When Motivational Interviewing was first introduced, there was a great deal of focus on specific techniques that would support the client in exploring behavior change. However, Rollnick and Miller (1995) felt like something was missing as they went around and trained people. They felt like they had taught people the words of Motivational Interviewing but not the music. Since then, the underlying spirit of Motivational Interviewing has been included which involves a particular mind-set and heart-set.
There are four key components to the spirit of Motivational Interviewing, and they are interrelated. They include:
Partnership
This component includes the belief that the client is the expert of their own experience. And the belief that the client knows what is best for them and what will support them in making the change they want. The conversation about change involves the collaboration between two experts. Ideally, it also means that in a session, the client does more of the talking than the counselor.
Acceptance
When collaborating with a client, there is a deep acceptance of what the client brings with them. Fromm (1956) described this attitude as 鈥渢he ability to see a person as he is, to be aware of his unique individuality. Respect means the concern that the other person should grow and unfold as he is. Respect thus implies that absence of exploitation.鈥� The opposite of this attitude would be judgement.
Compassion
When we make an intentional commitment to our client鈥檚 best interests, we are practicing compassion. Almost all major religions encourages the practice and cultivation of this virtue, and in Motivational Interviewing, we are prioritizing our client鈥檚 needs to our own. Compassion can also be a motivation for someone being a helping professional.
Evocation
What is interesting in many fields that focus on change is that the initial assessment usually attempts to determine what is wrong and what is missing, and looking at deficits versus strengths. Evocation is the belief that the client already comes with what they need for change, and our role as the clinician, is to support the client in bringing these strengths forward in order to change.
The spirit of Motivational Interviewing with this particular mind-set and heart-set also falls into the category of person-centered care. Others have called this style of care client-centered care (Rogers, 1965), patient-centered medicine (Laine and Davidoff, 1996), and relationship-centered care (Beach, Inui, and the Relationship-Centered Care Research Network, 2006), where the focus places the client鈥檚 perspective at the center. Miller and Rollnick (2013) added a broader perspective to person-centered care that included these principles:
1) Our services exist to benefit the people we serve (and not vice versa). The needs of clients (participants, patients, consumers, customers, etc.) have priority.
2) Change is fundamentally self-change. Services (treatment, therapy, interventions, counseling, etc.) facilitate natural processes of change (Prochaska and DiClemente, 1984).
3) People are the experts on themselves. No one knows more about them than they do.
4) We don鈥檛 have to make change happen. The truth is that we can鈥檛 do it alone.
5) We don鈥檛 have to come up with all the good ideas. Chances are that we don鈥檛 have the best ones.
6) People have their own strengths, motivations, and resources that are vital to activate in order for change to occur.
7) Therefore, change requires a partnership, a collaboration of expertise.
8) It is important to understand the person鈥檚 own perspective on the situation, what is needed, and how to accomplish it.
9) Change is not a power struggle whereby if change occurs we 鈥渨in.鈥� A conversation about change should feel like dancing, not wrestling.
10) Motivation for change is not installed, but is evoked. It鈥檚 already there and just needs to be called forth.
11) We cannot revoke people鈥檚 choice about their own behavior. People make their own decisions about what they will and will not do, and it鈥檚 not a change goal until the person adopts it.
The spirit of Motivational Interviewing, again, is more of a mind-set and heart-set. It underlies all of the techniques, and if a clinician is ever in a situation where they don鈥檛 know what to do or where to go with a client, the clinician can always fall back on the spirit and in just being present with the client.
We will continue our blog series next month about 鈥渃onversations about change鈥� and will take time to explore what Motivational Interviewing is NOT! I hope you all have a great month and have opportunities to use and practice Motivational Interviewing!
For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu