It’s not my intention to give full information or an extensive discussion on every theory. This website is intended to be a starting point and the main difference with other websites is the visual representation of the theory, which I hope will help get to grips with the theory. There are also links it the bottom to get your further research started.

Motivational Interviewing

William R. Miller,  Terri Moyers and Stephen Rollnick 1983

Introduction

This approach was born out of frustration whehn working with clients, offering them solutions and finding more resitance istead of motivation. Motivational interviewing tries to come alongside the client, rather than an opposites side problem solving ‘other’. It’s about not trying to solve the problem for the client but to help them solveit themselves. Giving them ownership in other words. I would highly recommend Stephen Rollnick’s website if you want to find out more to start with. Since this is a technique, and not a model to follow instantanteously, this needs thought, study, practice and/or training and a degree of confidence in applying this with a client. So by definition, what I can offer here especially, can only be an introduction to, rather than a full explanation of, motivational interviewing.

 

How does it work?

The basic principle is that you can’t create motivation for the client, you need to create it with them. When a friend is in trouble or is going through change, a lot of people’s reaction will be to try and put their friend in a better place by trying to solve their problem for them or coming up with (i the eye of their friend) simplistic solutions that don’t work for them. What looks very straightforward to us can look very complicated and challenging for someone going through the process of change or through a problem. This is mainly because for them, a lot of other factors are at play at the same time, which aren’t there for the person ‘at a distance from the change/problem’ who tries to help them. Their emotianal state, self-image, view of their self-efficacy, other issues we’re not aware of, other people, and lots more can get in the way of finding the motivation to implement change or a solution.

An example:

If you come across someone who has a boss who’s really nasty about them behind their back, it’s easy for us to say “cut them out! Look for another job!” For the person going through this it may not be that simple. They may be in anotherwise dream job they can’t easily replace, loyalty to colleagues who have become friends may be involved, or their loyalty to customers. They may have invested a lot of energy, emotion and training into that specific job or career and there may not be other comparable opportunities out there, etc… In other words, their motivation to do something about the situation is low to non-existent. 

Professional response

Within a professional context it’s not as straightforward as saying ‘find another job’ or ‘change careers’ and with more complex issues, other aspects such as personal pride, upbringing, a sense of failure etc… come into play, causing the client to be very low in motivation and resist support. People generally feel more positive about something if they can walk away with their pride and self-image restored. In other words if they’ve come up with the solution themselves, or if they’ve taken ownership of the situation.

At first sight it looks like some sort of confidence trick to ‘make people believe they’ve come up with the solution’. That’s not what’s going on in motivational interviewing. Clients do genuinly come up with their own motivation and solution to their problem, and it’s often best they do that because they know the situation and themselves best. Practitioners function as prompts, as explorers with the client, not for the client. They ideally offer up the soil in which the seed of motivation can sprout and grow, encouraging the client to get started.

Also, the old adage of ‘it’s better to teach someone to fish, rather than giving them a fish’ applies here as well. If a client has practised ‘getting motivated’ they have a base from which to start next time the same happens. In addition, we are role modelling for the client as well.

 

How do we use this?

This explanation is all nice and well, but when you are in a consultation with a client who is very low on motivation, it’s easy to panic and not know where to start in the moment. I’ve come across clients who are in a real pickle, career management wise, but who literally don’t want to talk. It’s easy to assume reasons but until you hear from the client why they don’t want to talk and why they don’t want support, it’s difficult to know for sure. Understanding often comes through communication and sometimes we can only start with an assumption, which the client may react or at best, respond to, which opens up the door for more communication and understanding.

  • Sometimes I’ve been able to open up a channel of communication with the client through shifting focus onto something else, often banale, that has nothing to do with the situation. This could be asking what they did yesterday, or what sports they are into, or something similar.
  • Other times, especially when a client is ‘on a different planet’, not paying attention to even you being there, saying something startling (not something controversial, mind!) can jolt them out of their slump and make them respond. These examples bring us to what this theory is about and they are examples of the ‘Engaging’ process below or starting the process of engaging anyway.

The process

There are two different factors involved in motivational interviewing, both of which we’ve touched upon:

  1. The practitioner’s attitudes – the example we used is to go with the client rather than solve the client’s problems for them.
  2. The 4 basic processes of generating motivation in the client – reflected in the two examples above.

