For those of you following along, we posted a brief article talking all about the basics of Motivational Interviewing (MI).

This week, we’re continuing our discussion on MI, with a new article focusing on the Goal and Processes of MI. We dig a little deeper into the goal of MI and how to get there. We cover the Stages of Change patients go through as they gradually shift perspective on changing a harmful behavior and the fundamental processes counselors often use to encourage this progress.

Read below to see how MI works from start to end.

In the last segment of this three-part article series, we introduced Motivational Interviewing (MI).

We’ve discussed the kind of “spirit” and environment that must be achieved before any techniques of MI can be used successfully. We’ll now look more closely at the goal of using MI and the MI processes that can be applied to guide conversations between counselors and patients to ultimately achieve behavioral change.

The Goal of MI

MI is a counselling method that focuses on enhancing a patient’s motivation to change a longstanding behavior for a better quality of life.¹

It’s common for patients to feel conflicted about making life changes, which can lead to delays in progress.² These conflicted feelings surrounding change can be referred to as ambivalence. The goal of MI is to acknowledge, explore, and, resolve feelings of ambivalence that often prevent change from happening.² With MI, feelings of ambivalence can be resolved by exploring a patient’s deepest motivations and values.²

Counselors practicing MI help their patients overcome ambivalence towards change by identifying their patient’s values and thinking patterns that determine their outlook on change.³ This information is then used by counselors to connect with and inspire patients to change their outlook and modify their behaviors.³

The approach used in MI to resolve feelings of ambivalence is heavily based on the phrase ‘ready, willing, and able’, which outlines the three critical components of motivation. These components are¹:

• Whether change is an immediate priority (readiness)

• The importance of change for the patient (willingness)

• The confidence to change (ability)

By using MI techniques, the counselor can provide the most effective motivational strategy to the patient’s current level of readiness to change, or “stage of change”.¹

The Stages of Change (SOC) Model for Resolving Ambivalence

The Stages of Change (SOC), first developed by James O. Prochaska and Carlo Di Clamente in 1977, is a behavior change model that describes readiness to change as a dynamic process in which the pros and cons of change create feelings of ambivalence.¹ The SOC model outlines the framework for understanding the slow process that patients must pass through as they work towards resolving their ambivalence and changing a behavior.¹

The stages are presented in five consecutive parts that describe the patient’s readiness for change¹:

Note that MI is particularly helpful when clients are in the Precontemplation and Contemplation stages, when readiness to change is low, but it can also be useful throughout the entire change cycle.²

Building off of Prochaska and DiClemente’s SOC model (which focuses on the internal processes most patients experience when working to resolve ambivalence) are the four fundamental processes of change. The SOC model is often worked through by using the four fundamental processes.

The Four Fundamental Processes of MI

The four fundamental processes of change focus on the working relationship and the collaborative processes that take place between the counselor and patient during discussions.⁴

MI has four fundamental processes used to describe the ideal “flow” of a conversation between a patient and counselor: Engaging, Focusing, Evoking, and Planning.

Although there is a common order in which these processes happen (indicated by the arrows in the chart) in some cases, the conversation between the counselor and patient may bounce back and forth between a few or all of these processes.²˒⁴˒⁵

This differs from the SOC model, which usually occurs in the order of the five stages.²

Review the respective descriptions of each of the four fundamental processes.⁵

Engaging

• Most foundational process

• Productive dialogue through careful listening

• Counselor understands and accurately reflects the patient’s perspective while bringing attention to their strengths and autonomy

Focusing

• Patient and counselor work to identify how conversations will be focused and guided towards change

Evoking

• Counselor explores and helps the patient identify their reason for change through facilitating and eliciting their motivations

• Involves normalizing and removing judgement from any ambivalence the patient may feel towards change

Planning

• Patient and counselor take a closer look at how change can be achieved

• Counselor may help to solidify the commitment to change, develop an individualized plan for change, and ensure the patient is ready to plan the steps towards change

Conclusion

The goal of MI is to resolve feelings of ambivalence towards changing a behavior. By using the four fundamental processes of MI, counselors can guide discussions with patients and use the SOC model to track their progress towards resolving ambivalence and achieving change.

In the next and final segment of this three-part article series, we’ll look at the counseling strategies used to resolve ambivalence once their SOC has been determined.

References

1. D. I. Lubman, K. Hall,T. Gibbie. Motivational interviewing techniques facilitating behavior change in the general practice setting. Australian Family Physician - The Royal Australian College of General Practitioners (RACGP). 2012;41(9).

2. Substance Abuse and Mental Health Services Administration. Chapter 3 - Motivational interviewing as a counseling style. In: Enhancing motivation for change in substance use disorder treatment. 2019.

3. UMass Amherst. Definition of motivational interviewing. Umass.edu webpage PDF. Updated Unknown. Accessed January 19, 2024.

4. Butler Center for Research. Motivational interviewing. Hazelden Betty Ford Foundation. Updated 2017. Accessed February 14, 2024.

5. Motivational Interviewing Network of Trainers. Understanding motivational interviewing. motivationalinterviewing.org. Updated 2021. Accessed January 19, 2024.