Motivational interviewing: helping people to change
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Few methods have experienced such spectacular progress in such a short time as motivational interviewing. Its success is due to several factors: it facilitates the relationship with the patient, its effectiveness is scientifically evaluated, and it has been developed collaboratively. Today, motivational interviewing is applied to a wide variety of contexts, and depending on the context, the recipients of motivational interviewing can be clients, patients, students, mentees, mentors, addicts, offenders or inmates.
Similarly, those who practice motivational interviewing can be mentors, educators, therapists, coaches, psychologists, doctors or nurses. This is what makes this tool so powerful.
What is motivational interviewing? Broadly speaking, we can understand motivational interviewing as a tool for people to change what they do not like about themselves. That which produces a great dissonance, and therefore, displeasure. This is achieved through conversation with the interviewee. Through this tool we manage to break down the barriers that prevent or hinder people from changing.
The truth is that we talk about change every day and in a natural way. We make requests to others and we are very sensitive to aspects of everyday language that denote reluctance, willingness, commitment... In fact, apart from transmitting information, one of the most important functions of language is to motivate and influence the behavior of others. It can be something as simple as asking someone to pass the salt or as complex as negotiating an international treaty.
There are also conversations about change that take place in the form of consultation with a professional. Through these, one person tries to help another person change. Doctors, dentists, nurses, dietitians and nutritionists also have conversations about behavior and lifestyle change.
"Things don't change: we change ourselves."
-Henry Dvid Thoreau
Motivational interviewing pays attention to natural language about change. Its purpose is to have more effective conversations about it. This is especially true when they occur in a context where someone is offering professional help to another person.
Many of these conversations are unhelpful or dysfunctional, no matter how well-intentioned the interviewer may be. Thus, motivational interviewing is designed to find a constructive way to overcome the challenges that arise when someone engages in motivating another person to change.
Specifically, motivational interviewing is about organizing conversations. In this way people can persuade themselves to change, based on their own values and interests.
Communicative stylesWe can think of helping conversations as lying along a continuum or segment. At one end we find the directive style. At the opposite end, we find the accompanying style. The middle of this continuum is governed by the guiding style, which is modeled after motivational interviewing. To put us better in this situation, let's imagine that you travel to a foreign country and hire a guide to help you.
"What people need is to feel heard."
-Mary Lou Casey
The guide's job is not to tell you when to arrive, where to go, or what to see or do. A skilled guide knows how to listen and offer expert information when necessary and according to your interests. Motivational interviewing falls in this middle territory between guiding and accompanying and includes elements of both. Guiding is a task in which it is often necessary to accompany, sometimes to direct and sometimes to do neither, leaving freedom or opening the range of possibilities that the guided person is able to perceive, and interspersing these three attitudes with intelligence.
For example, stimulating a child's learning most of the time implies that we act as guides. It demands that we intersperse periods of accompaniment or supervision with others of direction and others of freedom.
Avoiding the correction reflex is fundamental in motivational interviewingPeople come to a profession in which they help others for different reasons. It may be for wanting to give something back to society, to prevent and alleviate suffering, to manifest love for God, etc. Ironically, these same motives can lead to an excessive use of managerial style in providing this help. The directive style can become ineffective or counterproductive when we want to help people.
When we use the directive style we also use the correction reflex. We want to help people so much that we often impose what they should or should not do. But this, unfortunately, creates resistance. Precisely one of the objectives of motivational interviewing is to minimize this resistance.
It may be helpful to clarify what motivational interviewing is not and to differentiate it from other interviewing methods. Motivational interviewing is not simply being nice to others. Nor is it the same as Carl Rogers' client-centered therapy. In motivational interviewing there is an intentional and strategic movement toward one or more specific goals.
Motivational interviewing is also not a "technique," an easy-to-learn trick that we can just add to our toolbox. Rather, it is a style of being with others, an integration of concrete clinical skills that promotes motivation for change.
It is a complex style that can be refined over the years. Nor is it a panacea or a solution to all clinical problems. Motivational interviewing was developed specifically to help people resolve ambivalence about change and reinforce their motivation.
Five key communication skills are used throughout the motivational interviewing process. These skills are as follows: asking open-ended questions, affirming, reflecting, summarizing, and providing information and advice, always with the client's permission.
As we have seen, motivational interviewing is a powerful tool that facilitates change in people. It weakens ambivalence towards it and fosters motivation. All this is possible through a guiding communicative style, without imposing anything and letting the client decide.
Bibliographical references
Miller, W.R., Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York: Guildford Press.
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