EmpathicPivot

It is seen as skilful method using well executed person-centred techniques such as empathy, active listening, and unconditional positive regard (Langer & Lietz, 2015).

It relies on “evoking” (Millar & Rollnick, 2023, p. 34) the intrinsic motivation of the person rather than “installing” (Millar & Rollnick, 2023, p. 34) motivation from extrinsic sources such as the practitioner or a legal mandate (Srivastava & Shetty, 2024).

Millar and Rollnick (2023), who developed MI, recognised the importance of Carl Rogers’ person-centred approach in which the quality of the therapeutic relationship—especially the demonstration of empathy and rapport—acts to “open the door for positive change” (p. 75). Unconditional positive regard contributes to the relationship by offering acceptance of the person as they are and engenders trust, respect, and recognition of the person’s worth and potential (Fuller et al., 2019).

MI also takes from the Transtheoretical Model (TTM)—which in turn is based on theories, such as person-centred and behaviourism—that proposes change as a process that happens over time (Langer & Lietz, 2015). TTM divides a person’s readiness to change into the formal stages of Precontemplation, Contemplation, Determination, Action, and Maintenance (Srivastava & Shetty, 2024).

Is person-centred with an emphasis on a collaborative therapeutic relationship (Millar & Rollnick, 2023). 

Empowers the person by emphasising strengths and requiring them to take responsibility to make the changes needed in their life, giving a greater sense of agency (Millar & Rollnick, 2023).

In using Carl Rogers’ “accurate empathy” (Millar & Rollnick, 2023) MI—and any other therapeutic model using a person-centred approach—has the capacity to consider and act on discriminatory or oppressive systems and structures in a person’s environment by creating space to explore and understand experiences, beliefs, attitudes, values and behaviour—instances of “socially-engineered trauma” (Avruch & Shaia, 2022, p. 3).

Millar and Rollnick (2023) outlined a broad overlapping and potentially non-sequential process as:

• Engaging: “Can we walk together?” (p. 73) – involves “listening well” (p. 76) to understand what the person is experiencing and build a good therapeutic relationship. Skills required include open questions, affirming, reflecting and summarising (OARS), especially mirroring to help the person understand what they have just said. 
• Focusing: “Where are we going?” (p. 93) – involves “clarifying what changes the person might make” (p. 94), setting shared goals and staying focused on them.
• Evoking: “Why would you go there?” (p. 108) – involves evoking the importance and significance of change through “change talk” (p. 108) that includes language reflecting “desire, ability, reasons and needs”. Thoughtful questions and reflections about change direct the person towards commitment and action.
• Planning: “How will you get there?” (p. 138) – involves building self-efficacy, affirming a person’s strengths, identifying previous success, reframing failures, building confidence in adaptive abilities. 

The practitioner’s role is collaborative in which they guide the person to make their own realisations and changes (Millar & Rollnick, 2023). To achieve this, it is deliberately based on a flat power structure and strong empathetic “working alliance” (Millar & Rollnick, 2023, p. 76).

The person is required to enter into a collaborative working relationship with the practitioner and to ultimately take responsibility for the decision and actions needed to make changes (Millar & Rollnick, 2023).

Millar and Rollnick (2023) suggest that MI is suitable for people with low motivation and ambivalence towards healthy behaviours and reduction of harm, including: smoking, drinking, cannabis and gambling addictions; management of chronic health conditions – asthma, cancer, pain, diabetes, heart disease, hypertension; promoting weight loss, dietary change, physical activity and medication adherence; student behaviour, return to work and occupation and academic performance.

The person should be experiencing cognitive dissonance and have increased change self-efficacy displayed in language reflecting hope and confidence (Millar & Rollnick, 2023).

Fuller et al. (2019) propose that MI is highly adaptive and flexible: 

• being a “brief intervention” (p. 30) when time is limited;
• used in a variety of settings for multiple outcomes; and 
• delivered in groups or individually including over the phone or video call.

Outcomes are supported by significant body of evidence (Millar & Rollnick, 2023).

Millar and Rollnick (2023) suggest that MI is not for everyone and that for people who are already highly motivated the MI process should jump to the “how of change” (p. 324). Some people are not ready to face change (Srivastava & Shetty, 2024). Practitioner’s need to be skilful in use of MI (Millar & Rollnick, 2023). MI focuses on conscious decision-making at the expense of embedded behaviours (Langer & Lietz, 2015).

Avruch, D., & Shaia, W. (2022). Macro MI: Using Motivational Interviewing to address socially-engineered trauma. Journal of Progressive Human Services, 33(2), 176-204. https://doi.org/10.1080/10428232.2022.2063622

Fuller, C., Taylor, P., & Wilson, K. (2019). A toolkit of motivational skills: How to help others reach for change(3^rd ed.). Wiley Blackwell.

Langer, C., & Lietz, C. (2015). Applying theory to generalist social work practice: A case study approach.Wiley.

Millar, W., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4^th ed.). The Guilford Press.

Srivastava, P., & Shetty, K. (2024). Motivational interviewing: Walking towards change. In M. Anand (Ed.), Mental health care resource book: Concepts and Praxis for Social Workers and Mental Health Professionals(pp. 159-173). Springer Nature. https://doi.org/10.1007/978-981-97-1203-8