Motivational Interview: Technology Changes For The Better - Self-development

2023 Author: Oswald Adamson | [email protected]. Last modified: 2023-05-21 20:18

A confused 35-year-old man is sitting in my office. He begins his story like this:

It seems to me that I have a problem … I'm a gambling addict. More precisely, I "got hooked on bets", I spend all my money in the bookmaker's office

- Can you clarify what “all your money” means? How often do you play? What are your bets? How much can you lose a day, a week, a month?

The man names the amount and specifies that within a week he can easily lower his entire salary for a month. After that, a frantic search for money begins: take a micro loan, borrow from colleagues, from friends …

- The amount of my debts is so great that it will not end well. I even began to sleep badly, so strong anxiety prevails. So I decided: it's time to "tie"!

- Are the amount of debt, anxiety and poor sleep the only reasons for your decision?

- No, not only. Most of all I am afraid that my wife will find out about my rates. I love her very much, but I have to lie to her all the time. If she finds out the truth, she can leave me. And I want to keep the relationship.

- Yes, this is a serious argument. But surely there are some reasons that lead to your betting? After all, why do you need it?

- I've already thought about it. It seems to me that in my life I do not have enough drive, passion, strong emotions. My work is boring, I get very tired. I don’t remember any more when there were some bright events. And when I play, I get distracted, forget about fatigue. Well, I hope that I will win - then I will give all the debts, I will buy some good present for my wife.

- It turns out that the main reason is the lack of strong positive emotions, bright events?

- Yes.

- Could it be that by getting rid of the betting game, you deprive yourself of positive experiences?

- Surely!

- Are you ready to stop playing anyway ?!

- I think yes.

“Okay, I like your determination. Where do you plan to start? What could be your first steps?

- Maybe I should try to find something that will distract me from the game? Well, are there any other ways to experience excitement?

- Great idea! What exactly do you want to try, what “other ways” might they be?

This is a fragment of the dialogue (as close as possible to the real one), which took place in the format of a "motivational interview".

Motivational interviewing is a psychotherapeutic technology developed in the early 1990s specifically for working with “difficult clients” (alcoholics, drug addicts, homeless people, juvenile delinquents, etc.)

Despite the diversity of psychotherapeutic schools and methods, up until the 1990s, practicing psychologists were dominated by the idea that those who did something “wrong” must be dealt with strictly and toughly. It was believed that only a directive approach, extrinsic motivation (carrot and stick) and control could help victims of bad habits.

Within the framework of the directive approach, the psychologist acted as an expert who explained to the client why his addiction was dangerous and why it was necessary to get rid of it. Extrinsic motivation was created through intimidation; after which it was necessary to strictly follow the recommendations of a specialist.

The implication was that the addicted person is absolutely helpless and unable to cope with his illness on his own. Therefore, he necessarily needs “wise but firm” external guidance.

Interestingly, in the middle of the same 1990s, the first scientific works began to appear evaluating the effectiveness of various psychotherapeutic techniques. One of the classic works on the topic was the book "The Psychology of Positive Change" by American psychologists James Prochazka and John Norcross. Two ideas from this book are especially important to us:

• a person cannot be forcibly changed from the outside, and all psychotherapeutic techniques only help those changes that a person decides for himself;
• there is a so-called "cycle of changes", at different stages of which a person needs appropriate psychological help and support.

The "cycle of change" consists of six stages:

1. Resistance to change. (“I’m fine and under control! Why should I change at all?” The problem is denied; the problem is downplayed.)
2. Reflections. (A problem is acknowledged, for example, "I spend too much money on bets, I have to do something about it!")
3. Preparation. (The person has concrete ideas about how to solve the problem. He plans the next steps to implement the change.)
4. Act. (At this stage, the actions planned in the third stage are performed. Regardless of a successful or unsuccessful result, the consequences are analyzed, plans are adjusted, etc.)
5. Saving changes. (Even if the problem is resolved as a whole, there are risks of breakdowns, “kickbacks.” Perhaps not the best alternatives to a bad habit have been found, or self-control requires too much effort. At this stage it is necessary to “optimize” the changes, make them convenient.)
6. Completion. (At this stage, the change is completely completed. The existing problem has lost its motivating force and has ceased to be something intrusive, beyond the control of the mind and will of the person himself.)

