Entrevista Motivacional (Motivational Interviewing - MI)

La Entrevista Motivacional (MI) es un enfoque terapéutico centrado en el cliente que tiene como objetivo mejorar la motivación intrínseca para el cambio de comportamiento mediante la resolución de la ambivalencia. La MI enfatiza la empatía, la colaboración y avanzar con la resistencia en lugar de la confrontación o persuasión. Implica escuchar activamente al cliente, reflejar empáticamente sus sentimientos y pensamientos, y guiarlo a través de un proceso de exploración de su ambivalencia hacia el cambio. La MI reconoce la resistencia natural al cambio y busca generar "discurso de cambio" del cliente al resaltar las discrepancias entre su comportamiento actual y sus metas, valores o aspiraciones. A través de preguntas abiertas, afirmaciones, escucha reflexiva y resúmenes, los terapeutas de MI ayudan a los clientes a clarificar sus metas, resolver su ambivalencia y fortalecer su compromiso con el cambio. Además de ayudar con problemas de drogas y alcohol, la MI ahora también se utiliza con trastornos de depresión y ansiedad, trastornos alimenticios, juego compulsivo y suicidio.

📌 Locus de Control (Locus of Control)

El locus de control tal como se utiliza en MI se refiere al grado en que un individuo siente un sentido de agencia con respecto a su vida. Alguien con un locus de control interno creerá que las cosas que le suceden están muy influenciadas por sus propias habilidades, acciones o errores. Una persona con un locus de control externo tenderá a sentir que otras fuerzas (como el azar, los factores ambientales o las acciones de otros) son más responsables de los eventos que ocurren en la vida del individuo. En general, la investigación ha sugerido que aquellos con un locus de control más interno son más exitosos, saludables y felices que aquellos con un locus más externo.

Ejemplos de Respuestas en MI (Examples of what a motivational interviewing therapist might say)

1. Afirmación (Affirmation): "Puedo ver que ya has tomado algunos pasos positivos hacia tu meta, y eso es admirable."

"I can see that you've already taken some positive steps towards your goal, and that's commendable."

2. Reflexión (Reflection): "Parece que no estás seguro de si tienes lo necesario para alcanzar tu meta. ¿Puedes contarme más sobre esas dudas?"

"It sounds like you're feeling unsure about whether you have what it takes to achieve your goal. Can you tell me more about those doubts?"

3. Pregunta abierta (Open-ended question): "¿Cuáles son las razones detrás de tu deseo de lograr esta meta?"

"What are the reasons behind your desire to achieve this goal?"

4. Declaración afirmativa (Affirmative statement): "Has demostrado mucha determinación en el pasado. ¿Cómo puedes aprovechar esa determinación ahora para trabajar hacia tu meta?"

"You've demonstrated a lot of determination in the past. How can you tap into that determination now to work towards your goal?"

5. Explorando importancia y confianza (Exploring importance and confidence): "En una escala del 1 al 10, ¿qué tan importante es para ti lograr esta meta? ¿Qué haría que fuera un número más alto?"

"On a scale from 1 to 10, how important is it for you to achieve this goal? What would make it a higher number?"

6. Escucha reflexiva (Reflective listening): "Parece que te sientes desanimado porque has enfrentado contratiempos. ¿Cómo podemos trabajar juntos para superar estos obstáculos?"

"It seems like you're feeling discouraged because you've faced setbacks. How can we work together to overcome these obstacles?"

7. Generar discurso de cambio (Eliciting change talk): "¿Cuáles son algunas formas en que lograr esta meta impactaría positivamente tu vida?"

"What are some ways in which achieving this goal would positively impact your life?"

8. Apoyando la autoeficacia (Supporting self-efficacy): "Basado en tus experiencias pasadas, ¿qué habilidades o fortalezas posees que podrían ayudarte a acercarte a tu meta?"

"Based on your past experiences, what skills or strengths do you possess that could help you move closer to your goal?"

9. Explorando discrepancias (Exploring discrepancies): "Has mencionado que quieres lograr esta meta, pero tus acciones no parecen alinearse con ese deseo. ¿Puedes ayudarme a entender qué está interfiriendo?"

"You've mentioned that you want to achieve this goal, but your actions don't seem to align with that desire. Can you help me understand what's getting in the way?"

10. Desarrollando un plan (Developing a plan): "¿Qué pasos específicos puedes tomar esta semana para progresar hacia tu meta? ¿Cómo puedo apoyarte en la implementación de estos pasos?"

"What specific steps can you take this week to make progress towards your goal? How can I support you in implementing these steps?"

6 Técnicas de MI (6 MI techniques)

1. Reflexión Simple (Simple reflection)

Implica comprender y reconocer las emociones, percepciones y desacuerdos del cliente.

