Maybe you have heard of it, but… do you really know what it consists of and what the functions of motivational interviewing are?
It is a clinical method that, due to its name, can be confused with other concepts and approaches. For a few years now we have been living immersed in a “culture of positivism” where certain terms have been squeezed to the point of losing meaning.
Motivation, self-improvement, willpower, resilience… seem to have become the panacea of supposed gurus and coaches who preach about the power of individuals to change their environment, ignoring other factors that undoubtedly influence people’s lives and that, sometimes, we have no control. But really, it has nothing to do with that.
Therefore, in this article, We explain to you what the true functions of the motivational interview are and how it is carried out.
Motivational interviewing is a clinical method that was born in the 90s by psychologists William Miller and Steve Rollnick.
It is an eminently practical procedure, based on the interview with the patient as the main tool. Throughout the different interviews that the professional carries out with the patient, It is intended for him to identify, recognize and take charge of the problems that are interfering in his life. and they are hindering you from achieving your vital goals.
In psychology, the term motivation is used to refer to the impulse that moves us to undertake certain actions. That’s where the name “motivational interviewing” comes from.
It is not a structured and standardized method, but rather a specific form of communication, which seeks to mobilize the patient so that he himself takes control of his situation.
Another element that characterizes motivational interviewing is that it assumes that not all people are prepared or willing to change. The first step that the professional must carry out to adapt his or her strategies is to recognize what stage of change the patient is in, relying on the transtheoretical theory of change.
The main functions of motivational interviewing are aimed at mobilize the patient to put into action all the resources available to him, becoming the engine of change. This method was developed to treat addictive behaviors, so it is commonly used in the treatment of:
As we mentioned previously, it is not a structured method, so we would rather talk about transversal principles that should underpin every interaction with the patient. The main ones are:
1. Express empathy
The relationship with the patient should always be marked by empathy. This implies an attitude of listening and acceptance, avoiding any type of judgment.
It should be noted that acceptance does not imply agreement or approval. We can understand another person and disagree with them.
2. Create discrepancy
It is understood that the patient who comes to the consultation has some type of request regarding some aspect or behavior that is creating discomfort. Therefore, when we talk about creating discrepancy, we are referring to enhance a discrepancy between the patient’s current behavior (that which creates discomfort) with a more positive future goal.
It is about highlighting the differences between the current state in which we find ourselves and where we would like to go, in order to mobilize the patient to start the path towards the stated objectives.
A key element is that it is the patient themselves who proposes their own reasons for wanting to change. It is common for the environment to demand a change in the person. but it will not last if it is not motivated by personal reasons.
3. Avoid arguments
To promote a positive attitude towards change and a good therapeutic relationship, discussions or direct confrontations should be avoided. The therapist should not try to convince the patient that they should change or that they have a problem, this should always come from the patient themselves.
Direct discussions with the patient will provoke opposition and resistance, distancing us from the therapeutic objective. It is about guiding the patient so that he himself can assume what the problem is and how to change it.
The motivational interview is not used to fight with the resistance to change that the patient maintains, but to turn them around, change the perspective and help the patient begin to see the situation in a different way. The therapist’s role is to generate doubt, reflection, introspection, questioning, new points of view…
5. Promote self-efficacy
Self-efficacy is a psychological construct, used to describe the perception that a person has about themselves in terms of ability or abilities to perform tasks successfully.
We often forget that, For a person to carry out a certain behavior, the first thing is that they think they can do it successfully. If we think that something is beyond our reach, we will hardly direct efforts to achieve it. Therefore, it is essential that we work so that the patient trusts himself and his abilities.
Related article: “Albert Bandura’s Self-Efficacy: do you believe in yourself?”
Therapist skills
In order to successfully perform the functions of motivational interviewing, there are certain therapeutic skills that will not help create the desired communication style. These are the following.
1. Open questions
The use of open questions is key in motivational interviewing. When we use open questions The patient must prepare a response, which will provide us with much more information than if we simply limit ourselves to asking closed questions. (those that are answered with yes/no or specific information).
2. Affirmations
When we talk about affirmations in the context of motivational interviewing, we are referring to validating the patient. Use phrases that validate the patient’s feelings, thoughts and sensations It will help you feel accepted and willing to collaborate.
3. Reflective listening
It consists of listening to the patient carefully and then confirm if we have understood you correctly. This can be done through questions such as “if I understand you correctly, what worries you is…”.
4. Summary
Consists in return those most significant aspects of the patient’s speech , after having listened to him carefully. In this way we focus attention on those points that we consider important for the therapeutic objective.
Differences with other therapeutic styles
As we see, the functions of motivational interviewing are not based on rigid or pre-established steps. It is about relating in a certain way, which we must always adapt to each patient.
It is evident that motivational interviewing differs from other therapeutic techniques or models; Some of those differences are the following.
Confrontation-based approaches
We have already talked about how motivational interviewing does not seek to confront patients, however this is not always the case in the world of psychology. From certain approaches, it has traditionally been understood that an important step in therapy was for the patient to recognize that they have a problem.
From this perspective, it is usually common to give too much importance to the diagnosis and present evidence of the problems, as well as to use discussions and corrections. Furthermore, the strategies to follow are set by the therapist and the patient must adapt to them.
Instead, The motivational interview does not seek to label the patient and identify themselves within a certain diagnosis. The important thing is that the patient finds the motivation for change without entering into fights or discussions, negotiating and agreeing on the strategies to follow.
Focus of skills training
In psychology, and especially within the cognitive-behavioral approach, it is common to focus on the training of certain skills (social skills, for example). This is a directive approach, in which “the expert” (in this case, the psychologist) teaches the patient how to do things correctly, and assumes that the patient is in the stage of change. .
However, The motivational interview seeks to get the patient to commit to the change and choose the strategies to carry it out. In addition, the different stages of change are taken into account, adapting the strategies used in each of them.
Non-directive approaches
Although motivational interviewing shares certain aspects with non-directive approaches and has a patient-centered style, It is more conductive than these. The therapist sets an objective (the change in an addictive behavior, for example) and guides the patient towards it, although the method used is indirect. Likewise, the therapist can offer advice and feedback.
Another difference is that, On certain occasions, the therapist focuses on creating discrepancy to generate some discomfort in the patient which encourages you to take the reins of change.
