All of us know how painfully hard it is to change what we routinely do, alter how we habitually feel or especially, adjust our epoxy-glued attitudes. Often, what makes these challenges more exasperating to accomplish is that we keep doing the same things, but on some level, we know our choices and reactions are not really satisfying and/or may not even be healthy for us. To further confuse matters, we often go through or get stuck in an unstable, vacillating cycle of conflicting reactions over our situations, feeling stuck in an emotional vortex.
Thankfully, many psychologists and other mental health professionals have training in Motivational Interviewing, an approach to tackling problematic patterns. Putting together “what works” from several client-centered treatment paradigms, William Miller and Scott Rollnick made a lasting contribution to the fields of psychotherapy, counseling, behavioral medicine and addiction services when, in 1991, they published the immediate classic, now in its 3rd edition, Motivational interviewing: Preparing people to change addictive behavior (Guilford Press).
A relatively current definition of “Motivational Interviewing” is “a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”[1]
Motivational Interviewing can be thought of as a precise form of listening to the “how’s” and “whys” of change by accurately understanding how ready a client or patient is for change. Simultaneously, and perhaps of even greater significance, Motivational Interviewing helps people understand more clearly their built-in mixed, contradictory feelings which is often outside of our immediate awareness about the specific change itself and the process of change.
Although originally designed to help people with addictions, Motivational Interviewing has been applied to many clinical issues such as eating disorders, medical treatment compliance, adolescent suicide, and anxiety disorders. A crude metric of the strong influence of “Motivational Interviewing” can be seen from the more than 4,000 PsychINFO ® database hits using that search term.
While helping people realize their mixed feelings about making change, it is easy to evoke a reactive opposition to making that very change! Counterintuitively, Motivational Interviewing aims to avoid such push-back, i.e., “resistance,” by helping the person discuss the pain they are currently experiencing from their choices and the reasons on why they would want to change.
The therapeutic goal is to help people develop their own, clearly understood and accepted internal motivations for making changes as opposed to externally-based reasons or internally conflicted motives. For example, rather than, “My doctor thinks I smoke too much,” helping a person come to their own cause of, “If I stopped smoking, I’d have more money, be less winded, and live longer.” Another might be changing the dangerously common, “I can text and drive because I can multitask better than most” to “I can crash in a split second and likely harm myself and others permanently. I care too much about myself and others to cause such destruction.”
The idea of being ready for change requires careful consideration. Research has borne out five discrete stages of change from a transtheoretical model of how people change.[2] These stages are as follows: Precontemplation, Contemplation, Preparation, Action, and Maintenance.
- Precontemplation implies the person sees there is “no problem.” Others around them certainly feel the impact of the person’s problematic behaviors, but they themselves are “good.”
- The Contemplation Stage is where the person has some awareness of a problem, but can only experience the downside, or “cons,” of change, feeling that any upsides are too remote and certainly not worth the effort.
- The Preparation Stage is getting ready to get ready. “I’ve joined a gym; going next week.” People in this stage have made some constructive changes, but there is no real momentum that shows a difference.
- The Action Stage is what it sounds like! After exerting much energy and time, people here are changing behavior and their feelings to have better experiences and quality of life. To be in the Action Stage requires a period of 1 day to 6 months.
- Maintenance Stage when the focus in on preventing relapse, consolidating gains and engaging in a new behavior or relating differently in the desired manner. If one can hold these gains for more than 6 months, they are said to be in the Maintenance Stage.
Essential to Motivational Interviewing is an empathic acknowledgment of the difficulty of change, use of reflective listening, avoidance of power struggles, and respect for a person’s agency and problem-solving capabilities. It has a practical focus on staying with realistic goals and helping the patient discuss the benefits of change. Motivational Interviewing is non-threatening and non-confrontational. It is certainly an approach worth discussing with your mental health care professional.
[1] Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change. New York: Guilford Publ. p. 29.
[2] Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2010). Stages of change. Journal of Clinical Psychology, 67(2), 143–154. http://doi.org/10.1002/jclp.2075
