Motivational Interviewing Posted on 06.28.20 Motivational interviewing is a psychotherapeutic approach that tries to help people move away from a state of indecision or uncertainty and towards finding the motivation to making positive decisions and reaching their goals.It gets them ‘unstuck’.It uses strategies that kickstart the other person’s own ability to change.It’s often used as an alternative to traditional counselling, and is a useful skill to have for more persuasive and effecttiveconversations in general.The PrinciplesDon’t tell people what to do …because it usually doesn’t work, even if you’re right. Basically, if people don’t feel they have a choice, they feel a real need to do whatever it is they’ve been told not to – to prove they still have free will. Really listen. If you can get the conversation started… you’re on your way. If they won’t talk – you can’t help them change, and listening is key to this. It is a non-directive style of conversation. which is empathic and genuinely trying to understand, with warm responses and mostly listening. If someone is expecting to be persuaded or told off about not adhering, this is unexpected! Let them tell you they need to change.The very best thing that can happen is for someone to tell you why they should change. If someone says it themselves without you saying it first, it’s much more powerful. Basically, ‘People believe what they hear themselves say’. Point out the ‘cognitive dissonance’. This is where people are struggling about actually making the choice to do – the thing they know they need to do.Not doing the tax return, giving up an addiction, exercising – whatever it is, pointing out how uncomfortable NOT doing it is – can be used to help them get the momentum going.People need to feel confident before trying to change.Even if someone is convinced of the need to change – if they don’t feel confident they are unlikely to try. Worse still, they can feel depressed since they feel stuck in the knowledge that they need to change..LanguageFor example, avoid using “I” or “you”. In particular, avoid: “I want you to do…” Or “You should do…” Keep in mind, someone will change if they want to do it – not if you want them to do it Instead, use more neutral language wherever possible: “You might consider…” or “how does it sound if we thought about it that way…”If you want to give an opinion, a more effective way might be to say: “Other people have found that…”The Main PointsExpress empathy through reflective listening.Develop a discrepancy between a person’s goals or values and their current behaviour.Avoid argument and direct confrontation.Adjust to resistance rather than opposing it directly.Support self-efficacy and optimism.Ask open-ended questions instead of “yes” or “no” questions (tell me more about…)Practice reflective listening. (so what you’ve told me is…..) Demonstrate that you have heard and understood by reflecting what they said.Summarise the conversation (OK, so far we’ve talked about… and you told me you feel…) It is useful to summarize periodically what has happened so far.Express empathy (that must be difficult, I can see that). Support and comment on the patient’s strengths, motivation, intentions, and progress.Have the other person tell you what their personal concerns and intentions are, rather than try to persuade them that change is necessary. (How would things be for you in an ideal world? What’s making things difficult?)DO: Listen to the other person’s problems & fears. DO: Pause before discussing ideas on how things could change. DO: Listen for the other person’s insights and ideas. DO: Collaborate. Can we join forces on this?DON’T: Pressure, fix, or control. .DON’T: Use scare tactics. DON’T: Forget to praise the person’s efforts.DON’T: Fall into the ‘expert trap’ – telling them what you think they need to do. The danger here is that they will switch off.The Change CyclePRECONTEMPLATION (people not considering changing their problem behaviour);CONTEMPLATION (entails the individuals beginning to consider both that they have a problem and the feasibility and costs of changing that behavior);DETERMINATION (the decision is made to take action and change);ACTION (the individual begins to modify the problem behavior; this stage normally continues for 3-6 months);MAINTENANCE (sustained change);If these efforts fail, a RELAPSE occurs, after which the individual begins another cycle, which can start at any earlier point. It is not uncommon for people to need a few relapses before they break free of unwanted behaviour.