Which of the following is the best definition of ambivalence from a motivational interviewing perspective?

Motivational Interviewing (MI) is often recommended as an evidence-based approach to behavior change. However, definitions of MI vary widely, including out of date and inaccurate understandings. This document provides a brief summary of what MI is, what is isn’t and where to go next if you are interested in learning more about this approach.

Inhaltsverzeichnis Show

What is Motivational Interviewing?
Core elements of Motivational Interviewing
Further questions
Good things
Less good things

What is Motivational Interviewing?

“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” (Miller & Rollnick, 2013, p. 29)

The most current version of MI is described in detail in Miller and Rollnick (2013) Motivational Interviewing: Helping people to change (3rd edition). Key qualities include:

MI is a guiding style of communication, that sits between following (good listening) and directing (giving information and advice).
MI is designed to empower people to change by drawing out their own meaning, importance and capacity for change.
MI is based on a respectful and curious way of being with people that facilitates the natural process of change and honors client autonomy.

It is important to note that MI requires the clinician to engage with the client as an equal partner and refrain from unsolicited advice, confronting, instructing, directing, or warning. It is not a way to “get people to change” or a set of techniques to impose on the conversation. MI takes time, practice and requires self-awareness and discipline from the clinician. (Miller & Rollnick, 2009)

While the principles and skills of MI are useful in a wide range of conversations, MI is particularly useful to help people examine their situation and options when any of the following are present:

Ambivalence is high and people are stuck in mixed feelings about change
Confidence is low and people doubt their abilities to change
Desire is low and people are uncertain about whether they want to make a change
Importance is low and the benefits of change and disadvantages of the current situation are unclear.

Core elements of Motivational Interviewing

MI is practiced with an underlying spirit or way of being with people:
- Partnership. MI is a collaborative process. The MI practitioner is an expert in helping people change; people are the experts of their own lives.
- Evocation. People have within themselves resources and skills needed for change. MI draws out the person’s priorities, values, and wisdom to explore reasons for change and support success.
- Acceptance. The MI practitioner takes a nonjudgmental stance, seeks to understand the person’s perspectives and experiences, expresses empathy, highlights strengths, and respects a person’s right to make informed choices about changing or not changing.
- Compassion. The MI practitioner actively promotes and prioritizes clients’ welfare and wellbeing in a selfless manner.
MI has core skills of OARS, attending to the language of change and the artful exchange of information:
- Open questions draw out and explore the person’s experiences, perspectives, and ideas. Evocative questions guide the client to reflect on how change may be meaningful or possible. Information is often offered within a structure of open questions (Elicit-Provide-Elicit) that first explores what the person already knows, then seeks permission to offer what the practitioner knows and then explores the person’s response.
- Affirmation of strengths, efforts, and past successes help to build the person’s hope and confidence in their ability to change.
- Reflections are based on careful listening and trying to understand what the person is saying, by repeating, rephrasing or offering a deeper guess about what the person is trying to communicate. This is a foundational skill of MI and how we express empathy.
- Summarizing ensures shared understanding and reinforces key points made by the client.
- Attending to the language of change identifies what is being said against change (sustain talk) and in favor of change (change talk) and, where appropriate, encouraging a movement away from sustain talk toward change talk.
- Exchange of information respects that both the clinician and client have expertise. Sharing information is considered a two way street and needs to be responsive to what the client is saying.
MI has four fundamental processes. These processes describe the “flow” of the conversation although we may move back and forth among processes as needed:
- Engaging: This is the foundation of MI. The goal is to establish a productive working relationship through careful listening to understand and accurately reflect the person’s experience and perspective while affirming strengths and supporting autonomy.
- Focusing: In this process an agenda is negotiated that draws on both the client and practitioner expertise to agree on a shared purpose, which gives the clinician permission to move into a directional conversation about change.
- Evoking: In this process the clinician gently explores and helps the person to build their own “why” of change through eliciting the client’s ideas and motivations. Ambivalence is normalized, explored without judgement and, as a result, may be resolved. This process requires skillful attention to the person’s talk about change.
- Planning: Planning explores the “how” of change where the MI practitioner supports the person to consolidate commitment to change and develop a plan based on the person’s own insights and expertise. This process is optional and may not be required, but if it is the timing and readiness of the client for planning is important.

