Weary of trying to get people to change? Frustrated with trying to convince clients to move off the streets, take their medications, stop drinking, follow up at the clinic, eat better, and take other steps to improve their lives? The good news is that there is an alternative and more effective approach to helping others—based on Motivational Interviewing (MI).

Motivational interviewing (MI) is a well-established evidence-based practice widely used in health and human service settings and it is growing in popularity among homeless service providers. Unlike many clinical approaches that tend to increase consumer resistance, MI is effective in decreasing resistance and enhancing willingness to change. Providers using the MI approach become a partner in recovery, not an authority figure dictating the treatment plan. This approach elicits and respects an individual’s values, wisdom, and motivation to change. Together, consumers and providers determine goals for treatment and work in collaboration to reach them.
The following core principles are the basis of MI:

• Express Empathy: When providers display genuine empathy they create safe spaces for individuals to share their experiences. The therapeutic relationship strengthens as individuals recognize that providers hear and understand them.
• Support Self-Efficacy: Outreach workers empower individuals by recognizing steps toward progress. For example, an outreach worker can affirm an individual’s accomplishment of cutting back alcohol use to three times a week instead of every day by asking how the consumer was able to do it.
• Roll with Resistance: People are less likely to change when they feel resistance. Providers want to avoid provoking resistance and instead try to diminish it. The provider using MI seeks to elicit the reasons the individual might want to change rather than the provider telling the individual why he thinks he should change.
• Develop Discrepancy: It is useful to help individuals examine how their current behaviors and choices fit with their values and goals. When there is dissonance between the two, individuals wrestle internally with their choices. Typically, the larger the discrepancy between desires and actions, the greater the importance of change. The provider’s task is to help the individual develop self-awareness of this discrepancy.

Ken Kraybill and Melissa Martin, of the PATH TA Center, interviewed PATH Providers from Bridgeway House of Elizabeth, NJ, SEARCH of Houston, TX, Hennepin County Mental Health Center of Minneapolis, MN, and Health Care for the Homeless of Baltimore, MD to learn about their experiences using MI. These PATH Providers took the following steps to implement MI as part of their homeless outreach:

• Asking permission to talk with individuals instead of assuming they want to talk;
• Creating a safe and accepting space;
• Learning what is important to the individual and addressing immediate needs;
• Finding out what services the individual wants and has the motivation to pursue;
• Refraining from pushing individuals into services they do not want;
• Determining the individual’s stage of readiness to change a particular behavior;
• Using open-ended questions; and
• Pointing out the individual’s strengths.

The forthcoming PATH publication, Spotlight on PATH Practices: Motivational Interviewing contains interviews with these PATH Providers addressing their involvement with MI, MI training, and implementation of MI at their agencies. The Spotlight also contains detailed information on developing MI skills and guidance on bringing MI to your agency and will be available on the PATH website.

Websites

Center on Alcohol, Substance Abuse, and Addictions
This website contains information on the MI method, training resources, and assessment tools.

Motivational Interviewing
This site is the official MI website. Founder William Miller contributes to this site with other members of the Motivational Interviewing Network of Trainers (MINT). It contains basic information on MI, a database of MI resources, and links to training opportunities.

Motivational Interviewing Network of Trainers (MINT)
This webpage contains a directory of MI trainers who participated in Miller and Rollnick's Training of Trainers workshop.

Motivational Interviewing Strategies and Techniques: Rationales and Examples
This quick tips document outlines the primary skills for MI practice.