Motivational Interviewing (MI) is a style of communicating where the practitioner has an open communication with the patient to study the priorities, wisdom and goals of the patient.
It is a collaborative process and also a form of partnership that sits between the therapist being a good listener and giving the right advice, whereas the patient providing all the information honestly without hiding anything.
Fundamental Processes involved in MI
Motivational Interviewing mainly consists of four processes that are followed by all the experts. But the important point here to note is that though these four processes are different and have their personal significance, they are not discrete from each other. They overlap each other, which means they do not have a specific start or end to it.
The most important aspect from therapist’s point of view is developing a good rapport with the clients so that they are able to trust the therapist.
The people who come for counseling face issues emotionally which are uncommon and so they hesitate in explaining it to anyone. So the therapist firstly builds trust with the client. Mutual respect is built by instilling a sense of equality in the mind of the client.
Open questions are asked and from the answers received, the therapist gets an idea of strengths and weaknesses, which are then conveyed to the client.
Once the initial process is completed, here in this step, the therapist helps the client in determining what actually is good for him or her.
The focus or the goal to be achieved is set by mutual understanding between both sides. But usually, the therapist encourages the person to determine what he wants to achieve from the counseling by using the information given by him like group counselling.
Sometimes the client comes with a pre-defined goal like leaving an addiction, mental illness, overcoming a relationship breakdown or some other condition. But when the client is unclear about what he actually needs to do, it is the responsibility of the therapist to aid him in deciding the goal.
Once the focus has been decided by both the sides, now the therapist have to figure out exactly when the patient is motivated and ready to make a change. This can be figured out by speaking patiently to the patient that suggests he is ready or willing to move in a direction, ultimately changing his life for good.
It is the job of a therapist to make patients aware of the consequences if they don’t bring a change in their lifestyle.
Knowing how to make the patient speak about his eagerness to make a shift from his normal lifestyle is the responsibility of the therapist.
A unique feature of this final process is that the plan comes from the patient’s side. The caliber and nature of the plan depend on the understanding, maturity and intelligence level of the patient.
The main focus of the therapist is to make the patient think by himself and chalk out a plan which would be very effective in the future.
Importance of OARS
There are various skills that define a good practitioner, but the four main skills are Open Questioning, Affirming, Reflecting and Summarizing. These four terms are summed up together in an acronym generally called OARS.
Open Questioning: These type of questions generates momentum as they cannot be answered in yes/no pattern. They basically demand a long and elaborative answer, thus paving a path for the client to speak about his side of the story.
Though closed questions too have their importance but as the answers are short, they mostly give a feeling of interrogation, whereas open questions create a conversation, thus building mutual respect and trust.
Affirming: It involves agreeing with the client’s views and showing empathy towards his views. This helps in building a rapport with the patient and makes him share his feelings and life story easily without shying away.
The patient is made to believe that the struggles and failures he has gone through was a one-off case and he can succeed in the near future.
Reflecting: Reflective listening is a very important aspect when it comes to MI. The therapist needs to show interest in what the client is saying and desire to understand his point of view.
Summarizing: Summaries strengthen a belief in patient that the therapist is paying attention to what has been said and is really interested in knowing your opinions and views.
Small summaries can be given throughout the session, and a concluding summary is given at the end, which sums up all the topics discussed in that particular session.
Many people want to make a change in their life, but low self-esteem and low confidence become a hindrance for them. MI makes them self-reliant on themselves and makes them visualize a future free of negative behavior. MI is a slow process and so you cannot expect a result overnight. You need to show patience with the consultation and treatment that is being provided. But in the long run, it is one of the best solutions and has shown more positive results.
The reliability and validity of motivational interviewing are assessed in “Assessing competence in the use of motivational interviewing.” Journal of substance abuse treatment (2005) by Moyers, Theresa B., et al.
The helpfulness of motivational interviewing is evaluated for the treatment of alcoholism by Miller and William R. in “Motivational interviewing with problem drinkers.” Behavioural and Cognitive Psychotherapy (1983)