One form of treatment for people experiencing substance use challenges, motivational interviewing, is heavily based on this understanding that having the right kind of support to make behavioural changes can lead to better, longer lasting results, as part of a complete treatment plan.
As psychologist William R. Miller says, “People are the undisputed experts on themselves. No one has been with them longer, or knows them better than they do themselves.” That is the thinking behind motivational interviewing, a practical and empathetic approach to counselling that helps people overcome the ambivalence they may have around their health challenges in order to make behavioural health changes.
“People are the undisputed experts on themselves. No one has been with them longer, or knows them better than they do themselves.”
Developed in the 1980s by Miller and another clinical psychologist, Stephen Rollnick, motivational interviewing is based on an understanding that changing a habit takes more than just wanting a change. The approach is more goal-focused than other forms of counselling and takes into consideration how difficult it is to make life changes.
In his book, Motivational Interviewing: Preparing People for Change, Miller says, “In motivational interviewing, the helper is a companion who typically does less than half of the talking.” This approach, working alongside people as they find the internal motivation they need to change habits, has been shown to be an effective part of helping people on the complex journey to overcoming substance use problems.
“Miller and Rollnick often found that people were ambivalent about stopping substance use, and were struggling to quit and unable to dig out that intrinsic motivation," says Terri-Lee Seeley, the director of interprofessional practice at Correctional Health Services and Forensic Psychiatric Community Services.
“Motivational interviewing addresses these challenges in a unique way. It's not as directive as other therapies. It's not about saying, 'You need to move towards abstinence right now,’ it's more about saying, 'How can I support you in what you want to do?' This strategy that has been used broadly over the years, it’s not new in the field of substance use and clinical work, but not everyone has the skills to do it. We have been focusing on upskilling our team to conduct this type of intervention.”
At the core of motivational interviewing is the supportive relationship between the clinician and the client, which is consistent with BC Mental Health and Substance Use Services' emphasis on trauma-informed, client-centred care.
According to Seeley, one reason the technique has seen such positive results is that the clinician is there not only to provide counselling, but also to support the change and highlight how well a client is doing through their choices. “It helps client by affirming the decisions being made and evoking change from them — they’re not being told what to do, rather they are being supported to find their own motivation."
"Client-centred care is collaborative, it's strength-based, and it's being aware that people who have experienced trauma need to be supported and go at their own pace to make change. All of those principles are consistent with motivational interviewing. It's one of the ways we can apply our clinical work through a lens of trauma-informed practice.”
The addition of motivational interviewing training and tools for staff means that even those without training in concurrent disorders will have increased competency in working with clients who struggle with substance use issues.
"Client-centred care is collaborative, it's strength-based, and it's being aware that people who have experienced trauma need to be supported and go at their own pace to make change. All of those principles are consistent with motivational interviewing."
"A lot of staff feel as if they haven't had enough experience in how to work with clients who have addictions, and we wanted to increase the competencies of working with clients with addictions," says Dr. Jane Sun, director of interprofessional practice for complex mental health and substance use. "That's what makes motivational interviewing different. It gives everyone the tools they need to have conversations when clients are suffering from cravings or wanting to use. They have tools to intervene in a meaningful and helpful way."
By providing motivational interviewing training to staff, BC Mental Health and Substance Use Services is fostering the kinds of relationships between clinicians and clients that lead to real transformations.
"Clients might not even be consciously aware that they're looking to change," Seeley says. "But, by being empathetic, by evoking those change responses and having compassion, we are able to walk alongside the individual in their journey of recovery."
"Motivational interview training has been rolled out across BC Mental Health and Substance Use Services and is being used by nurses, social workers, physicians, and many more disciplines," says Kathryn Embacher, senior director of patient care services for complex concurrent disorders. "Staff trained in motivational interviewing can use those specific skills in their everyday interactions with clients, as well as in care planning, therapeutic programming and one-to-one counselling."
Over the past year, BC Mental Health and Substance Use Services has been working with the Centre for Collaboration, Motivation and Innovation, an organization that helps create partnerships that improve health and well-being, to make motivational interviewing a provincial priority.
Since 2019, a team of leaders from BC Mental Health and Substance Use Services has trained 235 people across various disciplines in the province, both within BC Mental Health and Substance Use Services and in supporting community services. They are planning to develop an online training model this year to enable more people to be trained in motivational interviewing.