Therapists help clients envision a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior, and ultimately, to consider what might be gained through change. Motivational interviewing focuses on the present, and entails working with a client to access motivation to change a particular behavior that is not consistent with a client’s personal value or goal. Warmth, genuine empathy, and acceptance are necessary to foster therapeutic gain with motivational interviewing. Another central concept is that ambivalence about decisions is resolved by conscious or unconscious weighing of pros and cons of change vs. not changing.
The main goals of motivational interviewing are to engage clients, elicit change talk, and evoke motivation to make positive changes from the client. For example, change talk can be elicited by asking the client questions, such as “How might you like things to be different?” or “How does ______ interfere with things that you would like to do?” Change may occur quickly or may take considerable time, and the pace of change will vary from client to client. Knowledge alone is usually not sufficient to motivate change within a client, and challenges in maintaining change should be thought of as the rule, not the exception. Ultimately, practitioners must recognize that motivational interviewing involves collaboration, not confrontation, evocation, not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.
While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring, and can be characterized in a few key points:
- Motivation to change is elicited from the client, and is not imposed from outside forces.
- It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence.
- Direct persuasion is not an effective method for resolving ambivalence.
- The counseling style is generally quiet and elicits information from the client.
- The counselor is directive, in that they help the client to examine and resolve ambivalence.
- Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
- The therapeutic relationship resembles a partnership or companionship.
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