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People Know When We Believe in Them: The Four Principles of Motivational Interviewing
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Description: Motivational Interviewing (MI) is a collaborative, person-centered approach to elicit and strengthen motivation to change. It offers providers a means to connect with people through a grounded and purposeful conversation. “In the context of an empathic relationship, we seek to help people tap into their own wisdom and wishes. We try to help people talk themselves into changing, rather than trying to convince them to change,” offers Ken Kraybill, Training and Technical Assistance Specialist for the Homelessness Resource Center.
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Motivational Interviewing offers providers a useful framework for being with and interacting with people who are experiencing homelessness or struggling with substance use, mental illness, and traumatic experiences. It is rooted in an understanding of how hard it is to change learned behaviors, many of which have been essential to survival on the streets.

Motivational Interviewing (MI) is a collaborative, person-centered approach to elicit and strengthen motivation to change. It offers providers a means to connect with people through a grounded and purposeful conversation. “In the context of an empathic relationship, we seek to help people tap into their own wisdom and wishes. We try to help people talk themselves into changing, rather than trying to convince them to change,” offers Ken Kraybill, Training and Technical Assistance Specialist for the Homelessness Resource Center (HRC). Ken provides training in MI for homeless service providers nationwide for the HRC. He has used MI in his own work as a mental health specialist and case manager in homeless services since the early 1990s.  

MI is a collaborative process because it involves two people with their own areas of expertise.  The provider uses skills to explore ambivalence and to bring about “change talk” – client statements that express desire, ability, reasons, and a need for change. The client brings self-knowledge and life experiences to the relationship. A person knows whether or not he is ready to move in the direction of change. Together, the provider and client ask questions, discuss issues, and share perspectives. It is not a one-way exchange from provider to client, but a shared, two-way conversation.

Ken adds that it is important to understand the power of both verbal and non-verbal cues. “The way we interact, including our facial expressions, matter. We know when people are truly interested and when they are just acting like they are interested. If a provider isn’t genuinely interested in the person next to them, all the great techniques in the world won’t matter.”

Four principles provide a conceptual foundation for the practice of MI:
  • Expressing empathy
  • Developing discrepancy
  • Rolling with resistance
  • Supporting self-efficacy

Expressing Empathy

 We cannot change other people, but we can create an empathic environment in which people are more likely to move toward positive change. By creating a welcoming space, we invite people to safely explore conflicts and face difficult realities. MI relies on asking ample open questions and skillful use of reflective listening – both of which demonstrate genuine empathy. If a person is not yet ready to change, pressure from others may prevent him from moving toward it. Pressure rarely helps to facilitate change. Providers should strive to be non-judgmental.

Developing Discrepancy

People are more likely to choose to change when they recognize that their behavior is in direct conflict with their own personal values and goals. A provider using MI with someone who is not thinking at all about change can help by “amplifying discrepancy.” In this way, the provider helps to shine a light on the difference between what the person says they want and want they are doing. Amplifying discrepancy can help a person explore her own motivation to change. It is critical that reasons for change are not presented by the provider, but rather by the individual. Research shows that people come to know what they believe by hearing themselves say it.

Rolling with Resistance

The concept of resistance in MI is understood to be relational. Providers have the ability to influence people’s motivation to change – for good or for bad. When a provider argues for why someone should change, the common client response is to resist “being told what to do.” On the other hand, when a provider works in a collaborative manner by helping the person develop his own arguments for change, client resistance is likely to diminish. When resistance occurs, it is a signal to the provider to change strategies.

Supporting Self-Efficacy

A primary goal of MI is to provide hope and enhance confidence that change is possible. A person will always encounter obstacles in his life. An individual’s level of self-efficacy – a belief and confidence in one’s ability to change – is a key piece of motivating change. It is also a good predictor of treatment outcomes. Often, we can help people increase self-efficacy by helping them to see the strengths they already possess and have used in past situations to effect change.

People know when we believe in them. This can be a self-fulfilling prophecy. It is important not to underestimate the provider’s own belief in a person’s ability to change. Providers need to see people through a lens of hope and expectation that the person might change. “If we don’t think people have a chance of changing, then they are likely to borrow that belief from us. Conversely, if we truly believe clients can change, they will begin to see the possibilities for themselves,” says Ken.

Ken says it is important to understand the power of both verbal and non-verbal cues within the interactions between providers and the people they work with. “The way we interact, including our facial expressions, matter. We know when people are truly interested and when they are just acting like they are interested. If a provider isn’t genuinely interested in the person next to them, all the great techniques in the world won’t matter.”

Visit the HRC Motivational Interviewing Topic Page to learn more.

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Type of Resource: HRC Resource
Organization: SAMHSA
Publication Date: 2010
Location: Rockville, MD
Phone: 617-467-6014
Steven Samra from Nashville
February 27, 2010
10:43 AM
 
As a Recovery Specialist and a Veteran Services Coordinator who works with clients in distress on a daily basis, I am often in the unique position to use Motivational Interviewing in a wide array of interactions. As a formerly homeless consumer of many services over the past two decades, I can attest to the positive impact Motivational Interviewing has had on me as I struggled with addiction, a bipolar disorder and homelessness.

Today I am a firm believer in, and supporter of, the use and spirit of MI. I'm also an ardent cheerleader for the philosophy of Radical Loving Care that arises from the core of the servant's heart, two additional ingredients I believe add tremendous depth to Motivational Interviewing. By seeing individuals not as cases to be solved and moved on but as complex human beings who need a holistic approach that allows them the benefit and satisfaction of resolving their own internal conflicts, I think we bring to them a sense of self worth, hope, dignity and collaboration in their lives. For those of us who've languished in the streets, ignored by much of society, the mere idea that someone else might care enough to listen is powerfully motivating in itself.


   
 
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