2. Reflexión Amplificada (Amplified reflection)

Implica reflejar las declaraciones del cliente de vuelta a él con mayor intensidad, lo que permite al cliente escuchar sus propias declaraciones de nuevas maneras, le permite reconsiderar lo que dijo y le da la oportunidad de aclarar o revisar sus declaraciones.

3. Cambio de Enfoque (Shifting focus)

Está diseñado para desviar la perspectiva del cliente de las barreras que bloquean el progreso hacia una perspectiva que puede ser más productiva.

4. Acuerdo con un Giro (Agreement with a twist)

Implica estar de acuerdo con el cliente para apoyarlo, pero proporciona un ligero cambio de dirección. Esta técnica combina la reflexión y el reencuadre y permite al cliente entender que el consejero escuchó lo que dijo, pero le da una nueva dirección en la que enfocarse.

5. Énfasis en la Elección y el Control (Emphasis on choice and control)

Enfatiza a los clientes que ellos están en control de la circunstancia y tienen la opción de decidir hacer un cambio, lo que empodera la autodirección y la libre elección.

6. Reencuadre (Reframing)

Implica que el consejero proporcione un nuevo significado o interpretación a los problemas de un cliente, lo que le da al consejero la oportunidad de tomar una declaración negativa y convertirla en una declaración positiva.

Documento completo traducido del original en inglés | Motivational Interviewing (MI)

Motivational Interviewing (MI)

Motivational interviewing (MI) is a client-centered therapeutic approach that aims to enhance intrinsic motivation for behavior change by resolving ambivalence. MI emphasizes empathy, collaboration, and rolling with resistance rather than confrontation or persuasion. It involves actively listening to the client, empathetically reflecting their feelings and thoughts, and guiding them through a process of exploring their ambivalence towards change. MI acknowledges the natural resistance to change and seeks to elicit "change talk" from the client by highlighting discrepancies between their current behavior and their goals, values, or aspirations. Through open-ended questions, affirmations, reflective listening, and summarizing, MI therapists help clients clarify their goals, resolve their ambivalence, and strengthen their commitment to change. In addition to helping with drug and alcohol issues, MI is now also being used with depression and anxiety disorders, eating disorders, compulsive gambling, and suicide.

📌 Locus of Control

Locus of control as used in MI refers to the degree to which an individual feels a sense of agency in regard to his or her life. Someone with an internal locus of control will believe that the things that happen to them are greatly influenced by their own abilities, actions, or mistakes. A person with an external locus of control will tend to feel that other forces—such as random chance, environmental factors, or the actions of others—are more responsible for the events that occur in the individual's life. Overall, research has generally suggested that those with a more internal locus of control are more successful, healthier, and happier than those with a more external locus.

Examples of what a motivational interviewing therapist might say

1. Affirmation: "I can see that you've already taken some positive steps towards your goal, and that's commendable."

2. Reflection: "It sounds like you're feeling unsure about whether you have what it takes to achieve your goal. Can you tell me more about those doubts?"

3. Open-ended questions: "What are the reasons behind your desire to achieve this goal?"

4. Affirmative statements: "You've demonstrated a lot of determination in the past. How can you tap into that determination now to work towards your goal?"

5. Exploring importance and confidence: "On a scale from 1 to 10, how important is it for you to achieve this goal? What would make it a higher number?"

6. Reflective listening: "It seems like you're feeling discouraged because you've faced setbacks. How can we work together to overcome these obstacles?"

7. Eliciting change talk: "What are some ways in which achieving this goal would positively impact your life?"

8. Supporting self-efficacy: "Based on your past experiences, what skills or strengths do you possess that could help you move closer to your goal?"

9. Exploring discrepancies: "You've mentioned that you want to achieve this goal, but your actions don't seem to align with that desire. Can you help me understand what's getting in the way?"

10. Developing a plan: "What specific steps can you take this week to make progress towards your goal? How can I support you in implementing these steps?"

6 MI techniques

1. Simple reflection

Involves understanding and acknowledging the client's emotions, perceptions, and disagreements.

2. Amplified reflection

Involves reflecting the client's statements back to them with increased intensity, which enables the client to hear their own statements in new ways, allows them to reconsider what they said, and gives them an opportunity to clarify or revise their statements.

3. Shifting focus

Is designed to deflect the client's perspective from the barriers that are blocking progress to a perspective that may be more productive.

4. Agreement with a twist

Involves agreement with the client in order to support them, but provides a slight change of direction. This technique combines reflection and reframing and enables the client to understand that the counselor heard what they said, but gives them a new direction upon which to focus.

5. Emphasis on choice and control

Stresses to clients that they are in control of the circumstance and have the choice to decide to make a change, which empowers self-direction and free choice.

6. Reframing

Involves the counselor providing a new meaning or interpretation to a client's problems, which gives the counselor an opportunity to take a negative statement and turn it into a positive statement.

Original document - Motivational Interviewing (MI)

🎯 Motivational Interviewing (MI)