Remember the television show Columbo starring Peter Falk?
The fictional Columbo was a detective who solved murder mysteries – hugely popular in the 1970’s. Having recently used this analogy with a group of second year undergraduate students on the social work programme I teach on I realise that some of my cultural references may be a little dated! But I’m going to go with it!
Columbo was a humble and unassuming character who had the ability to get anyone to tell him anything, despite their initial resistance – very disarming. When someone said something to Columbo that was conflicting or inconsistent, he would rub his head and say, “I noticed yesterday you said one thing, and now you are saying something else. I’m confused.” He would say things like, “Could you clarify this?” or “Help me understand.” Columbo did not accuse those he was questioning but rather by taking the responsibility for his confusion, he disarmed the other person who then would slowly feel comfortable telling him the things he needed to know to solve the crime. The Columbo Method is to present the facts that appear to conflict, give the person the benefit of the doubt, and then ask questions for clarification.
Miller and Rollnick in their 1991 book “Motivational Interviewing: Preparing People to Change Addictive Behavior” badge this as ‘developing discrepancies’, showing people that what they said at one point doesn’t correlate with what they are saying now, or what they say they are going to do doesn’t fit with what they say they will do. It’s the gap between where the person has been, or is, and where they want to be. I am minded to talk about my dalliance into Slimming World but won’t because there is indeed a discrepancy between my ‘I must lose weight’ and ‘Oooo Pizza!’
Helping Clients develop discrepancy is “the active ingredient underlying motivational interviewing’s efficacy” say Miller and Rollnick, going on to state that “Motivational Interviewing is an effective, evidence – based approach to overcoming the ambivalence which stops people making desired changes in their lives”. The emphasis though – because of intrinsic motivation as a more effective method of motivation – is on personal choice and responsibility for the future.
Internal (or intrinsic) motivation is motivation that comes from within. Maybe things like ‘I want to feel healthy’, rather than, ‘I want to lose 2 stone’. The latter is an external marker, the former, an internal motivator. Intrinsic motivation is associated with greater long-term change. Research shows people with low internal motivation have worse outcomes and people with higher levels of both internal and external motivation have better outcomes. (Deci and Ryan, 1985, 1987, Curry et al 1991). So, ‘I want to lose 2 stone and I’m doing it because I want to feel healthy’, is perfect.
Motivational Interviewing was developed initially in response to working with client resistance in alcohol treatment in the late 1980’s but is now widely considered as been helpful in many areas where motivation to change is required. Most social work practice involves either supporting someone to consider change and initiate it, or supporting someone to readjust to a change thrust upon them, for example, an older person having a stroke or heart attack. It’s helpful as it can work in relatively ‘brief’ interventions and is a more helpful ‘stance’ in working with high levels of resistance in clients than a confrontational or coercive style.
Motivational interviewing builds on Carl Rogers’ optimistic and humanistic ideas that we all have the capacity to change and become the best version of ourselves – we just need to figure out how. It’s about people’s capabilities for exercising free choice and changing through a process that works towards self-actualization. Essentially, motivational interviewing activates the capability for beneficial change that everyone possesses. Once ‘activated’ some people can continue change on their own, while others require more formal treatment and support over the long journey of recovery or adjustment.
The therapeutic relationship for both Rogerian and motivational interviewers is a democratic partnership. Your goal in motivational interviewing is to elicit self-motivational statements and behavioural change from the client in addition to creating client ‘discrepancy’ (the Columbo Method) to enhance motivation for positive change.
The idea of developing discrepancies originated from cognitive dissonance theory which suggest that there can be an imbalance between the internal and the external values of the individual. This causes a person to feel unbalanced. So, where there is incongruence between what a person feels and does this can cause a dissonance, an imbalance, or a feeling of not being true to oneself. Cognitive dissonance can make people feel uneasy and uncomfortable, particularly if the disparity between their beliefs and behaviours involves something that is central to their sense of self. For example, behaving in ways that are not aligned with their personal values which may result in feelings of discomfort. That uncomfortable feeling can be used positively to initiate motivation and therefore change.
We can ‘develop’ discrepancies by pointing them out sensitively and in doing so you create a gap between where the person has been (or currently is) and where they want to be. The individual can come to a realisation that their current behaviour is not leading them towards their goals, and they become more motivated and open to change. The goal is to resolve that the discrepancy by changing. In doing this you can offer and explore the positives and negatives of change and so ‘roll with resistance’.
The emphasis is on intervention and change not the issue which could lead us to ponder is change sustainable if an underlying problem is not dealt with successfully. Worthy of some reflection and consideration of this idea in relation to the individual you are working with.
This ‘Motivational Interviewing’ approach
- Encourages positive engagement
- Acknowledges and works with client resistance
- Is collaborative, not collusive
- Is a blend of different therapeutic approaches, inc. Person-Centred, Solution-Focused and cognitive-behavioural ideas with a process model of change.
- It has a belief in the possibility of change
- Shows respect for individuals
- (Hopefully) achieves empowerment
What doesn’t work to motivate
It’s tempting to try to be helpful by persuading – you might want to draw the persons attention to the importance or urgency of the problem being addressed. Or maybe put to them the benefits of changing a behaviour. These strategies are likely to backfire because you are trying to motivate extrinsically – not intrinsically. It usually only increases client resistance and decreases the probability of change.
Miller and Rollnick suggest as practitioners we sometimes use our corrective lens. We want to ‘put the client right’. We want to change their behaviour, so we argue or push back. This often simply leads to an impasse with the client standing their ground based on all the reasons not to change.
Strategies to use
- Express empathy
- Be Non-judgmental
- Make sure that the client is being heard and understood.
- Develop discrepancy – Help the client see the difference between their core values and their behaviour.
- Define the most important goals.
- Support self-efficacy – The Client’s must believe in their ability to change. I have a view that our role as social workers is to eradicate the need for social workers. We should work with people in such a way that they eventually don’t need us anymore because they have developed the skills or understanding they need. This is reminiscent of the strengths based approach in social work practice. It can be good to focus on such skills and strengths and on past successes because this….