As peer support specialists, we are always on the lookout for new ways to enhance our skills. With the ocean of knowledge out there, you may be wondering where to start. One approach that has shown significant benefits is Motivational Interviewing or MI for short.
This person-centered approach is designed to promote change by helping individuals explore and resolve their ambivalence.
Personally, this is one of my favorites. Not only does it bring huge benefits to the support process, but it’s also just kind of fun!
But what makes MI so effective in the peer support process? Moreover, what makes it fun?
Well, that’s what we are about to get into. We will take a look at some of the major benefits of this approach, as well as provide some actionable strategies. If you are looking to step up your peer support skills, trust me, MI is the right choice.
Table of Contents
What is Motivational Interviewing?
Lets start with a little background.
MI actually got its start in the early 1980’s in the field of addiction treatment. It combines different evidence-based approaches from cognitive and social psychology.
In MI, the idea is that people are ambivalent when it comes to changing problematic behaviors. It also acknowledges that there are different levels of readiness when it comes to change.
In MI, the idea is that people aren’t completely against change. Rather, that they are ambivalent when it comes to changing those problematic behaviors. It also acknowledges that there are different levels of readiness when it comes to change.
The overall goal of this approach is to work with the individual to help them develop motivation and move away from ambivalence.
The Power Of Choice
Think about the last time someone told you that you needed to do something. Even if it was something you knew you probably should do, you still might have felt some resistance.
It doesn’t feel good being forced into something.
This is exactly where MI comes into play. Rather than telling a person what he or she should do, the approach guides the individual into making these decisions on their own.
This is done through reflective listening and asking open-ended and thought provoking questions.
The Spirit of Motivational Interviewing
The fundamental spirit of MI is to encourage a trusting relationship and work together. In fact, it emphasizes a partnership-like approach. In other words, there is no superior role or authority figure in the conversation.
To make this possible, there needs to be an atmosphere of empathy and acceptance. This is what sets the tone for self disclosure and helps facilitate change.
Luckily for us as peer support specialists, this is where we really shine.
We understand that we are not above or different from the individuals we support. Not to mention that acceptance and empathy are the foundation of our work!
Why Use Motivational Interviewing?
Motivational Interviewing has been widely recognized for its effectiveness in facilitating change, particularly when it comes to behavioral health. Studies show that this approach not only increases motivation for change but improves treatment adherence and outcomes as well.
It’s a powerful tool that can help individuals overcome barriers and move towards their goals. But why is it so effective?
MI empowers individuals by placing them at the center of their change process. It fosters autonomy and self-efficacy, encouraging individuals to take ownership of their decisions and actions.
As mentioned before, MI is a collaborative process, where the peer support specialist and the individual work together as partners.
MI helps individuals tap into their intrinsic motivation to change. It helps them identify their values, goals, and align their behaviors with these aspirations.
By addressing ambivalence, MI can reduce resistance to change. It creates a safe space for individuals to explore their fears and concerns, and find their own reasons to change.
Moreover, people enjoy the process. A study by Raj Sanjay Shah et al. found that when using MI techniques such as reflection and affirmation in online peer-to-peer support sessions, clients were more satisfied with their experience.
Putting Motivational Interviewing to Work
The techniques in this approach are commonly known as OARS. The metaphor in the acronym is that there are two oars needed to steer a boat.
If both individuals aren’t in sync with each other, the boat (or conversation) will simply go around in circles.
Chances are, you probably covered the OARS techniques in your peer support training. Still, let’s take a minute to refresh your memory.
Open-ended questions encourage individuals to explore their thoughts and feelings. They can help uncover underlying motivations and barriers to change.
Affirmations are positive statements that acknowledge a person’s strengths and efforts. They can boost self-esteem and motivation, while also reinforcing positive behaviors.
Reflective statements involve mirroring back what the individual has said, often with added meaning or emphasis. They can help individuals see their situation from a different perspective.
Summarizing what has been discussed can help bring things together and highlight key points. Moreover, it can provide a springboard for further discussion or planning.
