Module 7: What is Motivational Interviewing (MI)?

Introduction

Motivational Interviewing (MI) is a method used in psychology to help people resolve

TheirExamineBestThatCognitive ambivalence about changing their behavior. The purpose of this reflective essay is to

examine cognitive behavioral therapy, motivational interviewing, clients with addictions, and the

best techniques to help this population. Different steps can be taken to help a client understand

that the thoughts he holds dear may not be accurate; one of the most effective treatments is

cognitive behavioral therapy.

What is motivational interviewing (MI)?

MI is an evidence-based approach and an alternative model to direct persuasion for

promoting behavioral change. Rollnick developed it, and Miller developed it in the 1980s

to aid individuals in changing their behaviors. Therefore, according to Miller & Rollnick (2013),

MI refers to a person-centered directive approach to facilitating

inner motivation and commitment to change. Moreover, MI is goal-oriented,

collaborative, and designed to enhance intrinsic motivation and individual readiness

to change within a setting of compassion and acceptance. Also, social work

practitioners utilize MI with an underlying spirit of partnership, evocation,

acceptance, and compassion (Miller & Rollnick, 2013). Furthermore, MI utilizes skills and

techniques such as partnership, compassion, respect for human autonomy, reflective listening,

and affirmation to foster client relationships (Miller & Rollnick, 2013). Moreover, MI's

core skills, although other models, such as brief interventions, motivational enhancement

therapy and drinker's check-ups were derived from MI, and the main difference is MI's intensity,

time, and structure. Also, MI is a powerful tool for professional practitioners in

behavioral health in addressing prevalent issues such as anxiety, depression, diabetes,

obesity, alcohol and substance abuse, and smoking (Rollnick et al., 2022).

What is the righting reflex? What are two examples of the righting reflex?

The righting reflex is a concept of MI that involves the natural tendency of health

practitioners to fix issues or advise clients about the right path to good health.

The righting reflex is activated when people hear others talking about a way their

reality is different from their wishes (Miller & Rollnick, 2013). Thus, health

PromotingTo.InnerTouses.PractitionersRealityPractitionersBetterLearn tend to steer their clients toward what direction they believe will serve them

better and reduce further suffering and stress (Miller & Rollnick, 2013).

However, whereas good intentions of helping typically facilitate the righting reflex,

quick solutions may need to be more helpful to the client. Nonetheless, practitioners should

learn, practice, and apply ways of responding to client problems, aiding them to feel

understood and motivated them to talk openly about their concerns.

For instance, health practitioners attend to a diabetic patient who does not take their

medication as prescribed. The caregiver knows how risky such behavior (medication

non-compliance) is, and the adverse consequences that can result. Healthcare workers

They should manage their feelings about the client and help them develop a solution.

Moreover, a patient with an eating disorder who binges and purges

multiple times daily. Clients change when they are ready, which may or may not be

when or how we think they should. Caregivers should calm their emotions about the

client's behavior, avoid a righting reflex and emphasize change talk.

What is client discord, and how is it different from resistance?

Discord is described as the client's statements about the problem intervention

processes or relationship with the therapist, specifically how they perceive things unfolding

(Miller & Rollnick, 2013). It is a normal human response to pressure or challenges when

making behavioral changes in ambivalent individuals. Therefore, a "yes, but" statement clearly

indicates a client discord. MI designs patient discord as an interpersonal process that counters a

motivational statement, a therapist's authoritarian stance, or directive (Miller & Rollnick, 2013).

Moreover, according to Miller Rollnick (2013), a client may demonstrate discord at

any time in the four phases of MI (planning, evoking, focusing, and engaging). Thus,

an authoritarian practitioner who confronts his/her clients in a directive manner

increases the likelihood of discord among clients. Hence, counselors should

demonstrate reflective listening and offer adequate support to minimize the risk of

discord and increase the likelihood of motivation, commitment, and client talk about

behavioral change. Examples of client discord are ignoring, arguing, negating, and

interrupting. Therefore, care providers should manage client discord by demonstrating

mindfulness of cultural diversity, countertransference, experiences differences, spirit

of MI and clinical settings (Miller & Rollnick, 2013). Furthermore, resistance is often referred to

as client-generated discord. Miller and Rollnick (2013) define resistance as denial, lack of

insight, and motivation. Resistance is about the clinician and toward him/her. Clients can

demonstrate resistance through arguing, challenging, discounting, interrupting, negating,

blaming, unwillingness to change, and ignoring. Nonetheless, clinicians can avoid client

resistance through reflection, shifting focus away from what seems to be a barrier to progress,

Moreover, it emphasizes personal choice and control. Therefore, an interviewer or interviewee

can influence and generate discord in the interpersonal context. Also, resistance is the client

We generated and directed toward the clinician (Miller & Rollnick, 2013).

