Motivational interviewing is designed to elicit a behavioural change in people who do not recognize the need for change, or they feel ambivalent about it. This technique has been successfully used in the mental health arena for many years and is successful because it puts a person in control of their own changes. The supporting adult acts as a facilitator, helping them to explore their feelings and different potential outcomes but never telling the person what to do. The person finds their own path to change and is therefore far more likely to stick to it to their plans.
MI skills can be adapted to almost any situation. Developing and using these skills will help you to become a better listener, help you to understand other people’s viewpoint, help you to help them to determine appropriate goals for behaviour change and help you to help motivate them to change their current behaviour to meet these goals. Change is more likely to occur if someone has voiced the desire for change.
In the third edition of Miller and Rollnick’s MI Helping People Change (1), they speak about four aspects of the spirit of MI – partnership, acceptance, compassion and evocation, within which can be found the acronym, DEARS. This has been slightly altered in more recent editions of Miller and Rollnick’s publications (4th Edition) (2). Carers find DEARS a useful addition to their toolkit in terms of communication and to enhance their understanding of MI, so we have kept it in our intervention under the original acronym. The main change is in their approach towards the concept of ‘resistance’, something which carers face on a regular basis when supporting a loved one with an eating disorder. According to Miller and Rollnick, “resistance” is just sustain talk which is a normal part of ambivalence. The word “resistance” carries a more negative connotation than “sustain talk”. However, since DEARS is a useful acronym when teaching the spirit of MI, we have kept it as in previous editions.
Developing Discrepancy – This helps Edi realize there is a difference between where they are today, and where they want to be in the future. Their current behaviour is likely to hold them back and reduce the likelihood that they can achieve their goals. Carers can help to motivate Edi to resolve the discrepancy by changing their behaviour.
“On the one hand, it’s so exciting watching you prepare for university and on the other I see you still restricting your food. What are your thoughts on dealing with any challenges up ahead?”
Expressing Empathy – People with eating disorders often feel that nobody understands them, they are totally alone and this is a terrifying position to be in. Carers can come alongside their loved ones and try to step into their shoes. Imagining what they are feeling, and listening carefully to their responses, can be a useful way of expressing empathy.
“You must feel so frustrated at times fighting this illness.”
Amplifying Ambivalence – It can seem like your loved one sees their eating disorder as their friend and ally. However, even the most resistant of people can recognize that there might be some negatives to their illness. Carers can look out for any small signs, notice them, repeat and amplify them in order to help their loved one to recognize that change might have some positive outcomes.
“You say you wish you could just enjoy life like your friends do. It must make you feel really sad that you’re missing out on this stage of life.”
Rolling with Resistance (sustain/discord talk) – People with eating disorders can become extremely upset, especially if they feel they are being pushed into a corner. Lecturing, nagging, pestering, arguing can quickly result in huge arguments and distressing scenes. When emotions are running high it can be useful to notice this and take a step back.
“I’m going to take some time out. You’re upset. I’m upset. Let’s come to this when we’re both feeling a bit calmer. I’m going to listen to some music for half an hour.”
“The strength of the relationship is so much m ore important than the strength of the argument” Dr Xavier Amador
Supporting Self-Efficacy – Allowing the person to take control of their own destiny and believing that they can do it. Your belief that they can create their own goals is incredibly motivational, and, with your support, they can find the best path towards these goals. Carers acknowledging that their loved one is making an effort and has the energy to try again when things don’t go according to plan helps to build and support their self-efficacy.
“You have done so well to get to this point in your recovery. You’ve shown so much strength and resilience and I very much trust that you’ll continue to fight back.”
(1) Miller, W.R. and S. Rollnick, Motivational Interviewing: Helping People Change (Third Edition). 2013, New York: The Guildford Press.
(2) Miller, W.M. and S. Rollnick, Motivational Interviewing, Helping People Change and Grow (Fourth Edition). 2023, New York, London: The Guildford Press.