Motivational Interviewing gives priority to resolving ambivalence. In the MI approach, consumers are generally viewed as feeling highly ambivalent about changing. Miller and Rollnick (2002 & 2013) believe that resolving consumers’ ambivalence generally has been given less attention in traditional approaches than is optimal. They see most traditional treatment approaches as being too action-oriented, or at least too quick to press clients into focusing primarily on making changes in their lives. The concern about this is that consumers often have mixed feelings about making changes, and a provider who presses a consumer to make changes immediately risks a) evoking resistance, b) promoting premature termination from treatment, and c) encouraging consumers to overlook the internal and external factors that may promote a reoccurrence of the health risk behavior even following initial success in change attempts.
The consumer/provider relationship should be collaborative and friendly. The MI framework fits best with a view that consumer change is best enhanced through positive reinforcement. Through positive reinforcement, a consumer’s environment rewards him or her for trying new things, such as opening up to another person about his or her difficulties, or trying new behaviors that fit with the consumer’s long term goals rather than continuing behaviors that provide short-term gain at the cost of long-term loss, etc. Recognizing that a consumer’s fears and sense of comfort with current habits and surroundings create strong ambivalent feelings about change, the MI model contends that ambivalence must be fully addressed and truly resolved in order to achieve long-term success.
Resolving Ambivalence: Key Concepts From MI
- Ambivalence is something you feel two ways about
- Ambivalence is normal
- Expressing ambivalence can facilitate change
- Expressing empathy (acceptance) through reflective listening reduces ambivalence and facilitates change
- “Lack of motivation” is often ambivalence: Both sides are already within the person.
- If you argue for one side, an ambivalent person is likely to defend the other.
- As a person defends the status quo, the likelihood of change decreases.
- Resist the “righting reflex” — to take up the “good” side of the ambivalence.
Source: Miller & Rollnick, 2002
Motivational Interviewing is not about helping people change;
it is about helping people resolve ambivalence about change.
In order to help people resolve ambivalence we need to resist the “righting reflex” and refrain from jumping in to take up the side of the ambivalence in favor of what we think is the right direction for change. When the interviewer defends a position (as the clinician did in the confrontational approach to trying to help Sal) the consumer will defend his/her position of non-change and the two will end up in a battle of wills or the consumer will submit, but not make any changes.