Motivational interviewing
Encyclopedia
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.
The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. These fundamental concepts and approaches were later elaborated by Miller and Rollnick (1991) in a more detailed description of clinical procedures. Motivational interviewing is a semi-directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed. Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal.
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. In order for a therapist to be successful at motivational interviewing, four basic skills should first be established. These skills include: the ability to ask open ended questions, the ability to provide affirmations, the capacity for reflective listening, and the ability to periodically provide summary statements to the client.
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 envision 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 focuses on the present, and entails working with a client to access motivation to change a particular behavior, that is not consistent with a client's personal value or goal. Warmth, genuine empathy, and unconditional positive regard are necessary to foster therapeutic gain (Rogers, 1961) within motivational interviewing. Another central concept is that ambivalence about decisions is resolved by conscious or unconscious weighing of pros and cons of change vs. not changing (Ajzen, 1980). It is critical to meet patients/clients where they are (Prochaska, 1983), and to not force a client towards change when they have not expressed a desire to do so.
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 four general principles:
Express empathy.
Empathy involves seeing the world through the client's eyes, thinking about things as the client thinks about them, feeling things as the client feels them, sharing in the client's experiences. Expression of empathy is critical to the MI approach. When clients feel that they are understood, they are more able to open up to their own experiences and share those experiences with others. Having clients share their experiences with you in depth allows you to assess when and where they need support, and what potential pitfalls may need focused on in the change planning process. In short, the counselor's accurate understanding of the client's experience facilitates change.
Develop discrepancy.
This 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). MI counselors work to develop this situation through helping clients examine the discrepancies between their current behavior and future goals. When clients perceive that their current behaviors are not leading toward some important future goal, they become more motivated to make important life changes.
Roll with resistance.
In MI, the counselor does not fight client resistance, but "rolls with it." Statements demonstrating resistance are not challenged. Instead the counselor uses the client's "momentum" to further explore the client's views. Using this approach, resistance tends to be decreased rather than increased, as clients are not reinforced for becoming argumentative. MI encourages clients to develop their own solutions to the problems that they themselves have defined. In exploring client concerns, counselors may invite clients to examine new perspectives, but counselors do not impose new ways of thinking on clients. Rolling with resistance allows therapists to accept client reluctance to change as natural rather than pathological.
Support self-efficacy.
This guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence. As clients are held responsible for choosing and carrying out actions to change in the MI approach, counselors focus their efforts on helping the clients stay motivated, and supporting clients' sense of self-efficacy is a great way to do that. One source of hope for clients using the MI approach is that there is no "right way" to change, and if a given plan for change does not work, clients are only limited by their own creativity as to the number of other plans that might be tried.
The main goals of motivational interviewing are to establish rapport, elicit change talk, and establish commitment language from the client. For example, change talk can be elicited by asking the client questions, such as "What makes you think this is a problem for you?" or "How does ______ interfere with things that you would like to do?"
It is important to keep in mind that client behavioral issues are common in the process of motivational interviewing. Change often takes a long time, and the pace of change will vary from client to client. Knowledge alone is usually not sufficient to motivate change within a client, and relapse behaviors should be thought of as the rule, not the exception. Ultimately, therapists must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.
While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points:
Adaptations of motivational interviewing include Motivational Enhancement Therapy
, a time-limited four-session adaptation used in Project MATCH
, 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.
Visit the NIAAA web site to learn more about Project MATCH or to obtain the MET treatment manual: http://silk.nih.gov/silk/niaaa1/publication/match.htm
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.
http://www.scribd.com/doc/19629380/Motivational-Interviewing-Glossary-Fact-Sheet-KSciacca-September09
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
psychologists Professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
William R Miller, Ph.D.
Ph.D.
A Ph.D. is a Doctor of Philosophy, an academic degree.Ph.D. may also refer to:* Ph.D. , a 1980s British group*Piled Higher and Deeper, a web comic strip*PhD: Phantasy Degree, a Korean comic series* PhD Docbook renderer, an XML renderer...
and Professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
Stephen Rollnick
Stephen Rollnick
Stephen Rollnick is a professor of clinical psychology at Cardiff University. Alongside William R Miller he developed many of the founding priniciples of motivational interviewing.- Biography :...
, Ph.D.
Ph.D.
A Ph.D. is a Doctor of Philosophy, an academic degree.Ph.D. may also refer to:* Ph.D. , a 1980s British group*Piled Higher and Deeper, a web comic strip*PhD: Phantasy Degree, a Korean comic series* PhD Docbook renderer, an XML renderer...
The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. These fundamental concepts and approaches were later elaborated by Miller and Rollnick (1991) in a more detailed description of clinical procedures. Motivational interviewing is a semi-directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed. Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal.
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
Mandate (criminal law)
A criminal court may impose a "mandate" on a person accused of a crime consisting of an obligation to engage in certain conditions or activities in exchange for suspension or reduction in penalty; such as, conditions of probation, conditional discharges, or other conditional sentences...
, 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. In order for a therapist to be successful at motivational interviewing, four basic skills should first be established. These skills include: the ability to ask open ended questions, the ability to provide affirmations, the capacity for reflective listening, and the ability to periodically provide summary statements to the client.
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 envision 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 focuses on the present, and entails working with a client to access motivation to change a particular behavior, that is not consistent with a client's personal value or goal. Warmth, genuine empathy, and unconditional positive regard are necessary to foster therapeutic gain (Rogers, 1961) within motivational interviewing. Another central concept is that ambivalence about decisions is resolved by conscious or unconscious weighing of pros and cons of change vs. not changing (Ajzen, 1980). It is critical to meet patients/clients where they are (Prochaska, 1983), and to not force a client towards change when they have not expressed a desire to do so.
