The definition below provides an excellent overview of the philosophy of MI, and the atmosphere that best supports an individual contemplating a change in their lives:
Motivational Interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change. It is designed to strengthen an individual鈥檚 motivation for and movement toward a specific goal by eliciting and exploring the person鈥榮 own reasons for change within an atmosphere of acceptance, collaboration, and compassion.
People often ask if there is a typical rhythm or flow to a Motivational Interviewing session鈥nd the answer, of course, is yes and no. Yes, there is a 鈥渕ethod鈥� to MI explained through the 4 processes (Engaging, Focusing, Evoking, and Planning) which are often sequential. And no, because even though these processes can often be sequential, they are also recursive. Some imagine these 4 processes as stair steps, each process can build on the next or the client and clinician may dance together up and down the staircase continually returning to prior steps as needed.
Again, the 鈥渕ethod鈥� or 4 processes of MI include Engaging, Focusing, Evoking, and Planning. It is likely that many of you already follow a similar sequence with your clients, and allow for the sequencing to shift, if you believe the session needs to go in a different direction based on the interaction you are having with the client.
Below, are brief definitions of the 4 processes and some aspects of each one as offered by Miller and Rollnick (2013):
Engaging
Process of establishing a helpful connection and working relationship
Aspects: asking permission, asking open ended questions, acknowledging that change is difficult, being comfortable with silence, allowing the client to talk more than the clinician, using reflective listening, and affirming client鈥檚 choice to be in the session
Focusing
Process by which you develop and maintain a specific direction in the conversation about change
Aspects: many options and tools but perhaps asking about what is important to the client or what they value鈥nd then linking these values to the client鈥檚 motivation and behavior, and focus the conversation on whether the client鈥檚 values align with their behavior.
Evoking 聽 聽 聽 聽 聽 聽 聽 聽 聽
Process of eliciting the client鈥檚 own motivations for change and lies at the heart of MI
Aspects: counselor listens for the client expressing motivation to change behavior鈥his motivation or interest in changing could be related to:
Desire: 鈥淚 would like to lose some weight.鈥�
Ability: 聽鈥淚 would be able to take my medications each morning with breakfast.鈥�
Reasons: 鈥淚 would have more energy if I exercised.鈥�
Need: 鈥淚 need to make better choices because I can鈥檛 keep living this way鈥�
Planning
Process of developing commitment to change and formulating a concrete plan of action
Aspects: the client is moving from talking about why he or she wants to change to how he or she plans to do it. Through the collaboration that is occurring with the client, he or she will tell you if they are ready to 鈥渢est the waters鈥� and actually begin discussing what the change will look like and how it will happen.
Steps to making the plan SMART and more sustainable include the following:
Specific (formulate the plan in terms of actions)
Measurable (something you could assess at the next session)
Attainable (is it realistic to achieve before the next session?)
Relevant (is the goal relevant to the client鈥檚 situation?)
Time Bound (set dates for specific actions)
Additional information about the 4 processes are located in previous blog posts, and lastly, Miller and Rollnick have also created several questions that may be helpful to ask yourself during each step of the process:
Engaging:
How comfortable is this person in talking with me?
How supportive and helpful am I being?
Do I understand this person鈥檚 perspective and concerns?
How comfortable do I feel in this conversation?
Does this feel like a collaborative partnership?
Focusing:
What goals for change does this person really have?
Do I have different aspirations for change for this person?
Are we working together with a common purpose?
Does it feel like we are moving together, not in different directions?
Do I have a clear sense of where we are going?
Does this feel more like dancing or wrestling?
Evoking:
What are the person鈥檚 own reasons for change?
Is the reluctance more about confidence or importance of change?
What change talk am I hearing?
Am I steering too far or too fast in a particular direction?
Is the righting reflex pulling me to be the one arguing for change?
Planning:
What would be a reasonable next step toward change?
What would help this person to move forward?
Am I remembering to evoke rather than prescribe a plan?
Am I offering needed information or advice with permission?
Am I retaining a sense of quiet curiosity about what will work best for this person?
For more information about Motivational Interviewing or related services, Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.