Motivational interviewing(MI)is a counseling technique introduced in the mid 1990s by two clinical psychologists, William Miller & Stephen Rollnick. They were using this technique with alcoholics in recovery.
In its purest form,MI is client-centered and client directed. The role of the counselor is to facilitate the resolution of the conflict the client may be having about making a change. If a client is showing signs of denial, this is not the cue for the counselor/social worker to push for change by confronting the client or giving the client advice; the client will give signals when the client is ready to continue forward with the changed behavior. This does not mean that the counselor is unrealistic or wishy-washy-MI methods are in fact, grounded in reality. The counselor (or facilitator!) does not even give the client any behavioral skills to practice-in this sense, the client is the expert on what will make the change work, or how to best cope with the addiction or other behavior the client wishes to change. The counselor's role is to assist the client in figuring out what those skills are. According to MINT (the official motivational interviewing training website), MI is "not a set of techniques used on people, but rather an interpersonal style" that can be used in all sorts of settings, not just counseling.
Motivational interviewing is often combined with other counseling styles, and is complementary to styles such as brief solution focused therapy and cognitive behavioral.
MI ties in nicely with the NASW Code of Ethics in that the foundation lies in the thought that the client is the expert on their own lives (again, according to MINT, if the counselor is behaving like the expert or diagnosing, that counselor is no longer engaging in MI). In the preamble of the Code of Ethics, it talks about the mission of social workers, which in part "seek to enhance the capacity of people to address their own needs." In Section 1.02 of NASW Code of Ethics, "Social workers respect and promote the right of clients to selfdetermination and assist clients in their efforts to identify and clarify their goals."
I am also thinking about how this goes well with the theory of Person in Environment (PIE); when practicing MI methods, the counselor is not diagnosing but truly meeting the client where the client is at in the process of change.
I remember many years ago going to a counselor through my employers wellness program b/c I was having some ambivalence around a certain thing I wanted to change; she was doing a great job of listening to me and practicing MI methods. Until one session, when she got really frustrated suddenly and said "Just ______ ________!" Well, I didn't go back to the counselor; what I did was dig my heels in and do the opposite of her advice. I did eventually do what she said, just at my own time and pace. I had to go through my own process in order to reach that same conclusion.
That being said, what are some challenges of MI methods? Has anyone been trained in these methods? How would you use these methods in your current practice setting?
As a clinician/Social Worker I love using MI when working with clients. I am very PIE and strengths-based focused in my clinical work and MI fits in very well with both of those theories. As Felicia pointed out it also fits in very well with the NASW Code of Ethics.
I have found that even though in its purest form MI does not including diagnostic work, it has still been an invaluable tool for me as I do not work with clients by thinking of them as their diagnosis. I may diagnosis or be aware of a diagnosis but it is not the crux of what my work with the client revolves around.
I worked at a mental health agency for 10 years and during that time supervised many BASW and MSW students in the practicum setting. One thing that I found important was when I assigned a student a client, the first thing I had them do VS read the clients chart was to meet the client and begin to build rapport with them. I was present at these initial meetings and modeled PIE and MI techniques to the students.
I had them do this with me prior to reading the client's chart in order to allow them to not think of the client as a diagnosis but to hopefully impart in them that the client was a person first and that their environment among other factors may have had an impact on the behaviors and choices that they made.
As a supervisor, I find myself utilizing MI techniques often with my staff. I challenge the staff to come up with their own answers (with guidance) on what the best approach may be with a client they are consulting with me on.
MI comes very naturally to me and I find myself utilizing it unintentionally with my children!
I like MI because it puts the patient at the center and allows them power in making their own choices. I think you bring up a good point, Felicia, with your example of the counselor who just told you what to do. I can get stubborn and do the opposite even when someone close to me tells me what to do, so it’s no wonder that clients we work with would feel the same way when their social worker tells them what to do rather than helping them work through it. I also like it because I certainly don’t have all the right answers, and MI helps the client figure out what is right for him or her, rather than expecting me to just give the magic solution.
I probably don’t use MI as much as I could be, and think I need to be more mindful about using these techniques. One specific use of MI that I do use is open-ended questions. I find it very helpful to get people talking and to make the visit feel more like a conversation rather than an interrogation. I also like the technique of having the client explore both sides of the choice they are considering. For example I had a teen girl come to me recently for a referral to therapy, but wasn’t quite sure that she even wanted to go. I asked her, “What would be good about going to therapy?” and “What do you think would be negative about therapy?” This helped me explore her fears (it turned out she was worried her parents could access her medical records), and ultimately helped her decide what to do.
I can see many uses of MI in my current practice setting. Some examples would be parents who are considering changes in their discipline strategies, teens who are using drugs or cutting school, overwhelmed kids trying to figure out what activities to cut out, etc. I don’t think it is necessarily useful in all situations for me, given that I also am involved in crisis intervention and concrete resource needs, but for some patients I can definitely work on using these techniques more often.
Just wanted to add a big thanks to Felicia for sharing her personal account with a Counselor. Her account gave a realistic picture of a Client's need to be heard during sessions and the importance for the Counsleor to acknowledge those needs. So often I have heard that Counselors are tenative with ambivalence and silence during sessions. I guess with Felicia's account we are reminded the importance of these two Client driven behaviors.
Motivational interviewing(MI)is a counseling technique introduced in the mid 1990s by two clinical psychologists, William Miller & Stephen Rollnick. They were using this technique with alcoholics in recovery.
