Motivational interviewing
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Motivational interviewing (MI) refers to a counseling approach in part developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. It is a client-centered, semi-directive method of engaging intrinsic motivation to change behavior by developing discrepancy and exploring and resolving ambivalence within the client.
Motivational interviewing recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. If the counseling is mandated, they may never have thought of changing the behavior in question. Some may have thought about it but not taken steps to change it. Others, especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years.
Motivational interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envisage a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change.
Motivational interviewing is considered to be both client-centered and semi-directive. It departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than non-directively explore themselves. Motivational interviewing is based upon five general principles:
- Express empathy, guides therapists to share with clients their understanding of the clients' perspective.
- Develop discrepancy, guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs. how they currently are (or between their deeply-held values and their day-to-day behavior).
- Roll with resistance, guides therapists to accept client reluctance to change as natural rather than pathological.
- Support self-efficacy, guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence.
- Avoid argumentation (and direct confrontation). Arguments create resistance.
The main goals of motivational interviewing are to establish rapport, elicit change talk, and establish commitment language from the client.
Adaptations of motivational interviewing include Motivational Enhancement Therapy, a time-limited four-session adaptation used in Project MATCH[1], a US-government-funded study of treatment for alcohol problems and the Drinkers' Check-up, which provides normative-based feedback and explores client motivation to change in light of the feedback. Motivational interviewing is supported by over 80 randomized clinical control trials across a range of target populations and behaviors, including substance abuse, health-promotion behaviors, medical adherence, and mental health issues.
Training in motivational interviewing methods is available through the Motivational Interviewing Network of Trainers (MINT) [[2]]. It has also been the subject of the Knowledge Application Program at the Substance Abuse and Mental Health Services Administration (SAMHSA) in the form of TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment, available free of charge at the National Clearing House for Drug and Alcohol Information [3].
Motivational interviewing techniques are sometimes used in a corporate environment as part of the human relations process. Corporates may also use the techniques during sales and marketing presentations and during workshop sessions allied to conventions and conferences. Using some of the techniques in this different environment is not properly called Motivational Interviewing, as MI is a therapeutic method that always contains the best interests of clients, not a set of techniques used to influence others to act in ways that are to the benefit of the individual using the techniques.
[edit] Applications of Motivational interviewing
Examples of motivational interviewing being applied include:
- MIDAS Trial - Motivational Interventions for Drugs & Alcohol misuse in Schizophrenia, a Randomized controlled trial in Manchester, United Kingdom.[4]
- CapOpus - Cannabis and Psychosis - Randomized clinical trial: Specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis in Copenhagen, Denmark.[5]
- Telephone quitlines for smoking cessation or alcohol abuse.
- Health Coaching
[edit] Sources
- Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People to Change. NY: Guilford Press, 2002.
- Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. 'Motivational Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 2. [6]
- Motivational Interviewing official website
- NCADCI order form
