What is Motivational Interviewing?
Change is difficult. Most people struggle against change and are creatures of habit. Think about it, do you drive the same route to work daily? Do you celebrate winter holidays the same way every year? Have you ever stayed in a relationship even when you were unhappy? If you answered yes to any of those, you are normal. But why do we struggle against change? What makes change so challenging?
Change is difficult because people fear the unknown. To some, the unknown presents perceived risks, challenges, and opportunities for failure, so people tend to stay in their comfort zones that provide a sense of familiarity and safety. When people are resistant to change, they’re left in a state of ambivalence. They’re left feeling unsure of their next move and often lack the motivation to make a positive change that could benefit their life. This ambivalence can present itself as anxiety regarding making a change, which results in the scary feeling associated with change.
While change can be intimidating, it can also be incredibly exciting. It can promote new opportunities, adventure, and growth. It can result in positive life changes and overall shifts in thinking, which can lead to better life situations and happier people.
So how does one help a struggling individual who is resistant to change and comfortable with their ambivalence? What can be done, and is this even possible? Luckily for this type of person, the skilled clinical team at Apex Recovery is well versed in a client-centered counseling technique known as Motivational Interviewing (MI). MI is an evidenced-based, collaborative technique that through its variety of principles and skills, moves a client away from a state of ambivalence and toward change. The beauty of MI is that it honors self-autonomy and promotes a sense of self-efficacy and confidence. Contrary to some other theoretical orientations and modalities, the therapist and client engaged in MI come together as a team. The therapist is available for support, and acts as a guide, rather than offering specific strategies or motivational interviewing techniques. This is a key component of MI, in which it involves the client looking inward to draw from their own personal strengths and resources to promote positive change. The therapist who utilizes MI knows to work along side the client and not take the lead, respects the client’s autonomy, knows to have the client’s best interest in mind, and knows that the client will be the one to produce the best ideas.
Four Principles of Motivational Interviewing
Motivational interviewing is comprised of four principles, or guidelines, that the therapist will uphold throughout the course of treatment: to express empathy, to support self-efficacy, to roll with the resistance, and to develop discrepancies.
As previously stated, change can be difficult and scary. Having said this, it’s important for a client to be in an environment in which they feel safe and supported, so the MI therapist utilizes empathy. They share in their client’s experiences by orienting themselves to the ways their client sees and thinks about different topics, so the client ultimately feels seen and heard. Feeling heard and seen will help to built rapport and increase the chances of the client being authentic in their process.
As stated earlier, Motivational Interviewing is different from most other therapeutic strategies in that the therapist works collaboratively with the client. The therapist acts as a source of support to “nudge” the client and does not act in an expert or authoritative role. This is an approach that focuses on a client’s strengths and own capabilities to promote change successfully. In developing self-efficacy, the client believes in their ability to promote change. Self-efficacy is essential and is achieved by the therapist’s orientation to the client’s previous successes, strengths, and skills.
Roll with the Resistance
From an MI perspective, resistance occurs when the client’s perspective of the problem differs from that of the therapist. Contrary to other therapeutic orientations and strategies, the MI therapist does not confront or challenge the client but instead supports the client with considering other points of view. The therapist avoids a power struggle or fight and instead “rolls with the resistance” by utilizing supportive and patient framing and exploration to ultimately help the client realize the need for change and come to their own solution to the problem.
The fourth principle of Motivational Interviewing involves the development of discrepancies. The likelihood of a client changing is increased when a client is able to see that their current status or state is not in line with what they hope for or envision for themselves. The MI therapist then draws attention to this by orienting a client to their strengths, values, and goals. An MI therapist might use a Pros and Cons list for example to help the client realize that their current attitudes or unhealthy behaviors are not increasing their changes of them reaching their desired goal, which results in the client’s motivation for change.
Motivational Interviewing Skills and Strategies
To help maintain the principles of motivational interviewing and guide the therapeutic process toward one of positive change, this therapeutic strategy utilizes several skillful techniques. Referred to as OARS for easy and quick recall, these strategies include: open-ended questions, affirmations, reflections, and summaries.
Contrary to close-ended questions, open-ended questions do not elicit short, limited responses such as “yes” or “no.” Instead, open-ended questions lead to a more in-depth elaboration and exploration that helps clients to further consider the possibilities and reasons for change. Some examples of open-ended questions that a client at Apex Recovery might be asked include but are not limited to:
What role does alcohol play in your life?
How has alcohol negatively impacted your life?
What are the benefits to expanding your sober network?
How might your life be different if you were sober?
What positive changes can you make now to increase your chances for success?
By preventing short, one-word responses and creating a platform for further exploration, open-ended questions force clients to truly examine the effects their behaviors have had on their lives and help keep them engaged in the discussion. While close-ended questions can lead to a client shutting down or not taking the conversation seriously, open-ended questions have a tactful way of getting the client to view situations, attitudes, and behaviors from a different perspective and help promote change.
Serving as positive encouragement, affirmations are a Motivational Interviewing technique that help to build rapport by drawing upon a client’s strength. As previously stated, the process of change can be uncomfortable, and some people might struggle with change several times before seeing progress. Knowing and understanding this, the MI therapist affirms the client’s strengths to further promote self-efficacy. For example, a client at Apex Recovery be sitting with their therapist in an individual session might hear, “You were really successful in stopping your use for awhile,” or “It took a lot of courage for you to return to treatment.” Affirmations are importance as they support a shift toward positivity, help to validate the client, and help the client to realize that change is possible.
Another technique to establish rapport, reflections, involve the therapist understanding and reflecting back to the client what the client said. This demonstrates to the client that the therapist understands their concerns from their perspective and ultimately helps the client to feel heard. For example, a client at Apex might endorse difficulty with concentration, communication, and anxiety, to which the therapist would respond, “It sounds like you’re having a difficult time right now.” Reflections are helpful in that they help to establish a safe environment built on trust and connection as the client feels understood.
Summaries are the last MI skill. Similar to reflections in that they recap what the client said, summaries are a longer reflection, help to demonstrate understanding, and highlight key elements of the therapeutic discussion. Summaries can also help the therapist to draw attention to both sides of the client’s ambivalence.
Change can be challenging, intimating, and uncomfortable. As creatures of habit, people can find safety in their comfort zones and struggle to make positives changes for success. Knowing this, the clinical team at Apex Recovery utilizes a therapeutic technique that is geared toward establishing the motivation for change. When you enter treatment with Apex Recovery, your therapist will help you build your own motivation for change. Through the use of the different principles and skills of motivational interviewing, the Apex clinical team strives to create an environment built on trust, understanding, and connection to promote the motivation and change that will ultimately lead to your success and happiness.
If you or a loved one are struggling with substance abuse and are seeking treatment or counseling, please contact us at Apex Recovery, today!