Motivational interviewing is a communication style that Wolverine Wellness has adopted for the way we do our work. It shows up in written materials, supervision, workshops, partnerships with others and it underlies the Wellness Coaching program. It’s a philosophy that allows us to meet students where they are and help move them forward in their educational and personal journeys. Five staff in Wolverine Wellness are uniquely qualified to train in this area, as they have been accepted into the international Motivational Interviewing Network of Trainers (MINT).
MI might be framed as a method of communication rather than an intervention. It’s sometimes used on its own or combined with other treatment approaches. There are a number of benefits of learning MI amongst other approaches to helping conversations:
- While MI started in the alcohol/other drug treatment arena, it’s been applied across a broad range of settings (e.g. health, corrections, human services, education), populations (e.g. age, ethnicity, religion, sexuality and gender identities), languages, treatment format (e.g. individual, group, telemedicine) and presenting concerns (e.g. health, fitness, nutrition, risky sex, treatment adherence, medication adherence, substance use, mental health, illegal behaviors, gambling, parenting, sustainability).
- It compares well to other evidence-based approaches in formal research studies and is compatible with the values of many disciplines and other evidence-based approaches.
- Although the full framework is a complex skill set that requires time and practice, the principles of MI have intuitive or “common sense” appeal and core elements of MI can be readily applied in practice as staff learn the approach.
- MI has observable practice behaviors that allow learners to receive clear and objective feedback from a trainer, consultant or supervisor.
The following information is lightly adapted from the motivationalinterviewing.com website
“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” (Miller & Rollnick, 2013, p. 29)
The most current version of MI is described in detail in Miller and Rollnick (2013) Motivational Interviewing: Helping people change (3rd edition). Key qualities include:
- Guiding style of communication, that sits between following (good listening) and directing (giving information and advice).
- Designed to empower people to change by drawing out their own meaning, importance and capacity for change.
- Based on a respectful and curious way of being with people that facilitates the natural process of change and honors client autonomy.
MI requires staff/coaches to engage with students as an equal partner and refrain from unsolicited advice, confronting, instructing, directing, or warning. It is not a way to “get people to change” or a set of techniques to impose on the conversation. MI takes time, practice and requires self-awareness and discipline from the people learning it. (Miller & Rollnick, 2009)
While the principles and skills of MI are useful in a wide range of conversations (medical, therapy, advising, supervision, etc.) MI is particularly useful to help people examine their circumstances and options when any of the following are present:
- Ambivalence is high and people are stuck in mixed feelings about change
- Confidence is low and people doubt their abilities to change
- Desire is low and people are uncertain about whether they want to make a change
- Importance is low and the benefits of change and disadvantages of the current situation are unclear.
- MI is practiced with an underlying spirit or way of being with people (CAPE):
- Compassion. Promoting the students’ welfare and well-being in a selfless manner.
- Acceptance. Taking a nonjudgmental stance, seeking to understand the student’s perspectives and experiences, expressing empathy, highlighting strengths and respecting a student’s right to make informed choices about changing or not changing. Acceptance has four parts:
- Absolute worth--no matter the behavior, the student is seen as deserving of respect and has should be supported in reaching their potential
- Autonomy support--expliciting commenting on the student’s autonomy to change or not
- Accurate empathy--demonstrated through complex reflections
- Affirmations--looking for and commenting on strengths and effort the student has demonstrated
- Partnership. Collaborating with the student. Staff/coaches are experts in helping people change; students are the experts of their own lives.
- Evocation. Students have within themselves resources and skills needed for change. MI draws out the student’s priorities, values, and wisdom to explore reasons for change and support success.
- MI has core skills of OARS, attending to the language of change and the artful exchange of information:
- Open questions draw out and explore experiences, perspectives, and ideas. Evocative questions guide students to reflect on how change may be meaningful or possible. Information is often offered within a structure of open questions (Ask-Ask-Offer-Ask) that first explores what the student already knows, then seeks permission to offer what the staff person knows and then explores the student’s response.
- Affirmation of strengths, efforts, and past successes help to build the person’s hope and confidence in their ability to change.
- Reflections are based on careful listening and trying to understand what the person is saying, by rephrasing or offering a deeper guess about what the student is trying to communicate. This is a foundational and probably the most difficult skill of MI. It’s also how to express empathy in MI.
- Summarizing ensures shared understanding and reinforces key points made by the student.
- Attending to the language of change identifies what is being said against change (sustain talk) and in favor of change (change talk) and, where appropriate, encouraging a movement away from sustain talk toward change talk.
- MI has four fundamental processes. These processes describe the “flow” of the conversation although we may move back and forth among processes as needed:
- Engaging: This is the foundation of MI. The goal is to establish a productive working relationship through careful listening to understand and accurately reflect the student’s experience and perspective while affirming strengths and supporting autonomy.
- Focusing: In this process an agenda is negotiated that draws on both the staff/coach and student expertise to agree on a shared purpose, which gives the staff permission to move into a directional conversation about change.
- Evoking: In this process the staff/coach gently explores and helps the student to build their own “why” of change through eliciting the student’s ideas and motivations. Ambivalence is normalized, explored without judgment and, as a result, may be resolved. This process requires skillful attention to the person’s talk about change.
- Planning: Planning explores the “how” of change where the MI practitioner supports the person to consolidate commitment to change and develop a plan based on the student’s own insights and expertise. This process is optional and may not be required, but if it is the timing and readiness of the client for planning is important.