What is the spirit of MI? Briefly describe each domain.

A specific way of characterizing MI's spirit. Miller & Rollnick (2013)

describe four fundamental elements of MI. They include compassion, collaboration,

evocation, and acceptance. Also, the spirit of MI involves the process and the

outcome. The process goal is to have the client express concerns about their behavior

Moreover, give reasons for change. The outcome goal is to aid the client in resolving

ambivalence, strengthening commitment to change, and increasing personal

motivation. Thus, a lack of the spirit of MI may result in applying techniques for

coercion or manipulation (Rollnick & Miller, 2019).

(Rollnick & Miller, 2019) define a partnership as a collaboration between the client and

the therapist based on the client's experiences, values, and views. Collaborations build a rapport

Moreover, it establishes trust in the practitioner-client relationship. (Stinson Clark, 2017) states

therapists should honor clients' experiences, choices, and perspectives. Hence, the care provider

asks the client's open-ended questions and listens keenly to their point of view rather than

attempting to understand and influence them with their personal beliefs and values (Miller &

Rollnick, (2013). Furthermore, (Miller & Rollnick, 2013) describes acceptance as the absolute

The worth of the client and what they bring. Also, acceptance involves accurate empathy,

absolute worth, autonomy, and affirmation (The Spirit of Motivational Interviewing, 2021).

Accurate empathy is the practitioner's ability to understand the client's experiences and feelings

accurately and sensitively. Nevertheless, absolute worth entails respecting and upholding every

client's inherentpotential and value. Moreover, respecting client autonomy involves accepting

and confirming the patient's right to personal control, informed choice, and self-

determination. Affirmation involves the therapist accentuating the client's positives,

acknowledging and appreciating their efforts and strengths (Miller & Rollnick, 2013).

Also, compassion refers to the therapist's ability to promote the client's actively

welfare and prioritize client needs (Miller & Rollnick, 2013). The practitioner should

demonstrate deliberate commitment to pursue client welfare and interests. Also, they

understand an individual's experiences, values, and motivations without engaging in

implicit or explicit judgment. Furthermore, compassion is an understanding that every

individual strives towards a fulfilling life but sometimes encounters barriers invoking

feelings of sadness, shame, and pain. Thus, compassion is acceptance of one's choices

and path, and respecting the difficult emotions an individual can experience along the

way (Miller & Rollnick, 2013). Evocation involves identifying motivation and resources already

within the person (Miller & Rollnick, 2013). Also, it entails more listening than talking, and

eliciting behavioral change instead of installing change. Multiple studies indicate that

motivation and resources for change are intrinsic. Therefore, practitioners should

promote clients' inner motivation and commitment to change by drawing on their

goals, values, and perceptions. Moreover, therapists resist the righting reflex by

responding appropriately and focusing on invoking the client's inner motivation for

behavioral change.

What are the four processes of MI?

Miller Rollnick (2013) has described four MI processes. They are engaging,

focusing, evoking, and planning. These processes are not linear, but they describe the

conversation and engagement between the therapist and the client about behavioral

change. However, if the engagement is lost at any phase of MI, the therapist halts and

re-engages the client. The engaging phase is the foundation of MI, and it involves establishing a

positive client-practitioner relationship to explore and understand the client's concerns. The

practitioner should apply reflective listening to understand the individual's

experiences and perspectives while respecting their autonomy and complementing

their efforts and strengths. Therefore, this process includes establishing a comfortable

environment for the client to feel free and talk comfortably about their problems and

plans for change (Miller & Rollnick, 2013).

Miller & Rollnick (2013) state that the focusing stage involves establishing a clear

direction, target goal, and behavior to attain. In this process, the practitioner discusses an

agenda with the client that relies on the practitioner's and client's expertise to agree on a common

goal. Consequently, this process allows the therapist to initiate an open conversation about

behavioral change with the client. Also, the evoking process entails the practitioner gently

exploring and helping the client establish their reasons for change by eliciting their intrinsic

motivations and ideas. The clinician aids the client in resolving ambivalence without judgment.

