Applications of Reflective Listening and Motivational Interviewing

Introduction

People are either motivated to change their behaviors or they are not, it’s completely up to them. A person must be intrinsically motivated to change their behaviors, such as quitting smoking, increasing exercise, or that unhealthy relationship, and if they do not, then they were not adequately motivated. Motivating and assisting people to change their negative behaviors is a major challenge for many individuals. Growing evidence suggests that involving people in the decision-making process is fostering their sense of self-determination, self-responsibility, and ownership. These all play a positive effect in terms of their motivation, satisfaction, adherence to an intervention, and even health outcomes. Making these changes possible are the optimistic and humanistic theories invented by Carl Rogers about people’s capabilities for exercising free choice and changing through a process of self-actualization known as motivational interviewing. Reflective listening is a key elements or skills of motivational interviewing.

The Beginning of Motivational Interviewing 

Rogers articulated that there was three essential and adequate therapist characteristics for client improvement: congruence, unconditional positive regard and empathy (Rogers, 1957, p. 96). It is argued that listening to clients is helpful because listening embodies empathy and encourages problem-solving, for which there is limited support. In contrast however, Martell, Addis, and Jacobson (2001) wrote that we can’t make the mistake of thinking that empathic listening in sessions alone can produce substantial relief of change for the client. The definition of Motivational Interviewing has evolved over many years and Rollnick and Miller’s most recent definition (2009) is, a collaborative, person-centered form of guiding to elicit and strengthen motivation to change.”  Today Motivational Interviewing has gained more influence and is forging new inroads in primary care where every provider is responsible for coordinating continuum based care (Volland & Blockberger-Miller, 2015).

Motivational Interviewing Techniques

Motivational interviewing involves five basic techniques or core skills. They consist of open-ended questions, reflective listening, eliciting self-motivational statements, supportive and affirming statements, and summary statements. William Miller, the developer, stated that motivational interviewing was discovered by accident. Motivational interviewing works by allowing clients to develop a self-help plan which works for them to help them work through their issues. It is ‘a person-centered, goal-directive counselling method for resolving ambivalence and promoting positive change by eliciting and strengthening the person’s own motivation to change’ (Miller and Rollnick, 2002). Motivational interviewing is maneuvering and seeks to guide the client towards change. However, it also allows clients to make their own decisions about what they want to achieve and change.

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Motivational Interviewing is a complex technique and one best used by advanced practitioners who are already skilled in using the core skills in coaching such as, active listening, summary and basic reflection, and using open questions (Passmore, Anstiss & Ward, 2009). Motivational interviewing involves coaching and supportive development of collaborative patient-centered goals for enhanced selfcare management. The theoretical underpinnings of Motivational interviewing cognitive dissonance theory, self-perception theory, and self-efficacy theory (N. H. Miller, 2010). In this sense Motivational Interviewing is well suited as a skill for coaching psychologists who already attract behavioral, cognitive behavioral and humanistic interventions within their coaching practice. It is, however, different from each of these approaches, while drawing on elements from all three (Anstiss & Passmore.) The goals of motivational interviewing are to create rapport, elicit change of behavior talk, such as statements indicating desire or the ability to change behaviors, and establish commitment language from the individual (Miller & Rollnick, 1991). This communication technique between the patient and the provider supports individual autonomy and seeks to enhance treatment adherence (Rollnick, Miller, & Butler, 2007). With the relationship of the client and helping professional at the core of a motivational interviewing approach, once trust is established, there is scope to explore more options. For example, accepting the patient’s decision not to treat one problem with compression may result in poor outcomes initially, but if trust has been established, this can allow opportunity for the patient to re-evaluate and reach a different decision.