The MI Process
In Motivational Interviewing there are four processes, engaging, focusing, evoking, and planning. These processes are not necessarily linear, however engagement needs to come first.
Otherwise, it can be difficult to build rapport and lead to misunderstanding.
The Four Processes
Engagement is all about building trust and rapport. During this stage it is made clear that the individual receiving support will not be forced into anything and their choices will be respected.
Engagement actually happens continuously throughout the process.
Focusing is where goals and priorities are set. This sets the tone for the conversation and well.. gives it focus. Again, this should be a collaboration with the individual receiving support leading the way.
Evoking is where MI skills really come into play. This stage is centered on increasing change talk around the agreed upon focus. Evoking uses open-ended questions, reflections, and summaries to move the individual away from ambivalence.
Planning is about taking the next steps towards change. However, this should still be done in a person centered way. While it’s ok to make suggestions or share experience, ultimately, the individual knows what plan will work best for them.
In fact, the more the individual is able to create their own plan, the better. If done effectively, the evoking stage will enable the individual to do this part on their own.
Change Talk Vs. Sustain Talk
During the MI process, there are two things you should be on the lookout for.
Paying attention to these cues is what helps the peer specialist guide the conversation. The objective in using these techniques is to increase change talk. Mainly, because the more people talk about changing, the more likely they are to do so.
When it comes to recognizing change talk, there is a catchy acronym for this model as well.
DARN-CAT is an acronym in Motivational Interviewing that helps you recognize different types of change talk.
It’s divided into two parts: DARN statements, which indicate contemplation, and CAT statements, which signify progress toward action.
Desire: This refers to the individual’s wish or longing to change. It’s about what the individual wants or doesn’t want.
Ability: This refers to the individual’s perceived ability or confidence in their capacity to change.
Reason: This refers to the specific arguments or rationales the individual gives for change.
Need: This refers to the individual’s perception of the necessity or urgency of the change.
Commitment: This refers to the individual’s level of commitment to making a change. It’s often expressed through statements of intent or commitment language.
Activation: This refers to the individual’s readiness or willingness to change. It’s about the individual’s mental preparation to begin the change process.
Taking Steps: This refers to the specific actions the individual has taken towards making a change.
By listening for and responding to these types of change talk, peer support specialists can guide individuals towards their goals. More importantly, we can foster their intrinsic motivation to move towards positive change.
DARN CAT comes in handy when trying to understand an individual’s commitment levels. Keeping this model in mind, we can reinforce an individual’s statements, encouraging positive changes.
To reinforce change talk, it might go something like this:
Sarah: “I really think I am going to start going to meetings, they sound like they might help”
Peer Support Specialist: “It sounds like you have put a lot of thought into this, going to meetings seems pretty important to you”
Sarah: “It is pretty important, I’m ready to start taking my sobriety more seriously”
Peer Support Specialist: “That’s awesome, what is the next step to make this a reality? Have you found a meeting you would like to go to?”
Sarah: “No, I really just kind of decided today”
Peer Support Specialist: “Well, maybe that’s something we could do together? Do you want to look up some meetings?”
Breaking things down
In this example, the peer specialist picks up on the commitment statement made by Sarah and reinforces her decision.
After hearing Sarah’s activation statement, the peer specialist uses questions to help guide the conversation towards taking steps.
What other types of change talk to you notice in this example?
Obviously, it won’t always be this simple. In fact, it might not even take a linear path through the different types of change talk, and that’s ok.
Remember, the goal of MI is not to force change.
The Righting Reflex
In Motivational Interviewing, there is a concept known as “the righting reflex”. This refers to the reflex to try and “fix” an individual. In other words, trying to impose goals and commitment to something they haven’t agreed to.
Resisting the temptation to “right” a person or “correct” a person’s choices can be difficult at times. However, it is imperative that we do so.
It may be easier to refrain from making statements like, “That is a bad idea” or “I don’t think you should do that”. However, even questions such as, “Are you sure that’s a good idea?”, can come from a place of wanting to “fix” someone.
