The 5 functions of the motivational interview

You may have heard of her, but... Do you really know what it is and what the functions of the motivational interview are?

It is a clinical method that, due to its name, can be confused with other concepts and approaches. For a few years we have been living in a "culture of positivism" where certain terms have been squeezed out of their meaning.

Motivation, improvement, willpower, resilience... seem to have become the panacea of ​​so-called gurus and coaches who preach about the power of individuals to change their environment, ignoring other factors that undoubtedly influence people's lives and over which, sometimes, we have no control. But actually, it has nothing to do with it.

Therefore, in this article, We explain to you what the true functions of the motivational interview are and how it is carried out.

• Related article: "Treatment of addictions: what does it consist of?"

What is the motivational interview

The motivational interview is a clinical method that was born in the 90s by the hand of psychologists William Miller and Steve Rollnick.

It is an eminently practical procedure, based on the interview with the patient as the main tool. Throughout the different interviews that the professional carries out with the patient, an attempt is made for him to identify, recognize and take charge of the problems that are interfering in his life and they are hindering you from achieving your life goals.

In psychology, the term motivation is used to refer to the impulse that motivates us to undertake certain actions. Hence the name "motivational interview".

It is not a structured and standardized method, but rather a specific form of communication, which seeks to mobilize the patient so that it is he himself who takes charge of his situation.

Another element that characterizes the motivational interview is that it assumes that not all people are ready or willing to change. The first step that the professional must carry out to adapt his strategies is to recognize in what stage of the change the patient is, relying on the transtheoretical theory of change.

• You may be interested in: "Types of motivation: the 8 motivational sources"

Main functions of the motivational interview

The main functions of the motivational interview are aimed at mobilize the patient to put in place all those resources available to him, becoming himself the engine of change. This method was developed to treat addictive behaviors, so it is commonly used in the treatment of:

• Eating disorder
• Obesity
• Alcoholism
• Smoking
• Dependence on other substances

As we mentioned earlier, it is not a structured method, so we would rather speak of cross-cutting principles that must underpin all interaction with the patient. The main ones are:

1. Express empathy

The relationship with the patient must always be marked by empathy. This implies an attitude of listening and acceptance, avoiding any type of judgment.

It should be noted that acceptance does not imply agreement or approval. We can understand another person and disagree with them.

• Related article: "Empathy, much more than putting yourself in someone else's shoes"

2. Create discrepancy

It is understood that the patient who comes to the consultation has some type of demand regarding some aspect or behavior that is creating discomfort. Therefore, when we talk about creating discrepancy, we mean enhance a discrepancy between the patient's current behavior (that which creates discomfort) with a more positive future objective.

It is about highlighting the differences between the current state in which we find ourselves and where we are. would like to arrive, in order to mobilize the patient to start the path towards the objectives raised.

A key element is that it is the patient himself who raises his own reasons for wanting to change. It is common for the environment to demand a change in the person, but it will not last long if it is not motivated by personal reasons.

3. Avoid arguments

To promote a positive attitude towards change and a good therapeutic relationship, direct discussions or confrontations should be avoided. The therapist should not try to convince the patient that he should change or that he has a problem, this should always start from the patient himself.

Direct discussions with the patient will provoke opposition and resistance, taking us away from the therapeutic goal. It is about guiding the patient so that he himself assumes what the problem is and how to change it.

• You may be interested in: "The Rapport: 5 keys to create an environment of trust"

4. Give resistance a spin

The motivational interview is not used to fight with the resistance to change that the patient maintains, but to turn them around, change the perspective and make it easier for the patient to begin to see the situation differently. The role of the therapist consists of generating doubt, reflection, introspection, questioning, new points of view ...

5. Promote self-efficacy

Self-efficacy is a psychological construct, used to name the perception that a person has about himself in terms of ability or skills to perform tasks successfully.

We often forget that, For a person to carry out a certain behavior, the first thing is that he thinks that he can carry it out successfully. If we think that something is beyond our reach, we will hardly direct efforts to achieve it. Therefore, it is essential that we work so that the patient trusts himself and his abilities.

• Related article: "The Self-Efficacy of Albert Bandura: Do you believe in yourself?"

Therapist skills

In order to successfully develop the functions of the motivational interview, there are certain therapeutic skills that will not help to create the desired communication style. These are the following.

1. Open questions

The use of open questions is key in the motivational interview. When we use open questions the patient must prepare an answer, which will provide us with much more information than if we simply limited ourselves to asking closed questions (those that are answered with yes / no or a specific data).

2. Affirmations

When in the context of the motivational interview we speak of affirmations, we refer to validating the patient. Use phrases that validate the patient's feelings, thoughts and sensations it will help you feel accepted and willing to collaborate.

3. Reflective listening

It consists of listening to the patient carefully and subsequently confirm if we have understood you correctly. This can be done through questions such as "if I understand you correctly, what worries you is ...".

4. Summary

Consists in return those most significant aspects of the patient's speech, after listening carefully. In this way we turn our attention to those points that we consider important for the therapeutic objective.

Differences with other therapeutic styles

As we can see, the functions of the motivational interview are not based on rigid or pre-established steps. It is about relating in a certain way, which we must always adapt to each patient.

It is evident that the motivational interview differs from other therapeutic techniques or models; some of those differences are as follows.

Confrontation-based approaches

We have already talked about how the motivational interview does not seek to confront patients, however this is not always the case in the world of psychology. From certain approaches, it has traditionally been understood that an important step in therapy was for the patient to recognize that he has a problem.

From this perspective, it is usual to give too much importance to the diagnosis and to present evidence of the problems, as well as to use discussions and corrections. In addition, the strategies to be followed are set by the therapist and the patient must adapt to them.

Instead, the motivational interview does not seek to label and identify the patient within a certain diagnosis. The important thing is that the patient finds the motivation for change without entering into fights or discussions, negotiating and agreeing on the strategies to follow.

Skills training approach

In psychology, and especially within the focus cognitive-behavioral, it is usual to influence the training of certain skills (social skills, for example). It is a directive approach, in which "the expert" (in this case, the psychologist or psychologist) teaches the patient how to do things the right way, and assumes that the patient is in the change.

Nevertheless, the motivational interview seeks to get the patient to commit to change and choose the strategies to carry it out. In addition, the different stages of change are taken into account, adapting the strategies used in each of them.

Non-directive approaches

Although the motivational interview shares certain aspects with non-directive approaches and has a patient-centered style, is more conductive than these. The therapist sets a goal (the change in addictive behavior, for example) and guides the patient towards it, even if the method used is indirect. Also, the therapist can offer advice and feedback.

Another difference is that, on certain occasions, the therapist focuses on creating discrepancy to generate some discomfort in the patient, that encourages you to take charge of change.