Supporting Others Toward Change
Reprinted from "Recovery" issue of Visions Journal, 2013, 9 (1), pp. 29-31
As caring people, we take notice when others in our lives appear to be caught up in doing things that are harmful (like misusing drugs) or avoiding what helps us be well (like exercise). For example, a person challenged with depression is drinking large amounts of alcohol on a daily basis, and this is clearly having harmful effects on their mental health.
It is natural that this leads to concern, and it makes sense that we would encourage positive change. However, when workers and family raise their concerns about the drinking, this person gets angry at them. He or she argues that “it ain’t hurting anything, and it’s nobody’s business.”
This leads to a question: how can we best talk to, and engage with, a person who is caught up in something that is hurting her or him, but who appears not to be open to positive change? Motivational interviewing provides some helpful directions.
Motivational interviewing refers to the research, ideas and conversation skills developed by psychologists William R. Miller and Stephen Rollnick. These can be applied in helping relationships where a person is caught up in behaviour that is harming their health, but who appears to be unwilling, unable or not yet ready to make positive changes.
It should be emphasized that motivational interviewing was developed to guide helping professionals in being more effective. In many cases, it may not be realistic or even helpful for friends and family members to “take on” this approach. A key reason is that professionals have a duty to develop helping relationships dedicated to the needs of the person served. A professional should not hold any personal expectations of what needs to be listened to or understood by the person served. In families and friendships, however, there are shared needs. And in many families and close relationships, there is an understanding that the thoughts and feelings of each member deserve to be heard and respected.
With this caution in mind, motivational interviewing does provide some important ideas for anyone to consider when encouraging someone who seems reluctant to make a positive change.
Tips for the lay person
It can be freeing to let go of the idea of interviewing and instead think and act from the place of dialogue (two people talking). The notion of interviewing can be intimidating or lead to something more like interrogation: “I ask the questions; you give me the correct answers,” for example.
Further, letting go of the goal of motivating someone can help us be more effective. Often, the best way to motivate someone is to not try to motivate them.
There is strong research suggesting that, despite our best intentions, confronting or “lecturing” someone who expresses opposition to change, usually makes matters worse. Instead of motivating the person to change, it can lead to anger, fear and shame, and even make challenges, like depression or social isolation, worse.1 It’s not uncommon for the person to dig in their heels even deeper. For instance, someone with a heavy drinking problem may feel overwhelming emotional discomfort when confronted, and this leads to increased drinking to make it go away.
Instead, Miller and Rollnick encourage helpers to focus more on their own way of being as a person, rather than trying to outwit and outplay others with slick motivation techniques and tricks.
Some principles for ‘being with’
Motivational interviewing describes four key principles that are proven to effectively guide our way of being when encouraging people to make positive change. These principles are not magic wands that will snap people into change, but serve as a framework supporting engagement—that is, when a person is committed, within a helping relationship, to meaningful exploration, discovery and change. Some signs of engagement include openness to discussing different points of view rather than defending one’s own, following-through on attending appointments, or taking an active interest in developing and working towards agreed goals. In therapeutic relationships, engagement is when both therapist and client are walking together on a shared same path. Helping relationships based on healthy engagement can open a door towards improved well-being.
The first principle, partnership, emphasizes not taking on the responsibility of getting someone to change. Instead, we need to work with the person. We invite developing a way of walking together. For example, rather than saying “I need you to quit your drinking,” you might say “I need some help in better understanding what you’ve been dealing with…what life has been like for you lately…how alcohol fits in with what you’ve been feeling…please help me learn what this is about for you…”
This principle includes relating in a way that communicates to the person: “I am not here to judge or make you different … I recognize and appreciate who you are, and I will work at finding a way to be with you as you are.” Of course, this is often easier said than done. It requires patience and letting go of judgments before they become roadblocks to good engagement. But when we don’t maintain acceptance, the person may experience judgment, shame and mistrust, which can lead to things getting worse.
The third principle, compassion, is about who we are in the relationship. It means setting aside some of our needs—to be right, to be the expert, to reduce our own worry about the person’s behaviour, etc.—and giving priority to the needs of the person we are concerned about. Compassion flows from having our heart in the right place as we walk beside the person, dedicated to serving their cause. When we serve from a place of compassion, then trust and engagement can blossom.
The fourth principle, evocation, focuses on drawing out the wisdom, strengths, ideas and preferences of the person. Rather than making it about our voice, we work toward their voice. For instance, instead of saying “you need to stop drinking because it’s harming your life,” we might get curious and ask questions like “what parts of your life are working?” and “in what ways does alcohol support what matters most to you?” or “based on your experience, in what ways might alcohol give depression more power over people’s lives?”
This kind of engagement isn’t so much about you getting answers; it’s more about inviting the person to connect to their own truth and perspectives. It opens doors for the person to connect more fully with their own wisdom, which can lead to genuine lasting change.
Related ResourcesThe third edition of Motivational Interviewing, by William R. Miller and Stephen Rollnick, was released in 2013. It offers a detailed practice framework, case examples and new perspectives from those described in the second (2002) and first (1991) editions.
Taking care of yourself
No matter what our role, we are all human and maintaining this quality of patience and trust in the process of engagement is hard. For some, such as helpers and family who are closely involved, there rightly can be a lot of emotional energy around the concern (e.g., fear for the person’s safety). In such cases, it might not be possible to engage fully from the principles of partnership, acceptance, compassion and evocation.
Whatever our role, it’s important to work toward engagement with a sense of acceptance and patience with ourselves. “One step at a time” and “progress not perfection” approaches help support good engagement with someone who is having difficulty getting on the path of positive change. Using these approaches is an act of compassion towards ourselves.
About the authorMark is a Clinical Specialist with Fraser Health’s Mental Health and Substance Use Services. He is dedicated to supporting professionals, programs and services in developing compassionate and effective engagement with people who have mental health challenges and problem histories with alcohol and other drugs
- Miller, W.R. & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.), New York: Guilford Press.