Is the MI Spirit Missing Something? Belonging, Inclusion, Liberation Psychology, Cultural Humility, and Motivational Interviewing.

Recently, my colleagues and I were discussing ways to create learning environments that foster inclusion and belonging. During this conversation the question came up: “is the MI Spirit of Compassion, Acceptance, Partnership, and Evocation missing something?” I surprised myself with the enthusiasm of my reply “yes!” In this article, I hope to better explain why I hold this opinion. I will review some key points from Liberation Psychology and Cultural Humility. Ultimately, I will propose a new component that could be added to the MI Spirit.

The MI Spirit

​The MI Spirit is one of the key components of practicing MI. Dr. Miller has explained that the MI Spirit is how we show up with others, it is “a way of being.” The MI Spirit is usually described as including four aspects: Compassion, Acceptance, Partnership, and Evocation. The acronym for these four components is CAPE, as in you put on your super hero CAPE when practicing MI… pretty clever isn’t it? These four aspects are described below in an excerpt taken verbatim from Miller and Rollnick’s Glossary of MI Terms (2013):

​Compassion—One of four central components of the underlying spirit of MI by which the interviewer acts benevolently to promote the client’s welfare, giving priority to the client’s needs.
Acceptance—One of four central components of the underlying spirit of MI by which the interviewer communicates absolute worth, accurate empathy, affirmation, and autonomy support.
Partnership—One of four central components of the underlying spirit of MI by which the interviewer functions as a partner or companion, collaborating with the client’s own expertise.
Evocation—One of four central components of the underlying spirit of MI by which the interviewer elicits the client’s own perspectives and motivation. See also Ducere.

​The MI Spirit aims to help us in adopting a stance of compassion that allows for a collaborative therapeutic alliance. We put on our MI “CAPE” before we meet with those we serve, so that we show up as our best selves. The MI Spirit calls us to check our judgments at the door and try to see the world through another’s eyes. We are asked by the MI Spirit to assume that the person we are helping has all that they need to solve their problems, our job is to help bring out others’ innate strengths, values, and solutions (Miller & Rollnick, 2013). On its face, this MI Spirit seems to have all that we need to develop an environment of inclusion and belonging. But the Spirit seems to be missing something when we step back and consider the larger social context of power, privilege, and oppression.

Liberation Psychology

​Liberation Psychology (LP) offers one approach to the important systemic issues of power, privilege and oppression. LP calls on us to reflect on the systems of power and oppression within which we live. This approach centers these systems in our work helping others. We are encouraged to avoid narrowly focusing on individual strengths/weaknesses, motivation, diagnoses, and life choices. Instead, the LP approach defines issues in terms of individual, cultural, and institutional aspects using a process called Trangulizing (Kant, 2015). The person who is helping is called to "zoom out” and see the problem in context of systems of power, history of oppression, and intersectional social identity. In this way, a holistic and clear explanation of the issue can be found.
​
If I were to apply this approach with a client, I might first explore what identities they hold, their history of interacting with institutions, and identify cultural considerations. Individual factors such as symptoms, motivation, and preferences would also be important. For example, I might find that the individual has had some rough encounters with “helpers” in the past who have made assumptions based on family background, race, and mental health status. I may also discover that they had been given hefty labels by institutions such as “felon,” “addict,” and, “offender.” Considering these factors, it is important for me to be clear about my own identities, power, and intentions when working with them. It would also be important for me to bring these cultural and institutional factors up throughout the process of supporting the client in their goals.

​Another important part of Liberation Psychology is how it defines the role of the “helper.” Individuals using a LP approach aim to help others not only by helping build motivation, access resources, or identifying internal strengths; LP calls upon us to have conversations about the larger systems of oppression through a process termed consciousness building (or conscientization). When we have a better understanding of how these systems are impacting us, perhaps we will be more likely to attempt to change those systems. Perhaps we will be less likely to hold shame and self-blame about some of the situations in which we find ourselves. And by talking overtly about how systems of power impact our lives, we can be more authentic and more human. Perhaps this provides a foundation from which we can begin to talk about developing a sense of inclusion and belonging (Martinez & Fleck-Henderson, 2014).
​
If I were to apply consciousness building to a client that I work with, I might practice some self-disclosure about my identities and how they impact my proximity to power. I would likely highlight the institutional and cultural factors at play with the client’s presented problem, especially if the client was overly focusing on individual factors. I could bring in some helpful terms to describe what has happened such as “socialization,” “exclusion,” “access to resources,” “stigma,” etc. This could result in some epiphanies related to how the problem came to be (and how the problem is not entirely due to the actions of one individual). Perhaps at the end of the conversation the client would have an increased ability to put words to what they had experienced during interactions with these systems of power.