This process requires that the practitioner pay careful attention to the client's talk on

behavioral change. Thus, the primary purpose of this phase is to elicit the client's inner

commitment and motivation for change, and enhance positive behavior to attain the

anticipated behavior (Miller & Rollnick, 2013). The planning process involves the MI therapist

supporting the client to develop an evidence-based plan grounded in the client's insights and

expertise. Also, the practitioner should ensure the plan meets the client's needs and targets within

a specified period. Nonetheless, it may not be required and is optional. Therefore,

formulating a specific plan of action involves setting goals, sorting available options,

developing plans, and establishing support (Miller & Rollnick, 2013).

What are reflections? What are two types of reflections?

Reflections refer to statements or responses that mirror, rephrase, or convey an

understanding of the client's thoughts, feelings, or motivations. They are essential

communication tools to demonstrate empathetic understanding, encourage self-exploration, and

facilitate a deeper understanding of the client's perspectives. Two types of reflections include

simple reflections, where the clinician mirrors the client's words or emotions, reaffirming their

expressed thoughts or feelings. For instance, if a client says, "I am worried about my health," a

simple reflection could be, "It sounds like your health is a concern for you." Complex reflections

involve a more profound exploration or rephrasing of the client's emotions or thoughts, adding

more complexity or depth to what was expressed. For example, if a client mentions feeling

frustrated with their progress, a complex reflection might be, "It seems like you are feeling

frustrated because you expected more progress by now." Both reflections aim to affirm the

client's experiences, encourage self-reflection and foster a trusting therapeutic relationship in MI

practice.

What are the core skills used in MI?

The acronym OARS is a brief way of remembering the core skills in MI. OARS are

client-centered guiding skills used to create the external space for the client to share their

thoughts, hopes, dreams, values, and experiences. The core communication skills in MI create

harmony in the relationship between a helper and a client, facilitating engagement (Westra &

Aviram, (2013).). Therefore, open-ended questions enable the patient to share more details with

the practitioner encourages engagement and gives room for more exploration. Also, open-ended

questions encourage the client to talk more, helping the clinician avoid premature judgments

Moreover, it keeps the conversation moving forward. Moreover, open-ended questions extend

Furthermore, it examines the client's values, ideas, perspectives, and experiences (Westera &

Aviram, (2013).). Consequently, open-ended questions gather broad descriptive details and

require a more extended response than simple yes/no answers or fill-in-the-blanks. These

questions often start with words such as "how....," "what...," or "tell me about..."

Miller Rollnick (2013) describes affirmations as appreciation and understanding statements.

Also, affirmations should be genuine and congruent because they build confidence in an

individual's ability to change. Affirmations recognize strengths and efforts, no matter how small

or large. Practitioners praisedesired behaviors and offer support to clients who describe difficult

experiences. Also, clinicians appreciate the client's strengths in coping with problems.

Thus, affirmations are essential in MI because they reinforce client talk and prevent client.

discouragement, build a healthy client-practitioner relationship, and support and promote self-

efficacy. Also, affirmations promote self-confidence and help practitioners acknowledge

difficulties the client experiences, facilitate change.Furthermore, reflective listening is another

the foundational skill of MI. Reflections arebased on careful listening and understanding of the

client's communication anddescription of their situation. Also, reflective listening is essential in

expressingempathy, hence predicting behavioral change. Moreover, reflections are not questions,

or statements. Practitioners should be mindful of their voice' intonation. Therefore,

reflections illustrate that the practitioner has accurately listened and understood the

client, strengthening the empathic relationship (Miller & Rollnick, 2013).

Miller Rollnick (2013) states that summarizing ensures clear communication.

between the client and the listener, shared understanding, and the reinforcement of

crucial points made by the speaker. Also, summaries illustrate that the listener has

been listening keenly and preparing the client to proceed to the next phase. Summaries

can be utilized at the beginning or end of a session and demonstrate a transition from

one stage to another. Practitioners summarize by selecting the details to be included or

omitted. They do not have to be comprehensive; the therapist can add more details.

to amplify the patient's ambivalent feelings.

What is change talk, and why is it important?

