Communication is a topic that spans every profession and enhances every relationship. Effective communication is imperative for expressing thoughts and opinions in a healthy way. In the healthcare profession, good communication can be a matter of life or death.
Motivational Interviewing is very well established and uses a series of foundational skills to accomplish favorable outcomes from counseling sessions. Since this method can be used in any profession it is a good topic for perinatal health professionals and advocates.
The concept of MI puts the burden for processing a solution on the counselee rather than the counselor. The counselor must master communication skills to guide and direct a client to a personal solution that is best for the current circumstance. MI abandons the idea that the counselor or therapist will assign a solution or dictate the answers, but rather allow the individual to come to conclusions and process information forming a specific, individualized plan. It is a method that encourages the individual to assess their own situation, determine their own goals, and form a plan to accomplish the desired change.
Motivational Interviewing is not a series of rules and processes used to reach a conclusion, but rather a way of having conversations and stellar interpersonal relationships. The spirit of MI focuses on three key elements: collaboration, listening and evoking the client’s ideas for change and stressing the importance of autonomy.
Motivational Interviewing goes against conventional therapy. It challenges the thought that if people understood the risks of a behavior they would cease the activity. Previous to MI, coercion and dictation was used to bring about change. Although that concept may sound promising and even practical, studies proved that individuals did not experience long-term change based on information shared or plans presented by a counselor. MI is more than a rigid set of rules to change behavior, it is a process that helps people understand their thought process, identify their emotional reaction to the problem, identify how thoughts and feelings interact to produce a pattern and challenge said behavior while offering an alternative behavior (Bundy, C., 2004).
Motivational Interviewing rests on eight components which are designed to provide motivation for change. These eight concepts include:
- Giving advice (about behaviors that need changing)
- Removing barriers (access to help)
- Providing choice (clients can choose whether or not to embrace change)
- Decreasing desirability (ambivalence towards change)
- Practicing empathy
- Provide feedback (from all contacts, not just therapists)
- Clarifying goals (or even the pathway to the goal)
- Actively helping (offering referrals, listening, advising) (Bundy, C., 2004).
The generations that are in childbearing ages can appreciate MI. Miller and Rollnick (1991), who explained the therapeutic process by describing eight steps to MI. The first step is to establish rapport. People need time to trust a provider and open up to a counselor. Maintaining a judgment free zone and practicing good listening skills will aid in the process. The second step is setting the agenda. A person using MI will set the agenda with the counselee and not for the counselee. This approach assures the client is thinking through the journey and establishing obtainable goals. The next step is to assess readiness for change. This step can be completed by simply asking the individual to state their willingness to change on a scale of 1 to 10.
Willingness and readiness are not synonymous. A counselor can learn a lot for the client’s response. Next, the MI process suggests sharpening the focus. If a topic is too broad, it will be difficult to form a plan and evaluate progress. The agenda should be isolated to one change at a time. Number five in the therapeutic process is identifying ambivalence. Patients may disagree or argue with the counselor. This does not mean collaboration will not be achieved, but rather show an understanding in allowable communication and compromise. Next, counselors should elicit self-motivating statements. A good communicator can help clients rephrase statements into positive affirmations. Number seven of the eight processes is handling resistance. When a counselor recognizes resistance, he must guide the counselee into an understanding that denying change or fighting conformation will retard progress. A counselor who is trained in recognizing this hurdle can address it easily and effectively. The final step is shifting the focus. A good counselor will help individuals stay on topic and focus on the major rather than the minor. Using time wisely is an important attribute in counseling.
Motivational Interviewing is a superior counseling technique because it asks the only person who can change their situation by constructing and individual plan and executing that plan. The MI principles share the concept that individuals must be motivated to change, that people have intrinsic motivations and ethics, counseling involves a relationship rather than a dictatorship and through empathic support and guidance real change can occur.
The philosophy of MI is heavily concentrated on the counsellor directing clients without personally assigning solutions or determining outcomes for the patients. As educators and advocates, this tool and skill can be used to bring about life-changing results where the autonomy of client’s is honored, respected and understood.
- Bundy, C. (2004). Journal of the Royal Society of Medicine. Changing behavior: using motivational interviewing techniques. PMCID 97 (Suppl 44): 43-47. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308798/
- Elliott, Stephanie, Risk Communication in Lactation Consulting (2018). University Honors Theses. Paper 647. Retrieved from https://doi.org/10.15760/honors.662
- Fyfe, Janice, et al. Improving communication and collaboration between lactation consultants and doctors for better breastfeeding outcomes. Clinical Lactation, vol. 7, no. 2, 2016, pp. 57–61, 10.1891/2158-07220.127.116.11. Retrieved from https://connect.springerpub.com/content/sgrcl/7/2/57?implicit-login=true
- Herman, K. C., Reinke, W. M., Frey, A., & Shepard, S. (2014). Motivational interviewing in schools : strategies for engaging parents, teachers, and students. Springer Publishing Company, LLC.
- Jones, A., Latchrford, G., Tober, G. (April, 2015). The British Psychological Society. Client experiences of motivational interviewing: An interpersonal process of recall study. Retrieved form https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/papt.12061
- Miller,W.R., Rollnick,S.(2009). Ten things that Motivational Interviewing is not. Behavioral and Cognitive Psychotherapy, 37, 129F140.
About the Author
Christy Jo brings over 20 years of teaching experience to the classroom. She has a passion for education and helping others reach their goals. Her informative, yet entertaining style makes learning enjoyable. Christy Jo has been awarded the United States Presidential Volunteer Award for her community service, the Phyllis Klaus Founder’s Award for her contribution to the Mother/Baby bond, the Above and Beyond Award for innovative projects that exemplify the mission of Public Health, and Lactation Educator Faculty of the Year from Childbirth and Postpartum Professionals Association.