Collaboration is the key to developing a therapeutic relationship
in which the clinician helps the client move toward change.
Fundamental Approach of MI
Counseling involves a partnership that honors the client’s experience. The client-centered, experience-near position of the counselor facilitates change and draws upon the local knowledge of the client. Focus is on exploration and support.
The resources and motivation for change lie within the client and can be enhanced by focusing on the client’s perceptions, goals, and values.
The clinician affirms and supports the client’s right of self-determination and facilitates self-efficacy. Responsibility for change is the client’s.
Mirror Image Opposite Approach
Imposes a set of assumptions on the client about “reality” that may not be consistent with the client’s subjective experience. This approach is consistent with scientific determinism which states that there is one objective reality that the clinician, as expert, must be able to discern, then interpret for the client. Focus is on clinician interpretation and persuasion.
The expert knowledge of the clinician takes precedence over the local knowledge of the client. This approach is based on a deficit model and places the responsibility on the counselor to “enlighten” the client.
The clinician is the authority and directs the client toward “the right” choices and behaviors. Responsibility for change is the clinician’s.
Source: Miller & Rollnick, 2002
Please watch these two videos which demonstrate both the non-MI confrontational approach and the MI approach to a conversation with a consumer/patient about managing his asthma in a primary care setting. Pay particular attention to how the consumer/patient reacts to the two conversational styles.
1) Non-MI Confrontational Approach Video
Here is a 5-minute video demonstrating the mirror image opposite approach to Motivational Interviewing, in which the clinician confronts Sal about managing his asthma.
2) Fundamental MI Approach Video
Here is a 5-minute video demonstrating the fundamental approach to Motivational Interviewing, in which the clinician explores Sal’s understanding of what works for him to manage his asthma.