The motivational interviewing technique is an approach to therapy that supports people making positive changes in behaviors that are causing them problems. It’s quite different from strategies in which a therapist or other professional would reprimand or even scold someone for continuing to do things that could be harmful: “If you don’t stop drinking, you’re going to be dead, Mr. Jones.”
When working with a loved one who is engaged in high-risk behaviors, a motivational approach can help diffuse a lot of the anger and struggle around the behavior. One way to think of this is that we are much more likely to change our behavior if we really want to do so (high motivation). We’re less likely to change if someone is telling us we have to.
Key components of motivational interviewing include:
• Empathy, letting the person know that you understand their struggle, pain, concerns, etc. This should never appear fake; you need to show genuine concern and understanding.
• Reflective listening, As the person talks, you mirror back to them what they’ve said, and continue to do so until there’s absolute clarity. This form of interviewing involves many questions: “You said you drink to help you get to sleep at night, is that right?” “As I heard it, you like the numbing effects of painkillers, but don’t like the way you have to hide taking them from your wife, is that correct?”
• Heightening internal struggle around a problem behavior, This involves stepping away from directives and nagging, such as: “You must take your medications!” or “Just say no to drugs!” to helping the person find his own reasons for making needed changes. This could include making lists of pros and cons around the problem behavior. In one column could be the euphoric feeling someone gets from an opiate like heroin, and on the other side could be the negative consequences (legal, financial, health marital, etc.) that have come from using.
• Supporting all positive change, Here it’s crucial to be a bit of a cheerleader. Every gain needs to be acknowledged. “Well done.” “That must have been hard.” “I’m so proud of you.”
• Avoiding struggle and debate/rolling with resistance, Again, in motivational interviewing you’re not telling the person what to do. If someone is talking about how much they like cocaine and how they’re not ready to stop, you need to avoid jumping in with statements like, “Don’t you know it’s going to kill you?” and “Can’t you see how it’s destroying your life?” Instead, stay the course with empathy, reflective listening, and increasing the internal struggle. A motivational interviewing stance might be, “You just told me how much you love the high of crack, and earlier you were saying how you hated the feeling of crashing after a three-day run, where the last time you ended up in the emergency room saying you wanted to kill yourself. How do you put those two things together?”
• Having no stated agenda, This may be the most difficult part of using a motivational strategy. Of course you want your loved one, or in the case of a therapist, your patient/client, to stop engaging in the behavior that is causing them so much harm. It’s important to try and keep this to yourself and work with the goals that the person has stated. If the issue is drinking and she’s saying she’s not ready for abstinence, that’s where you start. If the behavior is that she stops her medications every time she leaves the hospital and is saying she doesn’t want/need to take them, that’s where you begin.
While motivational interviewing is incorporated into the dual diagnosis model, it can be used with good effect in working with people who want, or need, to change a variety of behaviors. It’s also being used with good effect in working with people who have serious mental illnesses and lack insight (anosognosia) into their illness.
