How Many Therapists Does It Take to Change a Light Bulb? The Motivational Interviewing Take

By Michelle L. Drapkin, PhD, ABPP, author of The Motivational Interviewing Path to Personal Change

Have you heard this joke before?

How many therapists does it take to change a light bulb?

Typical Punchline: Just one, but the light bulb has to want to change itself!

The Motivational Interviewing (MI) Twist: One—and if the light bulb isn’t ready to change—you need to leverage some MI to empower it to find its spark inside.

MI helps us accept someone “where they are at.” It is a way of being—and we choose to not to give up, walk away, or “lay down” if someone doesn’t “want” to change or isn’t “ready. ” We help them find their own personal path to change, in a time and space that works for them. We work together with them to own that path. And, we accept where they are in their journey.

This is acceptance—not resignation. We are not resigned to give up, saying something like, “You’ve gotta want to change yourself” or “If you’re not ready, there is nothing I can do.”

What is MI exactly? “MI is a commonsense approach to behavior change that involves us using what we have inside ourselves… to inspire our behavior, rather than feeling pressured to make changes in our lives because of external factors. Which is also to say: MI is about empowering you. You are the one making all the choices.”1 So, the light bulb has to want to change from within, yes, and we can help empower it to do that. We don’t just walk away and give up.

Sound great? Sure, it does! MI is “simple,” but not easy. Let’s take a peek at some components of an MI approach that might help us all live into this “way of being.”

MI trainers like me describe MI as having both relational components (MI spirit and the basic communication skills—open-ended questions, affirmations, reflections, and skilled summaries —OARS) and more technical components (noticing, evoking, and reinforcing “change talk”). I will walk you through a quick overview of these components and then we can revisit our light bulb.

MI Spirit

There are four components to MI spirit:

Compassion: Compassion is about helping others in a way that is consistent with their values, culture, etc. We are not persuading or trying to convince someone what we think they should do, or what we need them to do. It’s about compassionately helping them in a way and direction that is meaningful to them.

Acceptance: Accepting someone genuinely and nonjudgmentally is an important part of the MI spirit. We accept that an individual is an autonomous being who can make choices for themselves, choosing a path that makes sense for them.

Partnership: This is my favorite part of MI spirit—collaboration, partnership, and the dual expertise we share with those we help.

Empowerment: We work collaboratively to help draw out the power inside each individual, coming from the stance that they already have it. Our role is to help them find it.

The MI spirit conveniently spells CAPE. Think of putting your “MI CAPE” on and how you would be more likely to help someone in a nonjudgmental, respectful way to empower and support their change journey.

OARS

The MI spirit partners with the basic MI communication skills: OARS.

O: Ask more OPEN-ENDED questions than closed questions

A: Use AFFIRMATIONS to reinforce someone’s strengths and values

R: REFLECT to connect and confirm understanding—and to reinforce change language—this is the key skill that often is missed in conversations

S: SUMMARIZE key points both at the end of and during conversations

We leverage a combination of the MI spirit with the OARS to “meet someone where they are at,” and to help move them toward what matters. And, we do that by focusing on change talk.

Change Talk

Change talk in MI refers to a specific type of language or dialogue or thoughts that a person engages in when talking about making positive changes in their life. It’s any language in the direction of change—as opposed to what we call “stuck talk” (or sustain talk), which is language related to staying the same/not changing. Change talk is an important part of the path toward change, and we helpers leverage it by listening for it, learning how to collaboratively draw it out, and reinforcing it when it shows up.

There are two main types of change talk in MI—preparatory (“getting ready”) change talk and mobilizing (“doing”) change talk—and we have a helpful acronym we use here, too: DARN-CAT.

Preparatory Change Talk (DARN)

The first part of change talk is the DARN—desire, ability, reasons, and need. These are any statements that express a person’s wanting to change, an acknowledgment of the capability or skills to be able to do it, ideas about the benefits or positive outcomes associated with changing, or an urgency to change. Here are some examples of what you might hear:

“I really want to improve my health.”

“I think I know how to manage my stress better.”

“If I quit smoking, I’ll have more time and energy to play with my kids.”

“I know I should lose weight because my doctor said it’s affecting my heart health.”

Mobilizing Change Talk (CAT)

The CAT—commitment, action, and taking steps—side of change talk is what we hear when someone is getting ready to make the change. They are starting to or are already doing parts of their change plan. It might sound something like this:

“I am going to do this.”

“I started working on this behavior change by…”

“I started doing part of this by…” or “I made a step toward doing this by…” or “I scheduled an appointment for…”

When a person engages in more change talk than stuck talk, it’s an indication that they are contemplating and leaning toward making a change. The opposite is true, too. If our light bulb doesn’t want to change, it is giving us some serious stuck talk. We can aim to elicit and reinforce change talk while minimizing sustain talk. By using the OARS and leaning into MI spirit, we can encourage clients (or light bulbs) to articulate their own motivations for change, which can increase their commitment to change in ways that matter to them.

Michelle L. Drapkin, PhD, ABPP, is a board-certified psychologist who owns and operates the Cognitive Behavioral Therapy Center, and has worked in behavioral science for more than twenty years. She has trained thousands of health care professionals and industry leaders in motivational interviewing (MI).