Motivational Interviewing

Originally developed by clinical psychologists to address substance use disorder, Motivational Interviewing (MI) is now recognized as an evidence-based approach for a broad range of people and their various concerns. MI aims to facilitate behavioral change by utilizing the language of change and empowering individuals to strengthen and connect with their values, where/how they find meaning, and build confidence in their capacity for change. Although MI focuses on behavior change, it is not a way for clinicians to impose advice, confrontation, or direction. With MI, people change when they decide to, not when someone tells them to. The spirit of MI prioritizes collaboration, acceptance, compassion, and curiosity. These concepts allow clinicians to embrace an individual’s conflicting feelings or attitudes toward change and engage individuals in an exploration of their own “why”. 

The Four Processes of MI

The four processes of MI summarize the experience of engaging with MI for both the clinician and the individual. These processes are not required to happen in order as the clinician and individual may move together in between these processes as a person’s motivations, life circumstances, and needs change. 

• Engaging
  • Although largely considered the first step in MI, engaging is a continuous effort from the clinician to foster a working relationship with the individual through active listening and supporting individual autonomy. Additionally, building a foundation of acceptance is crucial in the relationship between the clinician and the individual to create space for change. 

• Focusing
  • The area and direction of change is guided by both the individual’s wisdom and the clinician’s expertise. Agreement on goals provides the clinician and the individual with a clear focus on sustained change. 

• Evoking
  • This MI-specific process focuses on an individual’s change talk. Change talk includes statements that can offer insight into an individual’s readiness to change. For example, “I can’t keep doing this” or “I wish things were different”, are statements that highlight a desire to change. Evoking change talk through open-ended questions or targeted reflection allows the individual to reflect on ambivalence and the clinician to empower the individuals’ internal motivations. 

• Planning
  • Within everyone, there are the resources and skills needed for change. MI facilitates an exploration of the individual’s inner resources and skills to plan the best “how” of change. 

The Stages of Change

In MI, we conceptualize change as an ongoing process involving multiple stages.  This process is not necessarily linear, as people often shift back and forth from stage to stage.  The stages of change provide an understanding of the typical experiences individuals go through when engaging in behavior change.  Understanding these stages helps the clinician best match their interventions to where the client is at, and more importantly, helps the individual to understand that everything they experience (even relapse) is normal and to be expected as they move through the change process.

• Precontemplation
  • Individuals in pre-contemplation do not perceive a need for behavior change and, and therefore, express little to no motivation. At this stage of change, MI focuses on building rapport and increasing awareness of the potential problem through gentle exploration. 

• Contemplation
  • Individuals in contemplation can acknowledge a need for change but still struggle with ambivalence or indecision toward taking action. At this stage of change, MI focuses on resolving ambivalence by increasing confidence, addressing barriers, and identifying internal motivations. 

• Preparation/Planning
  • Individuals in preparation express readiness for change and plan the next steps. At this stage of change, MI focuses on building self-efficacy, goal-setting, and evoking change talk. 

• Action
  • Individuals in action have committed to behavior change and are actively implementing planned changes. At this stage, MI focuses on affirming progress and addressing setbacks, including relapse. Relapse is a normal part of the change process and presents opportunities for continued learning and growth. 

• Maintenance
  • Individuals in maintenance have shown the ability to maintain behavior change for a significant period. At this stage, MI focuses on solidifying coping skills around self-monitoring and resilience. 

Sources

https://motivationalinterviewing.org/understanding-motivational-interviewing

https://www.relias.com/blog/an-overview-of-motivational-interviewing-and-the-stages-of-change