Have a look at the illustration below:

Marcr - Career theory: Motivational interviewing - William R. Miller, Terri Moyers and Stephen Rollnick 1983Practioner’s attitudes:
  • This will involve a lot of careful thought about your attitudes generally and the way you practice more specifically. It’s about paying attention and being ‘in the moment’ with the client, allowing them to be your full focus, rather than any ‘ready made solutions’ or your own view on what the client is going through.
  • Your attitudes need to be part of a long term professional focus. Especially if you have a background in client centred work, this will normally be second nature to you. If you’re new to the profession you may need to pay specific attention to this aspect during any consultation so you create an awareness of where your focus is, of how well you’re doing in putting the client central and allowing them to take ownership of the problem/issue at hand and the solution.
The 4 basic processes:

This area of motivational interviewing also requires thought in how you are going to achieve these 4 processes within your own style of practice. It also requires a lot of practice and courage or confidence to start implementing them with clients. It involves you trusting the client as much as it involves in you trusting the process. The examples below are just that, examples, with the field of career management rather than additiction in mind. I would urge you to, at each stage, come up with examples and techniques you could use in each case.

1. Engaging:

Apart from the two techniques I mentioned above, which can start the engagement process, other techniques can be used to create engagement:

  • Creating a bond by allowing the client to talk about themselves and about unrelated matters for a bit. Asking open questions about their life and about things that don’t matter for the intervention can help. Commenting on something positive about them can help as well.
  • Creating dissonance (what would happen if you don’t do anything about this) in the client could help them engage and grab hold of the change.
  • Have a look at the page on the Stages of Change Model – precontemplation for other ideas.

What other techniques can you think of that fit in with your style of practice? Explore the other motivational theories and theories of change on here and elsewhere for ideas.

2. Focusing

This is no different from the ‘contracting stage’ in any career intervention but with a focus on the issue at hand and motivation (since we assume this is one of the main issues because we’re talking about a motivation theory).

  • You could intently listen to the client as to how challenging the agreement of the main focus can be. It’s very easy for us to unwittingly impose a focus on the client and the intervention but this stage especially needs to be client lead. Otherwise the client may disengage before we have even started. Listening skills and focused questioning such as feeding back (“so what you are saying is…”) could be very useful here. The key is to come to a mutual understanding and agreement.
  • Too ambitious a goal may further demotivate the client in that they see the mountain they have to climb (even within this one intervention) as higher than it is in reality.
  • Goals that are not ambitious enough may also cause the client to disengage by causing disinterest and boredom within the client.

Here too, think about what you can do, which techniques you can develop and explore to help the process.

3. Evoking

Communication is key here I feel. For example: this means allowing the client to explain and making use of:

  • Constructive silences: allowing time for the client to think and come up with their own answers rather than us giving in to the temptation of filling silences with more questions.
  • Open questions in which the client is encouraged to expand on what they are feeling, thinking, worrying about etc…
  • Challenging, but with tact and awareness of where the client is.
  • Reframingto put the client’s views in a different context and to make sure you understand them correctly
  • Repeating back to make sure your understanding is correct

Evoking what can happen or needs to happen in the future for the client:

Allowing the client to come up with solutions and supporting them in this by, for instance:

  • Putting them in context with the client (“how would that work if…”)
  • “What could you do if…” – solution focused questioning
  • Comparisons – what have you seen others do and how would that work for you?

As above, these are just examples of the techniques you can use; can you come up with any other ones that would work for you?

4. Planning

Once the client’s motivation has built up to a level that they can take full ownership of the issue at hand, the solution and the follow up or maintenance of the solution, planning can take place. The client and you can explore and agree on how change can be implemented and how the client is going to make sure this happens (client centred!).

Here too, think about techniques you can use and have a look at other theories on this site and elsewhere for ideas and techniques.

 

Critique

I think this is a really powerful theory and model that requires serious consideration. Often, ‘the client who doesn’t want to talk’ but is in a setting that they have to come and see you, is very challenging and can throw us. I think Motivational Interviewing can offer us a lot of techniques as well as a model for practice, preparation and training to help us relax more in situations like that.

More importantly, what do you think? What will get you motivated to explore, practice and apply motivational interviewing?

  • How does this compare to other theories of motivation and change?
  • What is the difference between motivational theories, theories of change and theories of learning?
  • How does this compare to Prochaska and DiClemente’s model for instance?
  • How does Motivational Interviewing compare to 2 factor theory especially? What are the differences in focus, approach, background and application? Are they significant?
  • Have a look to see what Brown would think about Motivational Interviewing.
  • Would this theory and model be easy to use? How would you get training? What is involved in the training to understand and use this model?

 

Useful links