Primarily motivational interviewing (MI) was developed as a method of psychological counseling for people who abuse alcohol but are not yet addicted. Subsequently, it has gained wide popularity both in the field of prevention and treatment of other addictions and as a universal method of short-term psychological counseling and psychological and social support for various categories of clients.
The popularity and relevance of MI are related both to the simplicity and accessibility of this method and to the fact that MI is effective even in the case of single visits and concerning those clients who are not seeking help on their own (including unmotivated, negative or skeptical ones).
Motivational interviewing was developed by American psychologists William Miller and Stephan Rollnick as a practical consequence of the theoretical model of readiness for change. Initially, the use of MI was limited to counseling people whose alcohol consumption reached a level that was hazardous to health but was not an addiction. Subsequently, the scope of MI expanded significantly, including counseling patients with addictions, both chemical and non-chemical (behavioral addictions).
Miller and S. Rollnick define MI as a directive, client-oriented method of counseling aimed at changing customer behavior through analysis and resolution of contradictions (ambivalence). Unlike non-directive approaches to counseling, MI has a specific structure and a determinate goal (behavior change). On the contrary to other directive approaches, MI does not allow pressure on the client, coercion, direct persuasion with emphasis on professional authority, expert advice, imposing diagnostic labels, and results that the client should achieve.
By the definition of its creators, MI represents a methodological approach, the style of interpersonal communication, strictly maintaining a balance of directing and client-oriented components, united by a philosophical concept and understanding of the mechanisms that launch change. Motivational interviewing is aimed at the formation, strengthening, and maintaining the motivation of the client to change problem behavior (harmful, dangerous to health and personality). However, it should be mentioned that MI does not include training and development of social skills, starting from the idea that the client initially has everything necessary to initiate the process of change. If he or she needs to expand social competencies, he or she will find opportunities for this (a new motivation will arise).
1) The desire for change comes from the client and cannot be imposed on him or her from the outside. There are aggressive motivational approaches based on coercion, persuasion, confrontation, and using external threats to pressure (for example, loss of work, family, or health). The use of such risks can be useful for a short-term change in customer behavior but does not produce lasting results. MI fundamentally differs from such approaches and relies on the identification of actual needs, mobilization of internal resources, and the client’s own goals to stimulate behavior change.
2) Only a client (not a specialist) can formulate and resolve the ambivalence. Ambivalence reflects the conflict between two unmet needs, as well as behaviors aimed at meeting these needs. Each line of behavior has a positive and negative side that the client is aware of. Consistent analysis of confusing, conflicting requirements is a tool through which customers learn to understand themselves and their behavior better. The task of a specialist who uses MI is to help the client in this analysis and guide the person in making those decisions that contribute to change.
3) Direct persuasion is an ineffective way to resolve contradictions. In working with problem behavior, the specialist is tempted to “help” the client, convincing the person of the seriousness of the problem, the danger of the situation and describing the benefits of changing behavior. Such actions are unacceptable within the framework of motivational interviewing, as reinforcing resistance and suppressing the client’s own will.
4) The general tone of motivational interviewing is calm and revealing (that is, aimed at the client receiving information). Persuasion, agitation, aggressive attacks, argument, criticism of patient behavior are absolutely unacceptable in the framework of MI. For some specialists, this style of counseling may seem “passive,” but it is it that allows to “mature” readiness for change without provoking clients to actions for which they are not ready. It is even possible to say that MI is characterized by increased respect and attention to the client.
5) The specialist directs the efforts of the client in the analysis and resolution of ambivalence. MI relies on the idea that changes in problem behavior do not occur due to conflicting needs and a lack of understanding of one’s possibilities for change. Therefore, to initiate a gradual process of change, it is enough to direct the client’s efforts in the right direction.
6) Willingness to change is not a stable characteristic of the client but reflects the dynamics of interpersonal interaction. Therefore, the specialist conducting MI should pay special attention to all manifestations of motivation or counter-motivation (resistance) of the client. The client’s resistance increasing during the MI process indicates that the specialist incorrectly assessed the client’s readiness for changes. Resistance can be reduced as a result of the correct actions of a specialist (“following the wave”).
7) The relationship between the specialist and the client is a partnership, excluding vertical interaction “expert performer.” Following MI, the specialist respects free will and freedom of choice of the client concerning the behavior.
The professional priorities of a specialist using MI include recognition of the freedom and independence of the client in choosing their life path; the desire to present and understand the client’s value system; adoption of the point of view, position, opinion of the client; increased attention and encouragement of the slightest manifestations of recognition of the existence of a problem and motivation for change; dynamic monitoring of customer readiness for changes; avoiding actions leading to the emergence and strengthening of customer resistance.
By themselves, MI techniques do not represent anything complicated or specific. Their use allows specialists to achieve a change in behavior with the correct understanding of the essence of MI. There is a list of the most typical motivational interviewing techniques:
Open questions. In contrast to closed-ended questions (when a specialist hypothesizes what the patient thinks), open-ended questions allow the patient to express their opinion.
Empathy. Doubts, irrationality, inconsistency, and other manifestations of ambivalence are reasonable in the MI process. The understanding of a specialist allows this person to accept the image of the client’s reasoning, which does not mean approval of his or her actions.
Active or reflective listening. It allows the person to make sure that the specialist has a good understanding of what the patient means. Moreover, it will enable to put the interests of the patient in the center and reduces resistance.
Providing medical information. To avoid increased resistance, medical information about individual risks or harm must be submitted in compliance with the following principles: as objectively as possible, without intimidation, indicating the data source, avoiding categorically, allowing the patient to determine the treatment strategy. The individual (subjective) significance of information, and not common words, is vital.
Structuring information. Summarizing statements of a specialist are needed to structure and organize the information received from the client. Generalization is a confirmation that the specialist listens and understands the client.
The use of MI ensures the development of a client’s sense of responsibility and self-confidence, making it possible to regard counseling as a process of solving problems common with a specialist, in which he or she takes an active position and makes decisions. The specialist, for his or her part, appreciates the ideas and supports the undertakings. MI allows establishing a trusting relationship with a client in which the person can entrust the problems to a specialist and describe the behavior in detail, without fear of condemnation and rejection.
Besides, it helps to reduce clients’ feelings of anxiety and distrust of treatment programs, encouraging the client’s desire to continue counseling and creating a positive image of professional assistance in general.