A key aim of MI is to shift the client from a mind-set dominated by staying the same to a mind-set dominated by desire for, and confidence in the ability to, change. But the shift has to come about from inside the client rather than being driven from outside. MI cannot manufacture change, it can only tap into a desire that is already present (Miller & Rollnick, 2009). When MI is done well, it is the client rather than the counsellor who voices the arguments for change (Miller & Moyers, 2006; p7).
In practical terms the task of the practitioner is to evoke the client’s own arguments for change, without crossing the line into suggesting that they should change. Avoid making any direct suggestion that the client should change anything.
The key strategy for tapping into the desire for change is to explore the client’s own views and experiences, searching out the signs or indicators of desire for, and confidence about, change, and reinforcing and elaborating these signs.
Language is central. MI uses the idea of ‘change-talk’ to refer to the signs and indicators of change, in contrast to ‘sustain-talk’ which contains the indicators of staying the same.
Recognising, evoking and reinforcing the client’s change-talk are core skills in MI.
Change-talk is any client speech that favours movement in the direction of change (Miller & Rollnick, 2010). It includes statements of:
- desire to change (e.g. sentences that begin with ‘I want’, ‘I wish’, and ‘I would like’),
- ability to change (e.g. ‘I think I could do that, but I’m not sure I am ready yet’),
- reasons to change (e.g. ‘If I do this, then I will be able to do that …’)
- need to change (e.g. ‘I need to do this for my health’, ‘I have to do this or it will end badly’).
At later stages, change-talk may also include statements about commitment to change.
The role of the practitioner is to be highly alert to signs of change-talk and to use active listening or OARS techniques (especially reflections and affirmations) to reinforce and increase the expression of positive statements about change. Open-ended questions are used to encourage (Naar-King & Suarez, 2011; p49-52).
Change-talk can easily be obscured by statements of previous efforts that were not successful (e.g. ‘I tried to talk to my boyfriend about condoms but he didn’t want to hear’). This statement indicates that motivation to change is present (Naar-King & Suarez, 2011; p49). Be alert to such double-barrelled statements and draw attention to the change-talk with reflections, affirmations, and open-ended questions.
When it is difficult to detect any spontaneous change-talk, a variety of conversational techniques, particularly using open-ended questions, can be used to try and uncover it.
Exploring values and hopes for the future;
Exploring strengths and assets;
Encouraging the client to talk about previous change efforts, both positive and negative;
Eliciting their understanding of the factors that promote successful change for them personally;
Eliciting their views of the factors that get in the way of successful change;
Exploring the meaning and influence of these understandings in the current context;
Eliciting the clients’ views about if and how they might want to make changes now.
More generally, the philosophy of this Practice Element, as with all of MI, is to maintain awareness of the client’s own change process and to be responsive to this process.
Ensure that clients who have experienced significant trauma are safe when evoking and elaborating on their own reasons for change.