If you don’t know about motivational interviewing (MI) it is a therapeutic approach to help people break out of addictions or harmful/negative behaviors, or at least to help motivate people toward positive change in their lives. MI begins with a very cool and simple premise:
Do not try to save people or tell them the right thing to do. Why? Because they you steal all the good ideas for yourself, and leave them with only the opposite, reactive ideas to that. Instead, you want to subtly guide the conversation and reflect their motive-related statements back to them until THEY are the ones who make the change-talk.
What does this look like? Two examples, the bad one and the good one:
Bad example:
Patient: “I don’t wanna be here, the court just told me I need to be. Stupid police arrested me, I wasn’t even drunk anyway.”
Therapist: “You were over the legal limit, so you shouldn’t have been driving. Don’t you see how your life needs to change?”
Good example:
Patient: “I don’t wanna be here, the court just told me I need to be. Stupid police arrested me, I wasn’t even drunk anyway.”
Therapist: I hear that you don’t want to be here, I get it. Since you are here, what do you want to talk about?"
^ This second approach avoids confrontation and judgment, and instead reflects back to the person their own motivated statement “I don’t want to be here”. Any time there is “change talk” you want to key in on that and try to reflect it back, like a mirror. Change talk can be anything from “I want…” to “I wish…” or “I need…” or “I will…” or really anything that expresses a motivation. Motivations are key to focus on in order to get people to start using change talk on their own.
Battling ambivalence is another key concept of MI, but you do it indirectly by reflecting the person’s ambivalence back to them, then sit back and wait. See how they respond. For example:
Therapist: “I see what you’re saying, you don’t want to give up drinking because you like how it makes you feel. And on the other hand, you realize your drinking is causing some problems for your family.”
Just tell them what they already said, but reframe it to be direct. Make sure to always come from an interested, genuine and empathetic perspective. No sarcasm or judgment, and no disinterest. You need the other person to feel like you are really genuinely interested in listening to them and you really care.
The acronym “RULE” is helpful to remember the key ideas:
R = Resist the Righting Reflex. This means ignore the impulse to tell the person what they should do. Of course you know they should reduce their drinking, or stop drinking and driving, or quit smoking or using drugs or whatever it is. But don’t be the one to tell them that, let them be the first to say it.
U = Understand the person’s motivations. See things from their perspective, listen to the things they say that reveal motivations of any kind, like desires, wants, needs etc.
L = Listen. This is about active and empathetic listening. This is not easy and is really a skill that must be developed. Most people do not truly listen when other’s speak. To actively truly listen is to focus your entire attention on the words and meanings they are saying, analyzing and parsing these in real time in your mind while making it seem like that’s not what you’re doing. You need to remain casual, friendly and empathetic. It’s important to be able to do this deep active listening while still seeming natural and normal. Not some kind of robot or like you are treating the person as a test subject.
E = Empower. Remember to respect their autonomy, THEY are the expert on themselves and THEY are the only person who can make themselves change. You cannot make them stop doing drugs or whatever the issue is, they need to find the motivation in themselves. Find ways to remind them of their own self-empowerment. If the person says “fuck it, I hate it here, I’m going to smoke crack when I get back home and you can’t stop me” you don’t need to argue or debate, you can say something like “You’re right, I can’t stop you, you can definitely do that if you want.”
Which brings up another key point, called rolling with resistance. When the person presents resistance or anger, don’t deal with it head on. Avoid it, let it miss you. This can mean accepting whatever they say, like for instance the patient is angry and starts shouting “you asshole, you don’t even have kids you boring loser, how are you supposed to know how I feel about my family?” instead of getting mad or defending yourself you can accept the insult, say something like “You’re right, I don’t have a family, I guess I never found the time. Sometimes I really regret that.”
By rolling with resistance you can diffuse their resistance and anger. You avoid a power struggle and let the insult pass over you like water off of a duck. By accepting it you diffuse most of its power, and the person is left not sure what to say, or at least feeling a bit silly and more open to a change of topic. They expected you to get mad back at them, like how most people would react, but you didn’t. You stayed calm and validated what they said. Basic de-escalation skills are also really important for MI, you should already know how to de-escalate someone who is highly agitated or angry, including with your words, tone of voice and body language.
Hm, what else is there about MI to mention? It has been empirically verified. It has a pretty high success rate at helping people change negative behaviors or habits, assuming it is done correctly. The biggest predictors of success are 1) the empathy of the practitioner, which can be effectively measured more or less objectively through observation, and 2) the amount of change talk elicited by the person.
Once you get the person to start advocating for their own positive changes, you know you’re on the right track. For instance, “I know I need to cut back on smoking, it’s ruining our finances and my family hates it, but my job is so stressful that it’s so hard to quit.” ← this is a huge win because, even though the person maybe doesn’t realize it, they just argued for their own positive change. Their statement of ambivalence to change hides the real gem, which is their own desire to change.
Then you reflect that back to them, like “It sounds like you really want to find a way to quit smoking. How do you think that would improve your life?” Keep it simple, let them respond one way or another. One part of good MI is to use a lot of open-ended questions to elicit their response, and limit the number of times you simply tell them things. Add an open-ended question after your reflection, like the above.
You can get good with MI and use it in your personal life too. Just the skill of being able to actively listen to people and know how to avoid triggering them, how to help them see things on their own, is super useful in everyday life.
For more info you can look up Motivational Interviewing online. There are some books about it, specifically by two psychologists Miller and Rollnick who wrote the original book and who first discovered MI.