Therapist Bill Matulich, PhD, provides helpful information to the public on Motivational Interviewing, a well-respected and widely practiced therapy technique. Motivational Interviewing (MI) is one approach among many that may be used to treat addiction. Individuals who are interested in learning about MI will find that it has many helpful techniques to offer, ones that can be learned during therapy sessions and have no expiration date. The more one practices MI techniques in day-to-day life, the more entrenched these skills become.
Matulich provides an easy to remember and understand definition of Motivational Interviewing: MI is an effective way of talking to people about change. Matulich notes that when he calls this therapy approach “effective,” he means that is research-based. In other words, researchers and clinicians have, on numerous occasions, assessed the merits of MI in practice and determined that it confers a psychologically therapeutic benefit. The main goal of MI is to help people think about change and work out a plan for change that can actually bring it about.
Therapists trained in Motivational Interviewing believe that a person may sincerely want change, such as to stop using drugs, but not actually know how to make that change. For this reason, MI is full of practical guidance on how to make changes for the better.
Core Skills Involved in Motivational Interviewing
A therapist who uses Motivational Interviewing to help clients, in recovery or otherwise, will have a core set of skills. A look at these skills provides a glimpse of what to expect from MI sessions. The following are four core skills that a Motivational Interviewing therapist possesses, will use, and teach to clients (because they are effective skills to use in all relationships): open questions, affirmations, reflections, and summaries. Therapists refer to these skills by the acronym OARS.
To get a person talking, open questions are more effective than closed questions. For instance, a therapist may ask a person in recovery, “How often did you use drugs?” the therapist can expect an answer that quantifies the frequency of drug use. If the therapist asks, “When did you first start using drugs?” the therapist can expect an answer that is fuller, one that makes the recovering person think about why the drug use started and persisted. The latter response opens up a dialogue that can more effectively get to the underlying emotions, thoughts, and behaviors underlying the drug abuse.
It is essential for a person in therapy to feel heard. Therapists trained in Motivational Interviewing understand the need to make clear to clients that they are being heard and that the process is collaborative and based on mutual trust. For instance, a therapist working with a recovering person may say, “As I understand it, in the past, you have turned to drugs in response to stress at work.” When a therapist does a reflection, there are two important results. First, the client feels heard and sees that the therapist is actively listening. Second, the therapist can make sure that they are on the same page as the client. Reflections give the client the opportunity to correct any misunderstanding on the part of the therapist.
Summaries are essentially longer reflections. The therapist will make more than one statement that directly relates to main topics that are being worked on throughout the therapy sessions overall. Summaries may occur at any time during a session, but often occur at the beginning of a session (to sum up previous discussions) and at the end (to give direction to the next sessions and beyond). It also helps bring the client into setting the agenda, and again, Motivational Interviewing is a collaborative process. The client can add a thread to the summary. For example, consider if a recovering client said to the therapist, “You left out what I said about my cousin’s wedding, I don’t want to go.” The client is now telling the therapist that there may be more to this topic than first meets the eye. The summary, in this scenario, was a technique to help the client talk about a pressing matter. Since the client has a concern in this area, the therapist can use this topic as an entry point to discuss the emotions involved as well as strategies to change the situation.
The Processes Involved in Motivational Interviewing
A therapist who uses Motivational Interviewing techniques to help clients make meaningful changes in their lives will be trained in four processes: engaging, focusing, evoking, and planning. These processes are designed to facilitate the therapy process and keep with the overarching goal of helping a person to (1) identify an area of life where change is wanted, (2) think through healthy ways to make that change, and (3) develop a plan that can realistically be put into practice to make the change.
Engaging is defined as the process of the therapist and client establishing a trusting relationship. Motivational Interviewing is collaborative, and the more each person trusts the other, the easier it will be to establish a healthy dynamic and deal with any misunderstandings that arise. Trusting a person is not only a gift one gives to that person, but to oneself. Having trust in the process, from the client’s perspective, is a way of accepting the help and healing that therapy offers.
Therapists are trained to understand the ways in which they may unintentionally undermine the engaging process.
Therapists using the MI approach should not label a client, assess a problem, and then try to fix it, nor offer solutions that cut into the client’s decision-making process.
Focusing involves creating an agenda that reflects the goals and priorities of all involved in the therapy process. The goal is to establish a clear plan for change, using the OARS skills. For instance, when a therapist skillfully summaries a client’s concerns, the therapist is selectively highlighting those issues which, if worked on, can help a client to make desired changes. Again, since MI is a pragmatic form of therapy, focus is critical. The therapist wants to effectively help a client make desired life changes, so keeping the sessions on track to do that is going to be necessary, on the part of the therapist and client.
Evoking is eliciting a client’s internal motivation for change. The therapist will try to create a therapy environment that draws “change speak” from the client. Practitioners of Motivational Interviewing understand a basic principle: People tend to bring about change in their lives more effectively when they are the source of the plan as opposed to someone else. Change speak is conversation that is supportive of the client making a change. There are numerous change speak examples, such as, “I can…,” “I will…,” “It is possible to…, “I want to…,” and “It would help me solve my problems if I…” Being able to articulate a plan for change is itself a step in the process of change.