Reflective Listening and Change

This is the common style of listening, or level one, that is used in our everyday conversations with others and is unhelpful even in basic coaching. In order to be successful with this coaching psychologists or counselors need to be aiming to listen at a level three or four and occasionally working at an informational level and share their findings with their client colleagues. Listening means to just keep quiet and wait for our turn to speak. Roadblocks for the speaker may be created due to the listener only listening at a level one or level two and may cause the movement forward to stop. Responses of reassuring cautioning or labelling, agreeing, or even asking a question are an example of such roadblocks. Professionals that may be stuck and seeking a way to move forward remain ambivalent about making changes and an intervention is possible to maintain growth. Using affirmative statements (sounds really bad), as well as questions that explore further detail the nature of the behaviors that created the feeling. Trying different approaches, the motivational interviewing coach will try leverage change through the building of change talk and in turn helps the coachee or client become unstuck. Change talk is basically simple statements from the counselor or coach, that focus on the desires or plans to help assist in the change in the behavior. If the coach is trying to avoid these roadblocks, motivational interviewing suggests that using a variety of reflection techniques. This stage is more likely the most effective approach to develop change talk.

 Roadblocks will spontaneously emerge during the course of the session without coach direction. Such responses provide the opportunity to ‘go with the flow’ while trying to develop more change talk by asking the coachee to elaborate. Reflecting back what has been heard by making affirmative statements is a very useful intervention from the counselor. Statements from the coach/counselor that focus on desires or plans for making a change in behavior is basically what is referred to as change talk.

 Motivational interviewing originally was developed to treat alcohol use disorders and has been extensively studied. First studies in the lives of adults and more recently in the lives of adolescents. Motivational interviewing has been used for marijuana use and dependence as well as for addictions to heroin, cocaine, and other drugs. Extensions of the early work on substance abuse led to trials of motivational interviewing with other kinds of behavior that are viewed as having an addictive or habitual element, including smoking and obesity. Other situations not characterized by compulsive behavior in which motivational interviewing has been tested are adherence to antiretroviral treatment, nutritional adherence, diabetes and other long-term medical care and avoidance of dental care in older adolescents, evidently have become a significant problem.

Discussion

Reflection is much like that of coaching, is not a submissive process. The coach decides on who or what to reflect on and what aspects are choosen to disregard. In this way the coach can direct the attention of the coachee/client and encourage them to focus on just the aspects which may help them to reframe the situation and to build a motivation for action. This is what makes those motivated to change to do so for the betterment of themselves. With motivational interviewing we have to have reflective listening as part of the solution to achieve change therefore, making reflective listening a key element in motivational interviewing.

References

• Blohowiak, D. (2008). Stop Saying, “What I Hear You Saying is…!” Information Executive, 11(3), 19. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=buh&AN=32035391&site=ehost-live
• Flaherty, L. T. (2007). What’s old is new: Motivational interviewing for adolescents. Adolescent Psychiatry, 30, 117–127. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=aph&AN=32967485&site=ehost-live
• Martell, Addis, and Jacobson (2001)
• Miller, N. H. (2010). Motivational interviewing as a prelude to coaching in healthcare settings. Journal of Cardiovascular Nursing, 25(3), 247-251.
• Passmore, J. (2012). MI techniques: The Typical Day. Coaching Psychologist, 8(1), 50–51. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=pbh&AN=74990451&site=ehost-live
• Passmore, J. (2013). MI techniques: Agenda Mapping. Coaching Psychologist, 9(1), 32–35. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=pbh&AN=91345568&site=ehost-live
• Passmore, J. (2011). Motivational Interviewing techniques reflective listening. Coaching Psychologist, 7(1), 50–53. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=pbh&AN=61480785&site=ehost-live
• Rautalinko, E. (2013). Reflective listening and open-ended questions in counselling: Preferences moderated by social skills and cognitive ability. Counselling & Psychotherapy Research, 13(1), 24–31. https://doi-org.cccneb.idm.oclc.org/10.1080/14733145.2012.687387
• Passmore, J. (2011). Motivational Interviewing techniques reflective listening. Coaching Psychologist, 7(1), 50–53. Retrieved from http://search.ebscohost.com.cccneb.idm.oclc.org/login.aspx?direct=true&db=buh&AN=61480785&site=ehost-live
• (Volland & Blockberger-Miller, 2015