Motivational interviewing is considered to be both client-centered
Person-centered psychotherapy
Person-centered therapy is also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s...
and semi-directive. It departs from traditional Rogerian
Carl Rogers
Carl Ransom Rogers was an influential American psychologist and among the founders of the humanistic approach to psychology...
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 four general principles:
Express empathy.
Empathy involves seeing the world through the client's eyes, thinking about things as the client thinks about them, feeling things as the client feels them, sharing in the client's experiences. Expression of empathy is critical to the MI approach. When clients feel that they are understood, they are more able to open up to their own experiences and share those experiences with others. Having clients share their experiences with you in depth allows you to assess when and where they need support, and what potential pitfalls may need focused on in the change planning process. In short, the counselor's accurate understanding of the client's experience facilitates change.
Develop discrepancy.
This 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). MI counselors work to develop this situation through helping clients examine the discrepancies between their current behavior and future goals. When clients perceive that their current behaviors are not leading toward some important future goal, they become more motivated to make important life changes.
Roll with resistance.
In MI, the counselor does not fight client resistance, but "rolls with it." Statements demonstrating resistance are not challenged. Instead the counselor uses the client's "momentum" to further explore the client's views. Using this approach, resistance tends to be decreased rather than increased, as clients are not reinforced for becoming argumentative. MI encourages clients to develop their own solutions to the problems that they themselves have defined. In exploring client concerns, counselors may invite clients to examine new perspectives, but counselors do not impose new ways of thinking on clients. Rolling with resistance allows therapists to accept client reluctance to change as natural rather than pathological.
Support self-efficacy.
This guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence. As clients are held responsible for choosing and carrying out actions to change in the MI approach, counselors focus their efforts on helping the clients stay motivated, and supporting clients' sense of self-efficacy is a great way to do that. One source of hope for clients using the MI approach is that there is no "right way" to change, and if a given plan for change does not work, clients are only limited by their own creativity as to the number of other plans that might be tried.
The main goals of motivational interviewing are to establish rapport, elicit change talk, and establish commitment language from the client. For example, change talk can be elicited by asking the client questions, such as "What makes you think this is a problem for you?" or "How does ______ interfere with things that you would like to do?"
It is important to keep in mind that client behavioral issues are common in the process of motivational interviewing. Change often takes a long time, and the pace of change will vary from client to client. Knowledge alone is usually not sufficient to motivate change within a client, and relapse behaviors should be thought of as the rule, not the exception. Ultimately, therapists must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.
While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points:
- Motivation to change is elicited from the client, and is not imposed from outside forces
- It is the client's task, not the counselor's, to articulate and resolve his or her ambivalence
- Direct persuasion is not an effective method for resolving ambivalence
- The counseling style is generally quiet and elicits information from the client
- The counselor is directive, in that they help the client to examine and resolve ambivalence
- Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
- The therapeutic relationship resembles a partnership or companionship
Adaptations of motivational interviewing include Motivational Enhancement Therapy
Motivational Enhancement Therapy
Motivational Enhancement Therapy or MET is a time-limited four-session adaptation used in Project MATCH , 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...
, a time-limited four-session adaptation used in Project MATCH
Project MATCH
Project MATCH began in 1989 in the United States and was sponsored by the National Institute on Alcohol Abuse and Alcoholism . The project was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment...
, 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.
Visit the NIAAA web site to learn more about Project MATCH or to obtain the MET treatment manual: http://silk.nih.gov/silk/niaaa1/publication/match.htm
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.
Applications of Motivational interviewing
Examples of fields in which motivational interviewing is being applied include:- Substance dependenceSubstance dependenceThe section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...
- Health CoachingHealth coachingHealth coaching is a method of guiding others to address their health and, if need be, make behavioral changes to improve health. Like traditional coaching, health coaches utilize goal setting, identification of obstacles, and use of personal support systems...
- Mental Illness
- Corrections and Criminal Justice
- Gambling
- Adherence to treatment in chronic illness
Sources
- Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
- Sciacca, K., "Motivational Interviewing Glossary and Fact Sheet" 2009,( Copyright Kathleen Sciacca, 2009)
http://www.scribd.com/doc/19629380/Motivational-Interviewing-Glossary-Fact-Sheet-KSciacca-September09
- Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People to Change, 2nd ed. NY: Guilford Press, 2002. ISBN 1572305630.
- Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people for change. New York: Guilford Press.
- Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change in medical settings: The development of brief motivational interviewing. Journal of Mental Health, 1, 25-37.
- Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. (1992) Motivational Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 2. http://casaa.unm.edu/manuals/met.pdf
- Prochaska, J. O. (1983). "Self changers vs. therapy changers vs.Schachter." American Psychologist 38: 853-854.
- Rogers, Carl (1961). On becoming a person: A therapist's view of psychotherapy. London: Constable. ISBN 1-84529-057-7.
- Rollnick, S., Miller, W.R., & Butler, C.C. "Motivational Interviewing in Health Care: Helping Patients Change Behavior". NY: Guilford Press, 2007. ISBN 1593856121.
- Steve Rollnick official website
- NCADCI order form
- (http://www.scribd.com/doc/19629380/Motivational-Interviewing-Glossary-Fact-Sheet-KSciacca-September09/ Motivational Interviewing Glossary and Fact Sheet, Kathleen Sciacca, 2009)