Motivational Interviewing – Part 1

Why bother to change? And why is change so hard? In his book Who Moved My Cheese, Spencer Johnson’s fable suggests that change is an intrinsic and inevitable part of life. The Cheese is a metaphor for anything that is important to us and therefore we want to hold on to it e.g. happiness, success, relationships. When the “cheese” changes (either by our design or outside of our control), it can provoke four possible behavioural and attitudinal reactions:

  1. Shock
  2. Defensive retreat
  3. Accept
  4. Adapt

We do not necessarily have to go through each stage depending on our attitude towards change, as this will determine how successfully we are able to navigate these reactions and the impact it has on us. Due to this challenge posed by change, people often find themselves feeling ambivalent about it and whilst they may be able to see both the benefits and costs of change, they remain undecided about the change and thus can become stuck any stage.

Today I attended the first day of a motivational interviewing course. I work with clients who are struggling with either new or longstanding difficulties with their mental health. I specifically work with people experiencing mild to moderate mental health problems as part of a primary care mental health service. Many of my clients want to be able to cope better with things or to change things , but all find this a challenging learning process and thus the process of change can then become frustrating and anxiety-provoking making many want to just give up.

Motivational interviewing (MI) is a humanistic approach which is client-centred. It focuses on eliciting a person’s intrinsic motivation for change by helping them explore and resolve their ambivalence (their mixed feelings about whether or not to attempt making change). This course has reminded me that motivation appears to be intrinsic to humanity even if the behaviour it results in can be viewed as subjectively/objectively helpful/unhelpful. Thus, change is a process that moves through phases.

According to the cycle of change, these phases are:

taken from: http://socialworktech.com/intervention/stages-of-change-prochaska-diclementi/

MI is basically a conversational style to facilitate change through following and guiding the client at whichever stage of change they are in. This means using different techniques of:

  • affirming
  • listening
  • open questions
  • summarising & reflecting
  • support ‘change talk’ (self motivating statements)

to varying extents according to the stage of change the client is in.

I learnt today that motivation is multi-layered and includes a range of internal and external factors which may act as a real (or imagined) barrier to, or facilitator of, change. Thus, Roger’s core conditions of empathy, congruence and unconditional positive regard are necessary for ensuring a safe therapeutic space within which the issue of change can be at least contemplated even if it is not always acted upon by the client.

How to use this learning?

Perhaps next time you are faced with managing, or making a change or a decision, look at the pros and cons of making that change or decision and the pros and cons of staying the same. The results could be thought-provoking…

Leave a comment on how you got on!

 

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