Topic 2 The Principles, Processes and Spirit of Motivational Interviewing

The Spirit of Motivational Interviewing

Within Motivational Interviewing, the health professional is viewed as a facilitator rather than expert, who adopts a nonconfrontational approach to guide the child or his parents toward change. The overall spirit of Motivational Interviewing can be described as follows:

  • Collaboration
  • Evocation
  • Supporting child autonomy
  • Being caring
  • Nonjudgmental
  • child-centered
  • Active listening
  • Requiring a mindful act of will for most

What’s the difference between motivational interviewing and the typical authoritative/paternalistic therapeutic style

The Spirit of Motivational interviewing

Collaboration: a partnership between the child and practitioner is formed. Joint decision making occurs. The practitioner acknowledges the child’s expertise about themselves

Evocation: the practitioner activates the child’s own motivation for change by evoking their reasons for change. The practitioner connects health behavior change to the things the child cares about

Honoring a child’s autonomy: although the practitioner informs and advises their child, they acknowledge the child’s right and freedom not to change. ‘It’s up to you’

Authoritative or paternalistic therapeutic style

Confrontation: the practitioner assumes the child has an impaired perspective and consequently imposes the need for ‘insight’. The practitioner tries to persuade and coerce a child to change

Imposing ideas: the child is presumed to lack the insight, knowledge or skills required to change. The practitioner tells the child what to do

Authority: the practitioner instructs the child to make changes


These Photos in the background of the table by Unknown Authors have been licensed under CC BY and CC BY-NC-ND

The Principles of Motivational Interviewing

The 4 processes in Motivational Interviewing: the RULE

  • Miller and Rollnick have attempted to simplify the practice of Motivational Interviewing for health care settings by developing four guiding principles, represented by the acronym RULE:

The righting reflex describes the tendency of health professionals to advise children about the right path for good health. This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo. Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behavior. Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the child’s motivations for change.

It is the child’s own reasons for change, rather than the practitioner’s, that will ultimately result in behavior change. By approaching a child’s interests, concerns and values with curiosity and openly exploring the child’s motivations for change, the practitioner will begin to get a better understanding of the child’s motivations and potential barriers to change.

Effective listening skills are essential to understand what will motivate the child, as well as the pros and cons of their situation. A general rule-of-thumb in MI is that equal amounts of time in a consultation should be spent listening and talking.

Child outcomes improve when they are an active collaborator in their treatment. Empowering childs involves exploring their own ideas about how they can make changes to improve their health and drawing on the child’s personal knowledge about what has succeeded in the past. A truly collaborative therapeutic relationship is a powerful motivator. children benefit from this relationship the most when the practitioner also embodies hope that change is possible.

The 2 Phases of Motivational Interviewing in Practice