The thinking behind motivational interviewing

Empathy, compassion and collaboration are key for motivational interviewing practitioners

By Ruth Hardy on August 29, 2018 in Workforce

This article comprises of excerpts taken from a guide on Community Care Inform about motivational interviewing. The guide is written by Karen Evans, a motivational interviewing counsellor, trainer and supervisor. Subscribers can read the full guide on Inform Adults and Inform Children.

The motivational interviewing practitioner is not the expert in the room; on the contrary, the client is. The practitioner believes in the client’s capacity to change, they look for strengths in the individual and help them explore their own solutions to their behavioural issues. The approach is collaborative and the practitioner seeks to empower the client. The practitioner is not coercive in their communicating, but compassionate and empathic.

Empathy is key. The practitioner really listens to the service user’s experiences and feelings. Empathic listening is less likely to be effective if the practitioner:

has a cluttered mind;
has physical or emotional distractions;
has environmental distractions;
is wearing an expert hat;
is mentally preparing their response;
is fitting the service user’s statements into preconceived ideas;
is making assumptions;
is interpreting and analysing;
is judging; or
is fixing it and finding solutions.

Empathic listening requires the practitioner to listen to the service user and provide a valuable sounding board in the dialogue. Reflective statements are initially superficial and focus on the facts of the story; as the rapport develops, reflections deepen and focus on emotion. It is important that reflections are statements and not questions; therefore the practitioner should not inflect their tone at the end of the statement.

Empathy can convey compassion toward the service user. It is a skill which exists in many therapeutic approaches, but motivational interviewing tunes into specific types of dialogue during empathic listening. These are sustain talk and change talk.

Sustain talk are all the things that are said that keep a person stuck in their behaviour. They are statements which often focus on the function of the behaviour, the enjoyment of the behaviour and the positives associated with it. These statements are more likely to result in the individual maintaining the behaviour.

Change talk are all the statements that are made that might lead the individual to consider behaviour change. These statements are often about the harmful consequences of the behaviour and the problems associated with it, and the statements are more likely to result in the individual moving towards change. The motivational interviewing practitioner listens carefully and tunes into any change talk that is presented in the dialogue. The sustain talk is not ignored, but reflections are more weighted towards the change talk than the sustain talk.

The belief that everyone can change their behaviour sounds like an obvious one, but the reality may look quite different in the social work profession. While many people and families change on their own, families can have cyclical patterns of behaviour and social workers may work with numerous individuals from the same family. Furthermore, given the difficulties in maintaining behaviour change, social workers will also work with service users who repeatedly return to previous patterns of behaviour.

Additionally, social work teams can develop cynical cultures, and allocations at team meetings can include judgments on service users with prevailing attitudes like “they will never change”. Given these factors, it can be challenging for social workers to remain buoyant and optimistic about change.

Motivational interviewing is not a tool box of techniques; it is a way of being with service users. It is crucial that practitioners maintain a positive belief about their service users’ potential and that they convey this belief in all their interactions. It is not sufficient to pretend that we believe in people while we have in fact written them off. This facade leaks and people sense the truth.

Further reading