A couple of years ago while I was working at a community mental health center, I was called in to the local hospital’s emergency room to do a screening for a state hospital admission.  The person I was to screen had been making serious suicidal statements and steadfastly refused to go to the hospital voluntarily.  As I walked into the ER the physician on duty told me that the individual would have to be involuntarily committed to Osawatomie State Hospital.

As it happened, I had just gone through training on Motivational Interviewing, and I said to myself, “Aha!  Here’s my chance to practice my new skills!”   The purpose of Motivational Interviewing is to help clients clarify ambivalence around a behavior change and to enhance his or her willingness to engage in a new, adaptive behavior.  In this case, the desired behaviors, from my perspective as a screener, were going to the hospital and staying alive.

As I talked with the client I used the Motivational Interviewing reflection skills.  Instead of arguing with him or telling him what he should be doing (which is what his family and the ER doctor had been doing), I spent the first part of the clinical interview finding out why he was suicidal and simply reflecting back what he said as well as validating his feelings.  I think, to his surprise, I did not sound like I was trying to change him, but to understand him.  As I listened and reflected what he was saying his resistance began to go down, and, when I asked him, to think about reasons why he might want to live.  As I reflected back to him his ambivalence, it freed him to start leaning in the direction of going to the hospital.  By the end of the interview he was willing to engage in treatment.

Motivational Interviewing is one of the central skill sets in the Integrated Dual Diagnosis Treatment model.  It also is a component in the Supported Employment protocol.  It can be useful around any issue in which an individual is stuck in some kind of unhelpful behavior pattern.  The goal is to create a space through skillful conversation in which the individual is able to articulate ambivalence around that behavioral problem and then to elicit and build up his or her own motivation to make a change.

The assumption on which this approach rests is the idea that, even when people are really stuck in a problematic behavior, there is very likely to be an unstated ambivalence around it, some unarticulated motivation to make the desired change that even they may be unaware of.  This is a key understanding when working with people who have long-standing patterns of behavior that may be decreasing the quality of their lives.  Somewhere within them there is probably motivation to change, but it may be well hidden and temporarily unavailable.

Those who have worked with individuals with psychiatric disabilities often find themselves frustrated because of what seems to be slow movement and low levels of motivation.  Motivational Interviewing helps the clinician to think about the client’s problem in a very different way, and to approach it with a set of skills that have been shown to be very effective precisely when people are stuck.  This approach can decrease the hopelessness that clinicians get into, and may well help the client to begin thinking about the problem situation in a different way.

These skills reflect a profound respect for the client.  We are not trying to tell the individual what to do and how to do it, but rather to discover what his or her own motivation is.  My experience in using Motivational Interviewing skills was that it decreased my own level of stress enormously and helped the client to do more of what they believed was in their best interest.