Challenging an individual or pointing out any negative consequences of their choices can move a person away from change. This is why empathy and understanding are crucial during this process.
Moreover, this is why training and guidance in this skill is so important.
The Need for Training in Motivational Interviewing
While MI may seem straightforward, it’s actually a pretty advanced technique. It requires a nuanced understanding and skillful application.
This is why training is essential.
Training programs typically cover the principles and techniques of MI, as well as provide opportunities for practice and feedback. Which is important, because practicing in real time is the only way to truly get a feel for this skill.
If possible, find a training program that offers follow-up sessions and coaching. Learning MI is kind of like learning a language. In other words, if you aren’t using it on a regular basis, there’s a good chance you will forget.
Moreover, ongoing supervision and coaching can help peer support specialists refine their MI skills and prevent drift from the model.
Remember, MI is not just a set of techniques, but a way of being with people. It requires practice, reflection, and continuous learning.
Practice, practice, practice…
Motivational Interviewing and peer support
I seriously recommend adding MI to your peer support skill set. In fact, the whole MHAPSS team recommends this skill. As peer support specialists, MI fits perfectly with our style of support.
It’s all about meeting a person where they are in the process and working together. Moreover, it holds the individual in unconditional positive regard, no matter their readiness to change.
Sounds like peer support to me!
And that is exactly what makes this approach so fun! We get to help individuals make their own decisions towards a better life! Once you have seen the power of MI and have a feel for how it works, I am sure you will understand why I say it’s fun.
Taking The Next Step
Interested in learning this skill? You can check with your local peer support agency to ask about upcoming MI trainings or check out one of the many platforms that offer them online.
Plus, you may even fulfill some of your CE (continuing education) requirements in the process!
If you are serious about incorporating this approach into your work, I would also recommend getting a copy of the book. It covers the technique in depth and provides plenty of examples.
Additional Learning Resources
Continuous learning is a big part of peer support. The following resources can provide further insight and guidance into the topic of Motivational Interviewing.
“Motivational Interviewing: Helping People Change” by William R. Miller and Stephen Rollnick
Websites and Online Resources:
Motivational Interviewing Network of Trainers (MINT): The official website of MINT provides resources, articles, and information about training opportunities related to Motivational Interviewing.
SAMHSA’s Motivational Interviewing Resource Center: The Substance Abuse and Mental Health Services Administration offers a variety of resources, videos, and tools for learning about Motivational Interviewing. (https://www.samhsa.gov/motivational-interviewing-resource-center)
“Talking To Change- A Motivational Interviewing Podcast” -This podcast discusses the technique and provides valuable insights into the process of MI.
These resources have been instrumental in writing this article. We encourage you to continue your education and would like to thank you for all the work you do!
-The MHAPSS Team
frequently asked questions
What is Motivational Interviewing (MI) and how does it benefit my role as a peer support specialist?
Motivational Interviewing is a person centered and collaborative approach that aims to inspire positive change. As a peer support specialist, MI helps you connect better with peers, while building trust and motivation. This technique pairs perfectly with the overall spirit of peer support.
Can MI be used effectively in mental health, substance abuse, and chronic illness support?
Yes, MI can be used in all types of peer support. Its core principles align with peer support’s collaborative and empowering nature. Moreover, it can be used at any stage to further growth and change.
How can I practice MI skills in peer support?
Practice active listening, ask open-ended questions, affirm strengths, and reflect on their thoughts to encourage change talk. To be truly effective when using this technique seek training and guidance.
What challenges might I face using MI in peer support and how do I tackle them?
Challenges include resistance, time constraints, balancing autonomy, and skill development. Address them through exploring resistance, setting priorities, and using the different MI techniques. On going training will help in overcoming challenges with this technique.
Elijah Meason is a Certified Peer Support Worker in the State of New Mexico. He is a SMART Recovery facilitator and is working toward getting his Masters degree in social work. He is currently working at a dual diagnosis treatment center helping individuals overcome mental health and addiction challenges.