Motivational interviewing is a counseling approach which was originally developed to work with substance abusers to assess and facilitate readiness for treatment. Its principles and techniques have been proven effective when dealing with people who are ambivalent about change. Motivational interviewing engages an individual in discussion about the process of change and the resolution of ambivalence. Individuals with autism spectrum disorder are well documented to prefer the routine, and experience increased anxiety regarding change. Students with Autism Spectrum Disorders, like substance abusers need to develop intrinsic motivation to overcome anxiety and take the risks associated with post-secondary programs. Significant resources and efforts are required to successfully complete post-secondary programs. Consequently, it behooves individuals with high functioning autism, their families and their counselors alike to assess readiness to commit to such programs prior to entering them. The principals of motivational interviewing might prove helpful in assessing readiness and developing a plan for individuals with high functioning autism who are transitioning from adolescence to adulthood.
Researchers have identified change as a fluid process which moves between several phases. The motivational interviewing approach respects and supports this concept of change. Prochaska, Norcross, and DiClemente have identified five key phases of change: pre-contemplation, contemplation, preparation, action and maintenance (Changing for Good, 1994). The first stage of change, pre-contemplation, occurs when an individual is either unaware or minimally aware of a problem. During the second stage of change, contemplation, an individual begins to develop some awareness of issues but have little or no interest in change. These first two phases are easy to overlook but crucial to begin the process of change.
Families of children with an autism spectrum disorder tend to be solution focused and may not consider the preliminary stages of change important. Such parents are often less likely to explore issues around transition and more likely to move right along to the planning stages. Unfortunately, this well-intentioned focus can be in direct conflict with their child’s possible lack of awareness or readiness to confront problems. The principles of motivational interviewing address the first two phases of change by emphasizing listening skills and the expression of empathy.
The general strategies of motivational interviewing include: reflective listening, asking open ended questions, using statements of affirmation, summarizing how an individual feels and eliciting self-motivational statements. Those who utilize the general principles of motivational interviewing build a positive relationship with the individual and use that relationship as a springboard to promote change.
Reflective listening is a central component of the motivational interviewing approach. Miller and Rollnick, pioneers in the development of motivational interviewing techniques believed listening was the answer whenever you were in doubt about what to do. Reflective listening can be as simple as repeating back to someone what you heard, or paraphrasing what was said and offering some feedback. The tricky part of listening reflectively is avoiding warning, judging or directing someone. If you are too pushy you can put the individual on the defensive and cause a breakdown in communication.
The use of open-ended questions is a great tool to discover an individual’s motivation for change. Open ended questions are an essential tool of motivational interviewing. Questions such as, “Would you tell me about…”, “How would you like things to be different…”, “How can I help you…”, “What do you want to do next…”, or “What have you tried before…” sends the message that you value someone’s opinion while also helping you to understand the individual’s perspective and interpretation of a situation.
Another important communication tool used in motivational interviewing is summarizing. By summarizing what you have learned you can highlight “change talk” by reviewing and clarifying potential ideas for change. You are also able to ensure that you clearly understand an individual’s perspective. For example you might say, “Let me see if I understand thus far.”
Giving affirmations is another strategy used in motivational interviewing to promote a positive relationship. Making statements that are genuine, and identify an individual’s strengths, help build the individual’s confidence in future success and ability to change. It establishes that you both are on the same team and working together towards change.
Motivational interviewing principals are also useful during the preparation, action and maintenance phases of change. Although it might appear counter-intuitive, it is imperative to respect and accept ambivalence and resistance to change. After discussing the pros and cons of making changes, an individual must next translate identified potential changes into specific reachable goals to develop a plan of action. During this time, resistance to change can be strong. Motivational interviewing addresses ambivalence about change and manages resistance by using known strategies such as reflection, clarification, shifting focus, and emphasizing personal change. Again, the key is to keep communication open and avoid the perception of being in conflict or judgmental.
Readiness for change should be generated from the individual, not the counselor or family. Studies show that when you argue for change resistance increases and increased resistance is usually associated with poor outcomes (Journal of Social and Clinical Psychology 24 (6), Markland, Ryan, Tobin and Rollnick, 2005). Hence it is important that individuals who decide to enter a post-secondary or vocationally-based program understand, and are in agreement with, any proposed transitional plan. The ability to “roll with the resistance” is a core principal of motivational interviewing. By managing resistance, counselors and parents can assist young adults who are ready and determined to successfully facilitate change
Motivational interviewing is an engaging and encouraging approach to promote change. The principals of motivational interviewing emphasize patience and empathy while promoting insight and self–determination. The relationship building communication tools of motivational interviewing, can be used to assist an individual in identifying personal values and life goals. Motivational interviewing techniques can help an individual with high functioning autism and his family decide whether they are ready to commit the time, resources and effort required for success in a post-secondary or vocationally based transition program.
