Motivational Interviewing is not a phrase many people would have heard of, except you work in some form of health care role. Motivational interviewing or MI is an effective, evidence -based counselling approach applicable to a wide wide range of psychological, behavioral and physical health issues. For example a medical doctor might use it as an approach to support a person whom they feel should stop smoking or change their eating habits because they’ve been diagnosed with diabetes. How to do Motivational Interviewing by Bill Matulich is a short eBook which attempts to explain MI is plain language, that is easy to understand and in my opinion Matulich succeeds in doing just that.
MI is a psychological approach and so most people who write about it tend to use a lot of psychological speak which the common man like me can’t understand. I’m sure you are wondering what led me to this book in the first place.I work as a Learning and Development Advisor in an organisation that provides non-clinical support for people with learning disabilities and mental health support needs. Which means I am responsible for providing and sourcing learning and development interventions for staff who provide the non-clinical support. The organisation uses the recovery approach to provide support to people with mental health support needs and in order to use a specific recovery tool we felt it would help if staff understand MI as a way for to engage the people they support. Because of this I am constantly on a look out for material that can make training people to use MI techniques easier and when I saw this book and the good reviews it was given I purchased a copy on my Kindle.
The book is in it’s second edition and is divided into four sections. I have written a quick overview of each section below. I believe you don’t need to be interested in MI to read this book. It describes some key MI skills which can be used in almost any situation that requires interpersonal communication and I will outline some of the skills discussed below. The four sessions in the book correspond with the different parts of a typical MI session.
The first section is titled, Preparing for the session.
Prologue: Preparing for an MI session
- Preparing your attitude – before starting an MI session you must make sure you have the right attitude. This is ‘right attitude’ is called ‘Spirit’ in MI and according to Matulich, it is really an attitude of extreme respect for your client.
- Preparing your mind: – this is about developing the right mindset for an MI meeting. With an MI meeting a person wants to achieve four things with the client which are: not to tell the client the solution to their problems, understand the client’s own motivations and solutions, to be listen empathetically and and empower the client with the aim of encouraging them to be hopeful.
- Preparing your space: ensuring you have good space devoid of distractions for the MI meeting.
- The section ends with a short checklist summarising what was discussed.
Act 1: Openings and beginnings
This refers to the start of an MI session. MI is seen as a brief session, so engaging a person from the beginning of a session is very important. In this part of the book Matulich describes the core components of starting an MI session which are:
- Engaging the client by developing rapport and establishing an environment of trust.
- Setting the agenda for the meeting which really should be a client-centered agenda.
In this part of the book Matulich also discusses the main tools of MI used at the start of an MI session which he also says are the actual tools used throughout any MI session. These tools are: Open Questions, Affirmations, Reflections and Summaries. An acronym for remembering these skills is OARS. If not for anything else, the way Matulich explains these tools is enough reason to read the book. The OARS set of skills are useful in almost every interpersonal communication and Matulich does take the time to use easy to understand illustrations and examples to explain how OARS are used in an MI context.
Other areas covered in this section are how to assess a person’s motivation around working on a particular issue (which is the aim of MI). This assessment can be done using a scaling question. Here is a sample scaling question: On a scale of 0 to 10, where 0 is not important at all and 10 is crucially important, how important is it for you to make this change?. Scaling questions are used to assess both the importance of making a change and how confident a person feels making the change. The section ends with a summary checklist.
Act 2: The middle of the session
If Act 1 has been done properly then you will have a better understanding of your client’s motivation. Act 2 is the stage in MI where a client is engaged in conversation that may lead to change. This involve identifying ambivalence (uncertainty about whether to make the change or not), listening for change talk (talk that points to the possibility of change) and using the OARS skills in a more strategic way to understand the client better and if possible move them toward an autonomous decision to make a change. This section too ends with a summary checklist.
Act 3: Summary and key question
This is the concluding part of an MI session and the aim is to summarise all the change talk heard up to this point and then ask a key question. A key question can be something like: What is your next step? Where does this leave you? After the person answers it is time to negotiate a change plan which should be written in a SMART (goals written to be Specific, Measurable, Attainable, Realistic and Timely) format. After the change plan is written then you can ask for a commitment to change and then end the MI session by appreciating the person for their participation and telling them how confident you’re in their ability to make a change.
For a seemingly complex topic, Matulic makes it accessible with this short book to anybody who is interested in the topic. But even if MI is not your thing, you can learn a lot from the OARS set of skills. After reading the first part of the book I changed my focus from learning about the whole MI process to mastering the OARS skills and if you do decide to read the book, that might be a good idea for you too.