Title

A Chance for Change

HS412-326A Counseling and Microskills

Emily Scott

April 15th 2016

 Abstract

Motivational Interviewing is not a model or a theory; it is a method of interacting with

clients to elicit intrinsic motivation. Its development was based on successful clinical encounters

and it has disseminated to all professional settings which would benefit from behavior change

including healthcare and the criminal justice system.

 Motivational Interviewing is extremely useful in behavioral change. Throughout this

paper I will describe in detail my understanding of the process of Motivational Interviewing. I

will reflect briefly on influences and which developed the process. I will describe the five

principles which provide a structure for teaching and understanding the method of Motivational

Interviewing. Finally, I will discuss why I believe Motivational Interviewing is a required as a

set of techniques in many agencies.

William R. Miller Ph.D. had written an initial and theoretical paper in 1983 on

Motivational Interviewing which became influential throughout the United Kingdom in the mid-

80’s where many of Stephan Rollnick Ph.D.’s colleges used it widely to change their own

techniques of respectful listening and encouraging intrinsic motivation. Together they challenged

each other to develop principles, a process of interacting with clients, which could illicit intrinsic

motivation. The spirit of Motivational Interviewing which influences the relationship with the

client which becomes both respectful and influential and makes the professional and the client

partners in behavior change. As they developed their book, there were many influences. Miller

stated that he was greatly influenced by the wisdom of Carl Rodgers who created a safe

environment for his clients before bringing up difficult discussions such as need for behavior

change. Daryl Berm’s theories of self-perception also helped in the development of Motivational

Interviewing with the idea in which attitudes and behavioral intentions are shaped by the act of

talking. Being a process of building a respectful relationship between professionals and clients,

Motivational Interviewing became immediately appealing to professionals in not only a clinical

setting of therapy but expanded and disseminated through unexpected venues of medical and

even criminal justice settings with potential use in many more applications.
 The Principles of Motivational Interviewing are: Express Empathy, Avoid Argumentation,

Roll with Resistance, Support Self-Efficacy, and Develop Discrepancy. The first principle is

Express Empathy as it is fundamental to Motivational Interviewing. Being a reflexive listener is

essential to beginning a respectful and co-operative relationship. Having similar or the same

experience does not make you a better or worse therapist rather it is the ability to suspend one’s

own history and advice for the time being and really listen is the most effective method of

expressing empathy. Second is Avoid Argumentation which is critical to illicit intrinsic

motivation. Conflict can be hard to avoid and resistance is a natural result. Taking an offensive

roll of pointing out that the client has a problem and requesting that the client change puts the

professional and the client at odds rather than co-operating, therefore, the relationship suffers.

The third is Roll with Resistance which is a difficult skill to master. The goal is to not meet

resistance directly but in fact to work with the person and accepting difficulties rather than

blaming, diagnosing, labeling or be given very directive advise. This defuses the frustration of

both professionals and their clients and provides relief as well as a sense of joining together to

meet the clients individual challenges. The fourth is Support Self-Efficacy has a great deal to do

with helping the client understand that there is ability to change and that the client will be

supported in this change. If this is not done before the topic of change is presented, the client

begins to enter a kind of fight or flight response due to anxiety which results in resistance. The

fifth principle of Motivational Interviewing is Develop Discrepancy which very simply

illustrates a diagram of the current behavior compared to where the client’s behavior should be

or wants it to be.

I believe Motivational Interviewing is a required as a set of techniques in many agencies

is because of the success in treatment, reduced frustration and burn out for professionals, and
because of the broad uses which it presents. In the video, Miller describes how eliciting intrinsic

motivation is the spirit of Motivational Interviewing. Essentially, finding a way to work with the

client to help the client want to make a behavioral change for the better, this process is so much

more effective for the process of change than any other means. I believe that real, not temporary

or feigned; behavior change is unsustainable without the individual’s desire to make that change.

The knowledge and tools for success in behavioral change is found in Motivational Interviewing,

therefore, I believe that it should be extremely desirable to many agencies. Finding ways to

partner with the client reduces frustration in both the client and the professional. Frustration is

common with practitioners, particularly perhaps, who deal in addiction and with other clients

who suffer from self-destructive behaviors. Conflict is common and frustration as a result can

cause harm to the client, creating a prejudice or distrust to therapy, as well as the therapist, who

can suffer from burn-out which is a condition of sever lack or total lack of empathy for others.

Avoiding, or at least, reducing the risk of burn-out benefits the agency with successful recovery

of patients and retaining practitioners. Rollnick discusses in the interview that Motivational

Interviewing is so much more applicable in the treatment process than in the should I/shouldn’t I

phase. Miller said that throughout the treatment process there are waves of ambivalence and

uncertainty, weighing pros and cons which arise in all stages and can cause resistance to

behavior change. I believe that Motivational Interviewing can be used during anytime of

resistance, therefore, any phase of the treatment process. Miller discussed using Motivational

Interviewing initially for alcohol addiction and it became used in drug addictions. Motivational

Interviewing deals with the difficult discussion of behavior change, which is pervasive in the

health care setting, criminal justice system and other agencies which are badly in need of
humanizing. I believe that the broad potential of application in many known areas where

behavior change is needed is another reason why agencies would require this skill set.

In conclusion, Motivational Interviewing is the process of interacting with clients to illicit

intrinsic motivation. It supports the client’s ability to change and assists the professional in

working with a client’s resistance to reduce frustration for both the client and the professional.

The influences which were instrumental in developing the process of Motivational Interviewing

are reflected in the spirit of the process and its principles. The five principles of which provide a

structure for teaching and understanding the method of Motivational Interviewing are Express

Empathy, Avoid Argumentation, Roll with Resistance, Support Self-Efficacy, and Develop

Discrepancy. Each develops a relationship beyond the clinical setting and supports the client in

behavioral change with respect and delicacy. Finally, I believe Motivational Interviewing is a

required as a set of techniques in many agencies because it’s effectiveness in treatment, it’s

defusing of frustration and resistance and it’s potential for broad application.
 References:

Class given video: MOTIVATIONAL INTERVIEWING: Preparing People to Change presented by

Miller, William R. Ph.D. and Rollnick, Stephen Ph.D. Produced by Horizon West Productions (1998)