational interviewing.
So those are both good things to know.
If you’re a clinician just starting out, and
you’re just beginning to use or learn motivational interviewing,
you have it way easier than
people who first started because we have some
roadmaps for you about “these are the elements
that are really important to pay attention to.”
So that’s an advantage.
But what a mistake it would be to think that
we actually know why MI really works or that
we’ve got the mechanisms of action for it
nailed down.
We’re just beginning to know a little bit.
That’s where we really are, is that we know
a little, tiny bit and there’s so much more to know.
And often, sort of clients will come to me
where they might feel, rightly or wrongly,
but they certainly feel as though they’re stuck –
there’s something kind of not quite working
for them. And so this sort of empathic approach,
the collaborative allows me, well hopefully
allows me anyway, to be able to go into their world,
and sort of understand it from kind
of their perspectives.
And if I’m able to do that, if they allow
me to do that, of course through the sort
of therapeutic relationship, then maybe we
can kind of move through together.
So I find that whole aspect really
helpful.
And I think there are two components, really,
that are equally important for me
when I think about how we do that, how MI
actually helps people resolve ambivalence.
One is that when people are ambivalent about
any area of their life, they tend to build
a sense of pressure about that decision, about
making the decision.
Often the pressure comes from outside – people
are pushing on them, giving them a hard time,
advising them, telling them they need to change
this or that – but just as often,
it comes from inside.
It’s, we begin to become frustrated with ourselves
– “Why haven’t I done this already?
What’s wrong with me? What’s it ever going to take? Am I ever going to get out of this indecision
and this this frustrated uncertain state”
– and I think as that pressure builds,
people become less and less able to work through
and resolve the ambivalence.
I think it actually contributes to people
becoming more and more stuck in a kind of
chronically ambivalent state.
And I think one part of what MI does is really
help to remove that pressure – to help people
take the pressure off so that they can begin
to think about the decision they’re trying
to make – the change they’re considering – in
a way that isn’t so affected by that pressure
and the pressure that sort of interferes with
their ability to think clearly and
think in a fresh way about what they want to do.
I think given that – given the ability to
take the pressure off – the other thing that
MI does is really help people to tap into
their own well of ability to make good decisions
for themselves – their own natural inherent
motivation to move in a positive direction,
for growth, for improved health and well-being,
and once people can tap into that and feel
supported in doing that – really invited to
do that – they’re very often able to
come to a decision, to solve the problem, realize
what it is that they want and need to do
and move forward.
