When involved with an individual who is struggling to cope with a personal challenge or problem behavior, a helpful technique may be Motivational Interviewing (MI). MI is a specific approach to helping others create a change in their thinking or behavior. Important considerations in the MI approach are that change is internally directed by the person, and not a result of influence or encouragement by the helper. Further, the underlying desire to change starts with the person facing the challenge. Another goal is to recognize the person’s ambivalence or resistance to changing and to accept it without judgement. Eventually, the person herself will express the reasons and benefits of the desired change and argue for the change.
The stages do not always occur in the same order, and some may not occur at all. When possible, however, it is important to remember the highlights of Motivational Interviewing and to raise them during the behavior change process. There are five stages to MI:
- The initial stage is to assess what the person’s beliefs are about the challenges he or she is facing. For example, the person wants to avoid others because she thinks she is disliked by neighbors in the senior community. Inquire about her attitude about changing the problem, not how it happened or why it occurs. Assess three items – R-I-C: (i) is the person ready to change, and rate on a scale of 1 to 10; (ii) then rate on a scale from 1 to 10 how important the change is; (iii) the third rating is how confident she is in making any changes in her actions, on a scale from 1 to 10. These ratings will vary but serve as a good measure of how strong the beliefs are and how resistant to change the person is. Insights about the likelihood of changing come from two follow-up questions to their 1 to 10 ratings. By asking what it would take to get a higher rating on the R-I-C items, the answer tells what the perceived barriers are. When asking why the ratings are not lower, the response suggests the amount of progress or success made so far, as perceived by the person.
- Stage two involves providing some education about the benefits of the change. And asking how new coping skills will help the person. It is important not to encourage change. It is important that the person believes you understand her beliefs or attitudes, and her underlying attitudes about the change.
- The third stage promotes confidence and goal setting. Recognize any resistance and ambivalence to change that are present. Take time to answer questions about any of the R-I-C factors – readiness, importance, and confidence. It may help to gently point out discrepancies that the person voices about a desire to change and the behaviors.
- Stage four provides some tips or suggestions on what new behaviors to try and what other approaches she may want to test. You may also ask for recommendations on who else may be able to help when trying something new. In a sense this is like giving a homework assignment and seeing if and how she completes it.
- Stage five emphasizes progress made when trying out the new behaviors. It also involves highlighting the benefits of the progress that has been made. It also helps to reinforce the new behaviors and recognize the motivation and determination she has shown in the process.
Motivational Interviewing is an effective, evidence-based approach to behavior change.
