Motivational
Interviewing is an evidence-based client centered,
yet directive consultation style that employs
skillful listening to create a collaborative
relationship within which the practitioner can
skillfully use directive listening techniques to
both address client reluctance to change as well as
to elicit and elaborate the client’s often very
personal motivations to initiate and persist with
behavior change (Miller & Rollnick, 2002; Rose,
Philips, & Welch, 2006).
MI is
grounded in the following principles:
1. Motivation, or readiness to change, is better
considered an ever-changing state rather than a
static personality trait (i.e., the individual is
neither motivated nor unmotivated). Clients enter a
behavior change consultation with a certain range of
motivation, and the activity of the interviewer
serve to increase or decrease the individual’s
readiness to change. Motivation, therefore, can be
considered a product of the helping relationship.
2. Accordingly, the practitioner’s interviewing
style determines, to a large extent, an individual’s
readiness to change, and in turn, significantly
impacts long-term behavior change. Practitioners who
employ confrontational or “top-down” techniques tend
to increase their client’s resistance; conversely,
the use of empathic listening decreases resistance
and increases readiness to engage in behavior change
conversations.
3. Ambivalence regarding change is a normal aspect
of the process of behavior change. Whatever the
target behavior, one can anticipate that the client
will have reasons to both sustain (i.e., status quo
talk) and to change (i.e., change talk).
Furthermore, there are almost always compelling,
albeit short-term and often idiosyncratic, reasons
not to change.
4. It is only human to defend the other side of the
ambivalence. If we argue for change, our clients
naturally will argue against change. The stronger
one pushes for change, the more forcefully the other
individual will articulate the argument for staying
the same. This is human nature. Impassioned
arguments by the consultant for change often
undermine the client’s investment in the change
process. This tendency to use direct persuasion and
“take up” the argument for change is called the
“righting reflex.” The efficacy of direct persuasion
as a motivational tool is inversely correlated with
the client’s level of ambivalence; the more
ambivalent the client, the less likely is direct
persuasion to be effective.
5. To help individuals argue the case for change, we
must understand, accept, and otherwise acknowledge
the argument for not changing. The righting reflex
often increases client resistance to change.
6. People commit to change more readily when they
have convinced themselves that they are better off
changing. There is much truth to the idea that one
can convince oneself of anything, if the case is
stated thoroughly enough. Therefore, the ultimate
goal of MI is to create a situation in which
individuals persuade themselves to change, rather
than having the clinician doing all of the
persuasion.
7. Consistent with an active, client-centered
approach, clients decide what behavior to focus upon
and what goals, if any, to set. Practitioners
provide information and options, but leave
decision-making to the client.
© Gary S. Rose, Ph.D. 2003-2006