ReplyDeleteIn its purest form,MI is client-centered and client directed. The role of the counselor is to facilitate the resolution of the conflict the client may be having about making a change. If a client is showing signs of denial, this is not the cue for the counselor/social worker to push for change by confronting the client or giving the client advice; the client will give signals when the client is ready to continue forward with the changed behavior. This does not mean that the counselor is unrealistic or wishy-washy-MI methods are in fact, grounded in reality. The counselor (or facilitator!) does not even give the client any behavioral skills to practice-in this sense, the client is the expert on what will make the change work, or how to best cope with the addiction or other behavior the client wishes to change. The counselor's role is to assist the client in figuring out what those skills are. According to MINT (the official motivational interviewing training website), MI is "not a set of techniques used on people, but rather an interpersonal style" that can be used in all sorts of settings, not just counseling.
Motivational interviewing is often combined with other counseling styles, and is complementary to styles such as brief solution focused therapy and cognitive behavioral.
MI ties in nicely with the NASW Code of Ethics in that the foundation lies in the thought that the client is the expert on their own lives (again, according to MINT, if the counselor is behaving like the expert or diagnosing, that counselor is no longer engaging in MI). In the preamble of the Code of Ethics, it talks about the mission of social workers, which in part "seek to enhance the capacity of people to address their own needs." In Section 1.02 of NASW Code of Ethics, "Social workers respect and promote the right of clients to selfdetermination and assist clients in their efforts to identify and clarify their goals."
ReplyDeleteI am also thinking about how this goes well with the theory of Person in Environment (PIE); when practicing MI methods, the counselor is not diagnosing but truly meeting the client where the client is at in the process of change.
I remember many years ago going to a counselor through my employers wellness program b/c I was having some ambivalence around a certain thing I wanted to change; she was doing a great job of listening to me and practicing MI methods. Until one session, when she got really frustrated suddenly and said "Just ______ ________!" Well, I didn't go back to the counselor; what I did was dig my heels in and do the opposite of her advice. I did eventually do what she said, just at my own time and pace. I had to go through my own process in order to reach that same conclusion.
ReplyDeleteThat being said, what are some challenges of MI methods? Has anyone been trained in these methods? How would you use these methods in your current practice setting?
Excellent Work Felicia, Can anybody speak to rolling c the resistance
ReplyDeleteAs a clinician/Social Worker I love using MI when working with clients. I am very PIE and strengths-based focused in my clinical work and MI fits in very well with both of those theories. As Felicia pointed out it also fits in very well with the NASW Code of Ethics.
ReplyDeleteI have found that even though in its purest form MI does not including diagnostic work, it has still been an invaluable tool for me as I do not work with clients by thinking of them as their diagnosis. I may diagnosis or be aware of a diagnosis but it is not the crux of what my work with the client revolves around.
I worked at a mental health agency for 10 years and during that time supervised many BASW and MSW students in the practicum setting. One thing that I found important was when I assigned a student a client, the first thing I had them do VS read the clients chart was to meet the client and begin to build rapport with them. I was present at these initial meetings and modeled PIE and MI techniques to the students.
I had them do this with me prior to reading the client's chart in order to allow them to not think of the client as a diagnosis but to hopefully impart in them that the client was a person first and that their environment among other factors may have had an impact on the behaviors and choices that they made.
As a supervisor, I find myself utilizing MI techniques often with my staff. I challenge the staff to come up with their own answers (with guidance) on what the best approach may be with a client they are consulting with me on.
MI comes very naturally to me and I find myself utilizing it unintentionally with my children!
Great post Arika. Can anyone give me any concrete examples of some of the MI techniques that you use?
ReplyDeleteI like MI because it puts the patient at the center and allows them power in making their own choices. I think you bring up a good point, Felicia, with your example of the counselor who just told you what to do. I can get stubborn and do the opposite even when someone close to me tells me what to do, so it’s no wonder that clients we work with would feel the same way when their social worker tells them what to do rather than helping them work through it. I also like it because I certainly don’t have all the right answers, and MI helps the client figure out what is right for him or her, rather than expecting me to just give the magic solution.
ReplyDeleteI probably don’t use MI as much as I could be, and think I need to be more mindful about using these techniques. One specific use of MI that I do use is open-ended questions. I find it very helpful to get people talking and to make the visit feel more like a conversation rather than an interrogation. I also like the technique of having the client explore both sides of the choice they are considering. For example I had a teen girl come to me recently for a referral to therapy, but wasn’t quite sure that she even wanted to go. I asked her, “What would be good about going to therapy?” and “What do you think would be negative about therapy?” This helped me explore her fears (it turned out she was worried her parents could access her medical records), and ultimately helped her decide what to do.
I can see many uses of MI in my current practice setting. Some examples would be parents who are considering changes in their discipline strategies, teens who are using drugs or cutting school, overwhelmed kids trying to figure out what activities to cut out, etc. I don’t think it is necessarily useful in all situations for me, given that I also am involved in crisis intervention and concrete resource needs, but for some patients I can definitely work on using these techniques more often.
Just wanted to add a big thanks to Felicia for sharing her personal account with a Counselor. Her account gave a realistic picture of a Client's need to be heard during sessions and the importance for the Counsleor to acknowledge those needs. So often I have heard that Counselors are tenative with ambivalence and silence during sessions. I guess with Felicia's account we are reminded the importance of these two Client driven behaviors.
ReplyDelete