One of the aspects of Motivational Interviewing that makes it so powerful is the spirit. MI is not just the techniques such as open questions and reflecting. The spirit, or feel of it, is just as essential. Listening to or watching an MI session, you sense this spirit. The client does, too. I often hear something from those who have attended my trainings. After they return to practice, an ongoing client will say something like, “Oh, I liked that. This was a good session!” This is the result of the MI spirit shining through.
Treat people as if they are who they can be
and you help them to become
who they’re capable of being.
– Goethe
I believe the greatest gift I can conceive of having from anyone
is to be seen by them, heard by them,
to be understood and touched by them.
– Virginia Satir
When MI sessions are coded for fidelity to the process, the spirit is assessed as well as metrics such as the reflection/question ratio. The spirit is assessed in global ratings. The coder chooses a number to grade each of five elements of the MI spirit. The grade reflects an overall impression of the conversation.
In the next few Tips, we will take a closer look at the elements of the spirit of MI. Here is an overview.
Partnership: The session feels like a collaboration. There is power sharing rather than an expert/client imbalance of power. The client’s expertise on his life is accepted and evoked at least as much as the clinician offers advice.
Acceptance:
Absolute Worth: The clinician conveys a belief in the inherent worth of the person.
Accurate Empathy: The clinician strives to understand the client’s point of view. This includes working to understand deeper meanings that are not said explicitly.
Autonomy Support: The clinician accepts the client’s autonomy. The client experiences control and choice during the session and is encouraged to view the whole change process from the position of being in charge.
Affirmation: The client’s efforts and strengths are acknowledged. The clinician actively works to find and point out positive characteristics.
Compassion: The whole session is focused on what is best for the client. The clinician can be trusted to put the client’s needs before her own.
Evocation: The clinician works to evoke the client’s own reasons for change and ideas about how the change should happen. There is much more calling forth reasons and ideas from the client than offering of suggestions by the clinician.