As a rule, people who are in the second stage of the "cycle of changes" turn to a psychologist, that is, those who admitted the existence of a problem and thought about how to solve it. The task of the psychologist is to help the client go through all the stages of the "cycle of change". It is important that a person goes through these stages himself.

The more independence the client has, the higher will be self-confidence (a sense of self-efficacy) and the more reliably the problem will be solved. The motivational interview is thus a psychotherapeutic tool that allows you to support and accompany positive changes, but at the same time leave the psychologist's client maximum independence.

To understand how this works, let's carefully read and analyze the dialogue given at the beginning of the note.

How is the conversation organized?

1. The psychologist does not try to "dig deep", interpret the words and actions of the client, and diagnose him. He accepts the formulation of the problem proposed by the client, which is understandable and convenient for him.
2. The psychologist asks clarifying questions that help understand the scope of the problem. This is a joint study of the problem, which must be carried out in a neutral, calm manner, without judgment or other emotional and ethical assessments.

3. The psychologist clarifies the client's decision to make positive changes (it is not always clearly formulated). It is very important here to learn about the reasons and motives for this decision. The technology is called "motivational interview" because the whole process of change is based on a person's internal motivation to solve a problem, become better, and make his life more prosperous and happy.

   The stronger and more obvious (for the person himself) the motives "to become better" are, there are more chances that he will go through the "cycle of changes" to the victorious end.

4. The motivational sphere of a person is contradictory. Even the most bad habits are expedient in their own way and are supported by certain internal motives. Therefore, it is extremely important to identify these counter-motives (also called "resistances") that will counteract positive change, and to consider how they can be neutralized.

5. The psychologist helps the client to brainstorm to come up with as many ideas as possible on how to start making positive changes. At the same time, the task of the psychologist is not to act as an expert and suggest the “correct” solutions, but to help the client to design and plan his own solutions as best as possible.

   Any ideas of the client on how he can get rid of the problem are accepted. But at the same time, the psychologist asks clarifying questions: "What will be your first step?", "When do you plan to take it?", "What resources may be needed for this?"
6. Next, the psychologist discusses with the client the results of his real actions aimed at solving the problem. Here, the psychologist's job is to provide emotional support and quality feedback. It is necessary to help the client calmly and objectively analyze failures and resistances, learn from them and, taking them into account, plan further steps to solve the problem.

Such dialogues correspond to the fourth and fifth stages of the "cycle of changes" ("Action" and "Saving changes"). They can be repeated exactly as many times as necessary to implement all planned actions and to consolidate positive changes.

From my work experience, I can say that almost all clients very quickly learn the very style of “motivational interview”, learn the main questions: “Why, why do I need this?”, “How can I do this?”, “When I plan the next steps ? "," What are the results of my actions? "," What lessons can I learn from them? "," What next action am I planning? " and so on. In fact, this is a model of self-improvement / self-development, which is quickly assimilated and which can then be applied independently.

Three important features of the "motivational interview"

1. Initially, this method was developed to work with “difficult clients” suffering from pathological addictions. But today "motivational interview" is successfully used to solve almost any psychological problem. For example, to solve difficulties and conflicts arising in close / family relationships.
2. A “motivational interview” will be successful only to the extent that the psychologist can step out of the role of “expert-expert” and begin to communicate with the client on an equal footing, in the role of a good friend.

3. "Motivational interview", like any psychotherapeutic technique, has its limitations. There are always people who do not trust themselves, have very low self-efficacy and automatically devalue any of their ideas / actions to solve the problem.

   They perceive the attempts of the psychologist to communicate with them on an equal footing as his weakness and incompetence. They need "wise but firm" outside guidance, fearing any form of independence. These people may be better served by other, more directive psychotherapy.

PS The term "motivational interview" is used not only in psychology, but also in personnel management. There, this method is used to identify work motivation, job satisfaction, clarify the prospects for the employee's professional development, draw up his motivational profile, etc.

The procedure may be a bit like a psychological "motivational interview", but the tasks are different: in personnel management it is diagnostics, and in psychology, it is the implementation of positive change.