Motivational Interviewing

March 14th, 2011

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Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence. It was developed by William Miller and Stephen Rollnick and evolved from the treatment of problem drinking. It’s a useful approach for working with clients around change and can be integrated with other treatment goals.

The literature on motivational interviewing distinguishes between the spirit of the approach and the techniques that are utilized. This spirit can be characterized in a few key ways:

• Motivation to change is elicited from the client and not imposed from the outside.

• It is the client’s task, not the therapist’s, to articulate and resolve his or her ambivalence.

• Direct persuasion is not an effective method for resolving ambivalence.

• The counseling style is generally a quiet and eliciting one.

• The therapist is directive in helping the client to examine and resolve ambivalence.

• Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.

• The therapeutic relationship is more like a partnership than expert/recipient roles.

Miller and Rollnick say that for a therapist accustomed to confrontation and giving advice, motivational interviewing can appear to be a slow process. However, the proof is in the outcome. More aggressive strategies, sometimes guided by a desire to “confront client denial,” can easily slip into pushing clients to make changes for which they are not ready.

Miller also says that motivational interviewing is like an interpersonal style. If it become a trick or a manipulative technique, the essence of it has been lost. The literature identifies several specific and trainable therapist behaviors that are characteristic of this style. Foremost among these are:

• Seeking to understand the person’s frame of reference, particularly via reflective listening.

• Expressing acceptance and affirmation.

• Eliciting and selectively reinforcing the client’s own self motivational statements; expressions of problem recognition; concern, desire and intention to change; and ability to change.

• Monitoring the client’s degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.

• Affirming the client’s freedom of choice and self-direction.

Motivational Interviewing is frequently used in the treatment of addiction and a lot of research has been generated on this work. The MI website also keeps a bibliography of research articles and information on professional training opportunities.

Many clients today are interested in egalitarian, client-centered approaches, especially when it comes to change around drug and alcohol use. Clients also want a competent, empathic and well-trained therapist. I think Motivational Interviewing responds to these needs and is an important approach for contemporary therapists to have in their toolkit.

image courtesy of Emmalynne Photography

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