Change talk refers to the client's statements demonstrating their desire, motivation,

ability, and commitment to change and attain a particular target behavior. Clients can

make statements revealing enhanced consideration of change. In MI, practitioners

guide clients to demonstrate change talk. Multiple studies have reported a positive

correlation between client change talk and positive outcomes. Thus, frequent client

change talks increase the likelihood of changing. Examples of change talks are a

person verbalizing the limitations of a status quo, strengths of change, demonstrating

optimism, and intention to change (Miller & Rollnick, 2013).

Therefore, practitioners should respond to change talk by asking for elaboration from

the client, reflecting, hence eliciting further elaboration and exploration, summarizing

what the client has said and affirming the individual's plans for change. Moreover,

practitioners should enhance low confidence in clients by shifting focus, reframing

and aiding the client to see things differently, and emphasizing personal control and

choices (Miller & Rollnick, 2013). However, change talk is different from sustain talk

because it describes client statements expressing the ability, desire, and motivation to

change, whereas sustain talk involves client statements expressing resistance and

we are staying the same.

Conclusion

Motivational Interviewing (MI) through counseling method helps people resolve

ambivalent feelings and instability that are the internal motivation that need to change

behavior. Building the person's motivation for change: MI focuses on enhancing an individual's

will and want to change by examining and resolving ambivalence. The counselor helps the

individuals identify their reasons for change rather than imposing reasons. MI evokes

Change/reasons for change: The counselor uses specific techniques to evoke statements from the

An individual that expresses their desire, ability, reasons, and needs for change. These "change

Talk" statements are believed to predict actual behavior change.

This assignment aims to have students describe their understanding of Motivational Interviewing (MI) prior to using MI's core skills when facilitating conversations about change.

1. What is the righting reflex? What are two examples of the righting reflex?
2. What is client discord and how is it different from resistance?
3. What is the spirit of MI? Briefly describe each domain.
4. What are the four processes of MI?
5. What are reflections? What are two types of reflections?
6. What are the core skills used in MI?
7. What is change talk,elaborated and why is it important?

Define MI in your own words. Please include references to the spirit, core skills, and importance of change talk.

Succinctly describe the righting reflex and at least two examples of practitioner behaviors that may increase client discord

Succinctly describe client discord and how it is different from the term resistance.

Identified and elaborate on all four domains that comprise the spirit of MI.

Identify and describe all four processes.

Briefly describe what are reflections and why they are critical in MI. Also, identify two examples.

Briefly describe open-ended questions, affirmations, summaries, and exchanging information.

Briefly describe what change talk is and how it differs from sustain talk. Highlight its importance in MI.

reflections are

Please make any changes.

Thanks,

References:

Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping people to

Change (3rd Edition). Guilford Press.

Rollnick, S., Miller, W. R., & Butler, C. C. (2022). Motivational Interviewing in

Health Care, Second Edition: Helping Patients Change Behavior (Applications of

Motivational Interviewing) (Second ed.). The Guilford Press.

Rollnick, S., & Miller, W. R. (2019). What is Motivational Interviewing? The Spirit of

Motivational Interviewing.

Behavioral and Cognitive Psychotherapy,23, 325-334. Retrieved from

http://www.motivationalinterview.net/clinical/whatismi.html

Stinson, D, J., & Clark D, M. (2017). The Spirit of Motivational Interviewing.

In Motivational Interviewing with Offenders: Engagement, Rehabilitation, and

Reentry(Vol. 21, pp. 712-713). Guilford Publications. Retrieved from

https://ebookcentral.proquest.com/lib/portsmouth-ebooks/detail.action?

docID=4857669

Westra, H. A., & Aviram, A. (2013). Core skills in motivationalinterviewing.

Psychotherapy (Chicago, Ill.),50(3), 273-278.

https://doi.org/10.1037/a0032409

The Spirit of Motivational Interviewing (MI) and Change Conversations. (2021). The Homeless Hub. https://www.homelesshub.ca/blog/spirit-motivational-interviewing-mi-and-change-conversations

Our Affordable Therapy Services (2023). Kaizen Wellbeing.

https://www.kaizenwb.com/therapy-services

Salisbury, Allison. "Motivational Interviewing with Offenders: Engagement, Rehabilitation, andReentry." School Social Work Journal, vol. 44, no. 1, 2019, pp. 78-80.