Motivational Interviewing for Mental Health

Motivational Interviewing Uses Four General Processes 

Motivational interviewing (MI) is a therapy approach that helps patients identify problems, develop goals, and set a plan to achieve those goals. This therapy approach is very verbal and patient-driven, helping patients to feel more capable of enacting real change in their lives. The four processes or stages of change motivational interviewing are: 

1. Engaging – Engaging is used to involve the patient in talking about their issues, concerns, and hopes, and to establish a trusting relationship with the counselor. 
2. Focusing – Focusing is used to focus the conversation on habits or patterns that patients want to change. 
3. Evoking – Evoking is used to elicit a patient’s motivation for change, by increasing their sense of importance regarding change, their confidence about change, and their readiness to change. 
4. Planning – Planning is used to develop the practical steps patients want to use to implement the changes they desire. 

With the four motivational interviewing stages of change, patients can gain responsibility and the ability to improve their current situations. When a patient is truly committed to changing for the better, the possibilities are endless. Every person holds within them the potential for greatness. Sometimes it is simply a matter of standing in our own way. 

The saying goes that we are often our own worst enemies, which means that these negative thought patterns can become so normalized that we forget they are there. That sadly doesn’t mean they won’t still inform us of our behaviors and abilities. Through motivational therapy techniques, patients can learn to become more aware of these instances so they can one day break away from them. 

While there are as many variations in MI technique as there are clinical encounters, the spirit of the method is enduring and can be characterized in a few key points: 

1. Motivation to change is elicited from the patients and is not imposed from outside forces. 
2. It is the patient's task, not the counselor’s, to articulate and resolve the patient’s ambivalence. 
3. Direct persuasion is not an effective method for resolving ambivalence. 
4. The counseling style is generally quiet and elicits information from the patient. 
5. The counselor is directive, in that they help the patient to examine and resolve ambivalence. 
6. Readiness to change is not a trait of the patient, but a fluctuating result of interpersonal interaction. 
7. The therapeutic relationship resembles a partnership or companionship. 

The Core Elements of Motivational Interviewing 

Motivational interviewing (MI) is a cooperative, goal-focused way of talking that aims to boost a person's drive and commitment to change. The main parts of motivational interviewing include: 

1. Expressing Empathy: Showing understanding and acceptance of the client's views, feelings, and experiences without judging. This helps build trust and rapport. 
2. Developing Discrepancy: Helping the client see the differences between their current actions and their bigger goals or values. This difference can push them to think about change. 
3. Avoiding Argumentation: Staying away from confrontational or argumentative talks. Instead, the focus is on understanding the client's view and creating a supportive space. 
4. Rolling with Resistance: Meeting resistance or mixed feelings with empathy and understanding, not direct confrontation. This method helps lower defensiveness and opens up room for discussion. 
5. Supporting Self-Efficacy: Boosting belief in the client's ability to change by pointing out past successes, strengths, and resources. Building self-efficacy makes lasting behavior change more likely. 
6. Developing a Plan of Action: Working together to set goals and make a specific plan for change. This plan should be realistic, doable, and match the client's values and motivations. 

These parts together make up the base of motivational interviewing, focusing on a respectful, empathetic, and cooperative way to bring out and strengthen a person's motivation for change. Ultimately, there are many variations to this technique. That said, certain beliefs fuel the motivational interviewing method. 

Motivational interviewing therapists practice with: 

• Partnership: MI is a collaborative process in which the MI practitioner is the expert in helping people change and become experts in their lives. 
• Evocation: People have the resources and skills needed to change themselves. Motivational interviewing therapy is meant to draw out the person’s priorities, values, and wisdom to explore reasons for change and support it. 
• Compassion: The MI practitioners at Banyan’s facilities for mental health take a non-judgmental approach to promote and prioritize clients’ welfare and well-being selflessly and lovingly. 

Motivational interviewing therapy also uses OARS skills, which include: 

• Open questions that draw out and explore the person’s experiences, perspectives, and ideas. Motivational interviewing questions guide the client to reflect on how change may be meaningful or possible. These questions are usually open-ended (elicit-provide-elicit) to help the person explore what they already know, then seek permission to offer what the practitioner knows, and then explore the person’s response. 
• Affirmation of strengths, efforts, and past successes helps to build the person’s hope and confidence in their ability to change. 
• Reflections are based on careful listening and trying to understand what the person is saying through repetition, rephrasing, or offering a deeper guess about what the person is trying to communicate. This is how our therapists express empathy and make the individual feel understood and heard. 
• Summarizing ensures shared understanding and reinforces key points made by the client. 
• Attending to the language of change identifies what is being said against change (sustain talk) and in favor of change (change talk) and encourages a movement away from sustain talk toward change talk when appropriate.
• Exchange of information understands that both the client and therapist have expertise. Sharing information is considered a two-way street, and a therapist needs to be responsive to what the client is saying.