Motivational Interviewing: It’s All About Creating Change

Motivational Interviewing is a directive counseling style that is all about creating change. It works on modifying clients’ behavior by helping them explore and resolve their ambivalence. Using empathy, encouraging self-motivation, and diffusing resistance, the counselor helps clients develop their coping skills. The goal is to enable people to realize the discrepancy between behavior that helps them meet their personal goals and behavior that doesn’t.  Motivation for change occurs “when people see the gap between where they are and where they want to be.”

The technique has become the therapy of choice for many addiction counselors and, when combined with education, harm-reduction approaches, social support and (occasionally) Cognitive Behavioral Therapy, it has been proven effective in many cases, especially in the area of relapse prevention.

Motivational Interviewing is based on Abraham Maslow’s Hierarchy of Needs and his concepts of “self-actualization” and “self-transcendence.” Maslow’s theory is that at the most basic level we need food, water, sex, sleep and oxygen.  After taking care of those needs, we turn our attention to finding shelter and safety.  When those needs are satisfied, we look to meet our social needs—things like love, belonging, friendship, and intimacy. After that, we are driven to satisfy our need to think well of ourselves and strive to build self-esteem, achieve things, gain courage and confidence, and obtain the respect of others.

Once you have secured these needs in your life, then you are in position to begin to think about reaching the “apex” which is self-actualization. Self Actualization is the state where your needs for order, creativity, problem solving, are met and you realize your fullest potential. Self-Actualization was the apex of the hierarchy. At least until Maslow added the need for “Self-Transcendence.” In the Self Transcendence area, your spiritual needs are met. These needs are beyond and outside the self and are usually concerned with feeling a part of you will live on after you’re gone. People in this stage are concerned with issues such as success of their offspring and leaving a legacy.

Maslow believed that society’s full focus should not be on creating people who can work and fight, but instead on creating people who are self-actualized.  If people have their needs met at that level, he reasoned, then everything else would take care of itself.

With Maslow’s theory in mind and Motivational Interviewing techniques in hand, the therapeutic possibilities outside addiction counseling are interesting. It helped one member of a couple I worked with recently understand why she was upset with her partner and how to create change when she was certain it was impossible.

For teenagers who feel forced into therapy by their parents, it is an effective tool for building a therapeutic alliance under difficult circumstances. I have also seen MI break therapeutic logjams in cognitive-behavioral treatment for depression and anxiety. I also encourage parents to acquaint themselves with Motivational Interviewing. It can come in handy when your teenager begins acting out or shutting you down.

For those who want more information,  “Eight Stages In Learning Motivational Interviewing,” an article by Miller and Moyers in the Journal of Teaching in the Addictions is a good resource. Also Monty Roberts’ instruction manual, “OASAS Training of New Trainers and Supervisors.”

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