MI is framed as a method of communication rather than an intervention, sometimes used on its own or combined with other treatment approaches. There are a number of benefits of learning MI amongst other approaches to helping conversations:

MI has been applied across a broad range of settings (e.g. health, corrections, human services, education), populations (e.g. age, ethnicity, religion, sexuality and gender identities), languages, treatment format (e.g. individual, group, telemedicine) and presenting concerns (e.g. health, fitness, nutrition, risky sex, treatment adherence, medication adherence, substance use, mental health, illegal behaviors, gambling, parenting).
MI compares well to other evidence-based approaches in formal research studies.
MI is compatible with the values of many disciplines and evidence-based approaches.
Although the full framework is a complex skill set that require time and practice, the principles of MI have intuitive or “common sense” appeal and core elements of MI can be readily applied in practice as the clinician learns the approach.
MI has observable practice behaviors that allow clinicians to receive clear and objective feedback from a trainer, consultant or supervisor.

Further questions

What are some ways MI could be helpful in your work?
What are some reasons you might want to learn more about MI?
What might be a next step or two? If you are interested in learning more about MI, you might consider reading the next document in the series: Learning Motivational Interviewing or the core text by Miller and Rollnick (2013).

References

Miller, W.R. & T.B. Moyers (2017) Motivational Interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), 757-766
Miller, W.R. & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd Edition). Guilford Press.
Miller & Rollnick (2017) Ten things MI is not Miller, W.R. & Rollnick, S. (2009) Ten things that MI is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.

During general introductions at Motivational Interviewing Training workshops it is not uncommon to hear participants at the start of the day say they want to learn “how to motivate” others. Generally, these “others” are individuals they are in a supportive or helping relationship with. As facilitators responding, it is important firstly to ask, “Is it possible to motivate another person?” and to recognize that motivation is neither present nor absent in an individual but is a constantly changing state or process within.

All people are motivated, but not always in the direction clinicians and helpers would like them to be. For example, some people are motivated to keep smoking (known as maintaining the status quo) and others are motivated to stop smoking and move towards behaviour change. Motivation is present in both examples, yet it is the direction of the motivation which is the important element as individuals usually feel both a push towards and a pull away from change (Miller & Rollnick, 2013 & Romano 2021).

The process of behaviour change involves resolving the push and pull of the change (Clark 2019, Miller, 2012). Becoming ambivalent is the first step in developing motivation to change. Motivational Interviewing (MI) offers an alternative response to ambivalence, as it recognizes that ambivalence is normal, and it defines readiness to change as a dynamic and not a static factor (Miller, 2012).

Motivational Interviewing helps people explore ambivalence – what keeps the person doing what they do and what might move them towards wanting to make a change. It is a shift from the pre-contemplative stage of change, e.g. a client wanting to smoke, towards contemplation of change, e.g. a client thinking of quitting smoking (Prochaska & DiClemente, 1984). What clinicians and helpers evoke from clients therefore are arguments for both wanting to keep smoking – described as ‘sustain talk’ and arguments or reasons to stop smoking- described as ‘change talk’ (Miller & Rollnick, 2013).

Motivational Interviewing conversations assist clients to articulate this sense of being ‘of two minds’ (AIPC, 2015) by verbalizing the pros and cons of the behaviour change (Everett, Salamonson, Zecchin, & Davidson, 2009). This can be achieved by exploring the Good things/Less good things.

Good things

What are the good things about…? (name the behaviour under review).What do you enjoy about…?

What would you miss about…?

Less good things

What about some of the less good things? What are some of the things you don’t like so much about…? (name the behaviour under review).How do you feel about…? (explore the specifics the client has named as less good).

What are the things you wouldn’t miss about…? (explore the specifics the client has named).

This video might help you in understanding and responding to ambivalence:

Veriti conducts regular Introduction to Motivational Interviewing workshops, as well as Advanced Motivational Interviewing workshops. Veriti can also provide in house training for your organisation. For more information, please contact us.

References

Australian Institute of Professional Counselling. AIPC (2015). Principles and techniques of motivational interviewing.
http://www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/ Viewed 5 March 2017.

Clark, Michael. “Motivational interviewing for deradicalization: Increasing the readiness to change.” Journal for Deradicalization 20 (2019): 47-74.

Everett, B., Salamonson, Y., Zecchin, R., & Davidson, P. M. (2009). Reframing the dilemma of poor attendance at cardiac rehabilitation: An exploration of ambivalence and the decisional balance. Journal of Clinical Nursing, 18, 1842-1849. doi: 10.1111/j.1365-2702.2008.02612.x

Miller, W. (2012). Motivational Interviewing: What It Is, How It Works, How To Learn It. A 2 Day workshop, 7 & 8 of November, Brisbane, Australia.

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford Press.

Prochaska, J.O., & DiClemente, C.C. (1984).The transtheoretical approach: crossing traditional boundaries of therapy.

Homeward, Il: Dow/Jones Irwin. Romano, M., Arambasic, J. & Peters, L. (2021) Motivational interviewing for social anxiety disorder: An examination of the technical hypothesis, Psychotherapy Research, 31:2, 224-235, DOI: 10.1080/10503307.2020.1751892