Cultural Humility

Cultural Humility (CH) also has a focus on identifying and addressing systems of power. The first pillar of CH includes critical self-reflection. This means looking at oneself with a critical eye and acknowledging privileges associated with one's own culture, identity, or background. During this reflection we may gain a better perspective of how we show up when working with someone with less access to resources, power, and privilege. We might identify biases and assumptions that we have internalized, worldviews that we have adopted, and even some hidden internalized superiority or inferiority (Tervalon, M. & Murray-Garcia, 1998).
​
If I were to apply critical self-reflection, I might prepare myself prior to a meeting with a client to reflect on my various privileged identities, some advantages that society has given me due to these identities, and how these identities have impacted my perspective on the world. For example I could reflect on how I was brought up to believe that “hard work is always rewarded,” and notice how this unconscious assumption can uphold the myth of the US as a meritocracy. Critical self-reflection could include noting what assumptions I currently have about the person I am serving (even before I have met them) and questioning those assumptions. I might even reflect on my current process for how I provide service, how does it serve me and how does it (not) serve the client?

Another pillar or CH is to recognize and mitigate power imbalances. There are power dynamics inherent in any “helping” relationship, and these can be complex. It can become increasingly complex when you add social identities, power, and privilege. Noticing and naming these power dynamics can have a strong effect in developing an environment of belonging and inclusion. To mitigate these power dynamics, there are often changes we can make in our approach, adjustments we can make to processes, and aspects that we can influence in the environment (Tervalon, M. & Murray-Garcia, 1998).
​
To apply recognizing and mitigating power imbalances, I could name the fact that I am a social worker, a white man, and an out-of-towner to boot. Some of my identities and experiences could make it harder for me to understand or offer support, these identities may cause barriers in how the support is received. By practicing self-disclosure, acknowledging my limitations, and focusing on my intent to learn how best I can be of help, I might attempt to balance the relationship with the client. This could be a fruitful conversation and result in establishing trust and overcoming obstacles related to identity differences.

Adding to the MI Spirit

The MI Spirit is a great start as we aspire to connect with other people across difference. In the end, I think that the MI Spirit is missing something, especially when we think about inclusion and belonging. The MI Spirit is missing the social context of power as it applies to the helping relationship. Cultural Humility offers us practices such as critical self-reflection and addressing power imbalances. Liberation Psychology offers us an expanded problem formulation and centers our experiences with systems of oppression.

So, what is the MI Spirit missing? In a word - Equity. My proposed new MI Spirit is listed below (you will notice that I managed to keep the “CAPE”).

Compassion—One of four central components of the underlying spirit of MI by which the interviewer acts benevolently to promote the client’s welfare, giving priority to the client’s needs.
Acceptance—One of four central components of the underlying spirit of MI by which the interviewer communicates absolute worth, accurate empathy, affirmation, and autonomy support.
Partnership—One of four central components of the underlying spirit of MI by which the interviewer functions as a partner or companion, collaborating with the client’s own expertise.
Equity—[Has the potential to be] one of four central components of the underlying spirit of MI by which the interviewer acknowledges systems of oppression and their impact on the client and interviewer, the interviewer is committed to address the impacts of these systems on the client, interviewer, and helping relationship.

Works Cited

Kant, J.D., (2015) Towards a socially just social work practice: the liberation health model. Critical and Racial Social Work, 3(2), 309-317. http://www.liberationhealth.org/documents/s12.pdf

Martinez, D.B. & Fleck-Henderson, A. (2014). Social Justice in Clinical Practice: A liberation health framework. NY: Routledge.
​
Miller, W.R., and Rollnick, S. (2013). Motivational Interviewing: Helping people change. NY: Guilford Press.

Miller, R. M. & Rollnick, S. (2013). Glossary of Motivational Interviewing Terms. NY: Gilford Press.

Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of Healthcare for the Poor and Underserved,9(2), pp. 177-129.
​